Simple test could put an end to early births


Doctors at St Thomas’s Hospital in south London are using the foetal fibronectin test – which is already used in the United States – to help detect which women are most at risk of going into premature labour.

Around 40,000 babies are born between the 24th and 37th week of pregnancy each year. Babies born early, particularly before 28 weeks, can face health problems later in life, such as cardiovascular disease, diabetes and hypertension. The cost of keeping such babies alive is also astronomical. It costs around pounds 8,000 a week to keep a baby in a special baby unit and most children stay there for four to five weeks.

Foetal fibronectin is a protein which is found in the vagina of all pregnant women before 20 weeks of pregnancy. But it is not normally found from the 20th week of pregnancy until term. The protein acts as a “glue”, sticking foetal and maternal membranes close together and if it starts to appear in the vagina (detectable by taking a swab), it may indicate future problems.

American doctors have found that the presence of the protein in the cervix or vagina after 20 weeks is an “extremely powerful predictor”of premature labour. If recognised in time, measures can be taken to try to prevent the women giving birth prematurely.

St Thomas’s is currently offering the test to women at 24 and 27 weeks of their pregnancy. A quick swab is taken and the results are available after four days. If a woman is found to have fibronectin, she is offered special care at the hospital’s new prematurity outpatient clinic.

The presence of fibronectin can also be a marker for bacterial vaginosis (BV), a bacterial infection resulting from a decrease in beneficial organisms such as lactobacilli, and a glut of others. BV is found in 20 per cent of women and St Thomas’s carries out a separate test for it.

If the result is positive, the infection can be treated with antibiotics and the risk of premature labour reduced significantly.

At the launch of National Pregnancy Week, Lucilla Poston, Professor of Foetal Health who is supervising the projects for Tommy’s Campaign, the national baby charity to fund medical research, said that all pregnant women attending the hospital were being offered the test for BV, which was particularly useful for women with a history of problem pregnancies. They hoped 1,000 women would have taken part in the trial by the end of the year.

Professor Poston said that although the trial was in its early days, it had proved “strikingly successful”.

In the US, Professor Robert Goldenberg, of the University of Alabama, said that using the test had enabled them to diagnose who was suffering from contractions leading to premature birth and who could be safely sent home.

The professor also said that the evidence linking BV to premature birth was “so strong. It really is a major public health problem”, and that 14 separate studies had linked it to pre-term births.

At present the hospital’s research is being funded by Tommy’s Campaign but the charity aims to press the Department of Health to provide funding for the tests to be carried out nationwide at the end of the study.

Ultimately, they would be targeted at women with high-risk pregnancies, or those who may have suffered bleeding early on in their pregnancy.

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