New evidence shows examinations in pregnancy should be done differently

28 May 2020 | Pregnancy | Research and clinical trials

Research from the Royal Women’s Hospital’s Preterm Labour Clinic has shown that, for some women with a high-risk pregnancy, invasive testing may not be helpful in predicting preterm birth.

Around one in 20 women have a uterine anomaly – where the uterus has developed differently – and as a result, are at risk of giving birth preterm. At specialist centres, these women would usually be offered internal ultrasounds from an early gestation, to measure the cervix and see whether it is shortening, as this was thought to be a reliable indicator for preterm birth.  

As part of the research, experts at the Women’s have looked at the anonymous records of their patients with uterine anomalies over a 10-year period and have found that, in fact, measuring the cervix with this invasive test in the first half of pregnancy doesn’t give doctors any reliable information to predict preterm birth.

Lead researcher and registrar at the Women’s, Dr Kelly Hughes, says the research has instigated a change in practice at the clinic and doctors no longer deem these tests necessary for these women.

“Women in our Preterm Labour Clinic usually experience extensive testing as part of our care. While some of these tests can be uncomfortable for women, they are necessary for us to be confident that mum and baby are safe and well. But as a hospital with specialist knowledge in high-risk pregnancies and preterm birth, it’s important that we continue to review our care,” says Dr Hughes.

“Women shouldn’t have to go through invasive tests that don’t give us, as doctors, important information. The research we have conducted has provided valuable new evidence that shows that a shortened cervix isn’t an indicator for preterm birth in this particular group of women. As a result, we have reduced the number of invasive tests that we recommend for this high-risk group of women.

“This result highlights the need for further research into other markers of preterm birth that would be more useful in this particular group of women.  At the Preterm Labour Clinic, we are actively developing new tests for preterm birth based on biomarkers in vaginal fluid.”

The study has been peer-reviewed and published in the international women’s health journal, Acta Obstetricia et Gynecologica Scandinavica. Head of the Women’s Preterm Labour Clinic, Dr Penny Sheehan, obstetrician at the Women’s, Dr Stefan Kane, and Professor Terrence Haines from Monash University all helped with the research.