Preterm Surveillance Clinic

This is a specialist clinic which offers monitoring and treatment to pregnant women and people who are at higher risk of spontaneous early birth between 24 and 34 weeks of pregnancy (premature or preterm birth) or a late pregnancy loss (miscarriage) between 14 and 24 weeks of pregnancy. The clinic is led by obstetric consultants Ms Hoveyda, Ms Eshag and Ms Latif.

Why have I been referred to the clinic?

You have one or more risk factors for late pregnancy loss or early birth in your current pregnancy.

High risk factors:

• previous spontaneous early birth before 34 weeks
• previous late pregnancy loss (14 to 24 weeks)
• your waters broke before 34 weeks in a previous pregnancy (premature rupture of the membranes)
• previous surgery to the neck of womb (cervix) after an abnormal smear or cancer diagnosis, including removal of the neck of the womb (trachelectomy) or a cone biopsy
• a short neck of the womb (cervix less than 25 millimetres) found during a scan in this pregnancy or in a previous pregnancy; this would be detected on a scan that is performed transvaginally which means the probe is inserted into the vagina rather than placed on your tummy (abdomen)
• an unusually shaped or abnormal womb (uterus)
• diagnosis of Asherman’s syndrome
• previous pregnancy where you had risk factors for early birth and had treatment for this during pregnancy, such as a stitch in the neck of the womb (cervical cerclage)
• history of 2 or more late surgical terminations of pregnancy (this is when the pregnancy is ended)

Intermediate risk factors:

• previous treatment of the neck of the womb (cervix) where there has been removal of abnormal cells (LLETZ) at a depth of more than 15millimetres
• previous caesarean birth in the second stage of labour when the neck of the womb (cervix) was fully dilated.

For high risk factors you should be offered an appointment in the preterm surveillance clinic at 12 weeks of pregnancy and for intermediate factors you should be offered one between 16 and 20 weeks. If you have a scan in pregnancy before 26 weeks which unexpectedly shows the neck of your womb (cervix) is less than 25 millimetres long you will be referred for an urgent appointment in the clinic.

You will not be referred to this clinic for the following reasons:

• You had a previous early birth that was due to medical reasons such as pre-eclampsia – as in your baby was born early to prevent you from becoming unwell or because your baby was known to be unwell.
• You have had 1 previous surgical termination of pregnancy (when the pregnancy is ended early)
• You have had first trimester pregnancy losses
• You have had treatment of the neck of the womb (cervix) to remove abnormal cells (LLETZ) but this was less than 15 millimetres deep.

What does the preterm surveillance clinic do?

Its aim is to reduce your chance of early birth or late pregnancy loss. We look at your previous history and the results of the additional tests offered to you in the clinic to find out if you are at high risk of premature labour and whether you are likely to benefit from treatment or intervention. Sometimes we may think it is useful to monitor you more regularly and we may be able to offer you treatments that reduce the risk of late pregnancy loss or early birth.

Appointments in the clinic

The preterm surveillance clinic is held every Thursday morning in Clinic 22 in the Rosie Hospital. The phone number for this clinic is 01223 217660.

What will happen when I visit the clinic?

• You will usually speak with a doctor who will ask about your history and discuss your personalised plan of care. Not all treatments are appropriate or effective for all pregnant women and people.
• You will be offered a transvaginal scan where we put an ultrasound probe into your vagina to measure the length of your cervix because a short cervix increases your risk of late pregnancy loss or early birth.
• You will be offered a test of your wee (urine), called a midstream urine sample, which checks for bacteria that may indicate an infection of the bladder or urinary tubes. You will also be offered a swab of the vagina which checks for common bacteria. The vaginal swab will sometimes be taken using a speculum which is a plastic instrument inserted into the vagina to give a better view of the neck of the womb (cervix)). A urine sample and a vaginal swab are to check for bacterial infection because some bacteria can make a late pregnancy loss or early birth more likely.
• We will discuss what care can be given to a premature baby and how this will affect your labour, this will include discussion of the perinatal optimisation passport: Clinical_Passport.pdf (opens in a new tab)
• You will be advised not to have sexual intercourse during your pregnancy due to your higher risk of late pregnancy loss and early birth.

Do the tests have any risks?

All of these tests are safe for you and your baby. Some of the tests may mean you are offered further treatments such as thrush treatment, or those described below.

How often do I need to come to the clinic?

One of our team will discuss this with you at your first visit and you will have an individualised plan of care made. We see most pregnant women and people every two to four weeks depending on your risk factors and treatment.

If the results of the monitoring up until you are 24 weeks pregnant suggest that you are no longer at high risk of having your baby before 34 weeks, we will discharge you from the clinic.

You will then see your midwife or obstetrician for follow-up appointments. If you are among the small number of pregnant women and people who remain at high risk, we may continue to monitor you up to 32 weeks of pregnancy.

Please be aware that there are sometimes unexpected events which mean there may be delays in seeing you on the day of your appointment.

What treatment will I be offered if I am at high risk of late pregnancy loss or an early birth?

There are several treatments which we may offer you up to 24 weeks of pregnancy. These include one or more of the following:

Cervical cerclage, where a stitch is put around the neck of your womb (cervix). Progesterone (hormone) pessaries which you put into your vagina.

• Cervical support via a pessary ring, which is a silicon ring inserted by a doctor around the neck of your womb (cervix) to hold it in place.
• Antibiotics in pregnancy and labour.

If you are at high risk after 24 weeks of pregnancy, we may offer steroid injections to help your baby’s lungs develop.

Please contact maternity assessment (clinic 23) immediately to speak to a midwife on 01223 217217 if you are experiencing any of the following symptoms:

• Either a slow trickle or a gush of clear or pinkish fluid from your vagina or any increase in vaginal discharge.
• Backache.
• Cramps like strong period pains.
• A frequent need to urinate.
• A feeling of pressure in your pelvis. Nausea, vomiting or diarrhoea.
• Contractions more often than every 10 minutes.
• Strong pain, a smelly discharge or bleeding from your vagina. Feeling feverish, sick or have a temperature.

Contacts

Maternity triage (clinic 23): 01223 217 217

Preterm surveillance clinic: 01223 217660

Useful information and resources

Bliss charity for babies born premature or sick – Email bliss (opens in a new tab)

Group B Strep Support charity – helpline 0330 120 0796, Email Group B Strep Support Charity (opens in a new tab)

Group B Streptococcus (GBS) – Your pregnancy and your baby – Email Group B Streptococcus (GBS)

NHS Premature labour and birth – Email NHS Premature labour and birth (opens in a new tab)

Perinatal optimisation passport – Email Clinical Passport (opens in a new tab)

Tommy’s charity - Email Tommy's Charity (opens in a new tab)