Posted on Monday 30 December 2019
Susan Harper-Clarke with husband Graeme and sons Tom and Will
A woman who feared she would never have children after suffering two late miscarriages is now a mother of two thanks to a permanent stitch in her abdomen.
Susan Harper-Clarke, 41, was devastated when she lost her daughter, Emilia, after going into labour at 19 weeks in April 2010.
Doctors discovered that she had a weak cervix – also known as an incompetent cervix – where the neck of the womb weakens and begins to dilate and open too early in pregnancy, leading to miscarriage or premature birth.
To counteract an opening cervix, ‘stitches’ are often inserted in a process known as a cervical cerclage. Despite having a cervical stitch early on in her second pregnancy, Susan lost her daughter, Grace, at 21 weeks in April 2011.
The physiotherapist said: “It was heart-breaking to lose Emilia and then Grace, knowing that a little more time could have made all the difference and they could have been saved.
“I couldn’t understand why this kept happening because I had no risk factors – I didn’t smoke, I wasn’t overweight and I’d never had surgery to my cervix before.”
Susan got in touch with Professor Andrew Shennan, a consultant obstetrician at Guy's and St Thomas' and Professor of Obstetrics at King’s College London. He is also clinical director of Tommy’s Preterm Surveillance Clinic at St Thomas’ Hospital, who led and co-authored the MAVRIC study, a UK wide trial that took 10 years to complete.
Results of the trial, which have been published in The American Journal of Obstetrics and Gynecology, showed that an abdominal cerclage, or stitch, is proven to save babies’ lives and also reduce preterm birth in a group of high-risk women who have had a previous failed vaginal stitch.
Early into her third pregnancy, Susan enrolled onto the MAVRIC trial at St Thomas’ Hospital and was randomly selected to have the abdominal stitch. Together with her husband, Graeme, they now have two healthy boys – Tom born in July 2012, and Will born in April 2015, who started school this year.
Susan, from Teddington in south west London, said: “Although it was a major operation, I knew that I was in safe hands and that it was likely to be the only way I was going to have a healthy baby.
“During the trial I had regular tests throughout my pregnancy, and they all came back normal. The staff were amazing and held my hand through it all. Thankfully our story has a happy ending. Our sons are our little miracles and we owe their lives to St Thomas’ Hospital, there’s no way I would have had them without this stitch.”
During the MAVRIC trial, 111 out of 139 women recruited, who conceived and were given a random treatment, were analysed. It found that women receiving the abdominal stich, with prior failed cerclage rather than the traditional vaginal stitch, were more likely to have a baby that survived and less likely to give birth before 32 weeks of pregnancy.
This research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centres at Guy's and St Thomas' NHS Foundation Trust and King's College London, NIHR Applied Research Collaboration (ARC) South London, NIHR Clinical Research Network (CRN) South London and University College London Hospitals.
Professor Andrew Shennan said: “Some women will have multiple pregnancy losses in-spite of best management. We’ve been able to show that women who lose multiple babies, even after failed stitches will usually have successful pregnancies with an abdominal stitch. We have proven this is a life saver in the first randomised trial of the procedure. There are not many treatments in pregnancy that can make that claim. We are so glad to be able to help these women in their desperate situation.”
What’s the difference between an abdominal and vaginal stitch?
In pregnancy, the cervix helps keep the baby in the womb, as well as protecting the womb and the baby from infection. A cervix which shortens and opens early may lead to premature birth or miscarriage.
The stitch acts as a physical barrier to keep a baby inside the womb during pregnancy. It can be done in two ways: either through the abdomen or the vagina. The vaginal route is mostly used as it is less invasive and does not involve surgery. A vaginal stitch also means women may be able to have a vaginal delivery.
However, some women still miscarry or have early deliveries even though they have had a vaginal stitch put in. For this group of women, an abdominal stitch has been proven to be an effective treatment.
An abdominal stitch is placed higher up the cervix and provides a stronger physical barrier to keep a baby inside the uterus and prevent women from going into early labour. Women with a history of a failed vaginal stitch and preterm birth can have an abdominal stitch before they conceive as it does not affect a woman’s ability to become pregnant. The stitch is permanent, which means that women are unable to have a vaginal birth, and will need a caesarean section.