Making the case for continuity of midwife care
Babies born prematurely may need special care, are more likely to die and are more likely to have disabilities, or develop health problems in adult life than those born at full term.
Researchers at the NIHR Collaboration for Leadership in Applied Health Research and Care South London are developing a better way of supporting women who have a higher risk of preterm birth. Working with Lewisham Clinical Commissioning Group, they are trialling a new-style service at Lewisham Hospital in south-east London.
One of the features of the service is that pregnant women receive maternity care from a single midwife or a small group of midwives through pregnancy, birth and postnatally. Women who have this sort of continuity of care – building a relationship with their midwife over time – are more likely to give birth naturally and less likely to experience preterm birth.
Computerised interpretation of fetal heart rate during labour
Continuous electronic monitoring is used when changes to a baby’s heart rate are detected from manual checks, or when women have a higher risk of complications. The monitoring aims to detect any abnormalities early, so that clinicians can intervene. However, there are sometimes difficulties in interpreting the electronic outputs.
The INFANT software analyses fetal heart signals and assess overall patterns, generating a colour-coded alert if necessary. INFANT does not make recommendations for action following an alert – this is left to the clinicians, not the software.
Research funded by the NIHR Health Technology Assessment (HTA) Programme and the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands found that using this computerised decision-support system to interpret the outputs of continuous electronic fetal monitoring during labour did not show any advantages over clinicians interpreting the outputs themselves.
Progesterone prophylaxis to prevent preterm labour
The OPPTIMUM study aimed to look at whether the use of progesterone affects neonatal and childhood outcomes.
The study was funded by the Efficacy and Mechanism Evaluation (EME) Programme, a partnership NIHR and Medical Research Council. The NIHR Clinical Research Network supported all 65 sites across the UK, recruiting 1228 women to time and target.
The results of OPPTIMUM have prompted the Patient-Centred Outcomes Research Institute to undertake international individual patient-level data analysis as part of a major review into the use of progesterone for preterm birth treatment.
Rapid STI identification
Some sexually transmitted infections (STIs) are difficult to treat immediately because they’ve become resistant to commonly used antibiotics. Antibiotic resistance can be checked by testing the DNA code of bacteria and researchers are developing simple 30 min DNA tests to recognise the presence of the most common sexually transmitted bacteria such as N. gonorrhoeae and M. genitalium. The test also recognises particular mutations in the DNA, which determine whether a patient will respond to commonly prescribed antibiotics.
The research team are using NIHR Invention for Innovation (i4i) funding to develop and confirm the accuracy of these new tests using the diagnostic platform from industrial collaborator Atlas Genetics. If successful, implementation of the test could radically change the ways we treat patients in sexual health clinics and the community. Alongside this, the immediate and accurate use of antibiotics is vitally important to limit antibiotic resistance and deliver effective treatment.
Find a reproductive health study in your area
You can find out more about reproductive health studies in your area through the Be Part of Research website.
The NIHR Clinical Research Network (CRN) provides researchers with the practical support they need to make clinical studies happen in the NHS. This support covers every stage of research, from set up to delivery.
We provide world-class health service infrastructure - research support staff such as clinical research nurses, and research support services such as pharmacy, pathology and radiology - to support organisations seeking to conduct clinical research in the NHS in England. Some of this research is funded by the NIHR, but most of it is funded by NHS non-commercial partners and industry.
We support the set up and delivery of clinical research in the NHS through our Study Support Service and our Research Design Service helps researchers develop proposals to secure funding from our research programmes.
The Reproductive Health and Childbirth Specialty is one of 31 Specialties which bring together communities of clinical practice to provide national networks of research expertise.
Our job is to ensure that the reproductive health and childbirth studies that are included in our national portfolio of research receive the right support to ensure they are delivered successfully in the NHS.
The Reproductive Health and Childbirth Specialty oversees research that deals with areas such as:
- Birth defects
- Developmental disorders
- Low birth weight
- Preterm birth
- Reduced fertility
National Reproductive Health Clinical Specialty Leads
Each of our 15 Local Clinical Research Networks has at least one nominated local Clinical Specialty Research Lead for Reproductive health. These clinicians lead research groups to promote and support Reproductive health research within the NHS trusts in their area.
At a national level the local leads come together to manage the national Reproductive health clinical research portfolio. This involves regularly reviewing the progress of studies, identifying barriers to recruitment, and coming up with solutions and strategies to help overcome those barriers. Our National Specialty Group of clinical experts offer advice and support to commercial and non-commercial customers looking to conduct research in the NHS.
The NIHR Clinical Research Network Reproductive Health specialty group works closely with these organisations in integrating clinical research into NHS clinical service provision, and in driving priority setting that encourages research that will have the greatest impact on patients.
Royal College of Obstetricians and Gynaecologists (RCOG)
The RCOG encourages the study and advancement of the science and practice of obstetrics and gynaecology. It do this through postgraduate medical education and training development, and the publication of clinical guidelines and reports on aspects of the specialty and service provision. Our Global Health Unit works with other international organisations to help lower maternal morbidity and mortality in under-resourced countries.
Find out more about the Royal College of Obstetricians and Gynaecologists.
Tommy’s funds research into pregnancy problems and provides information to parents. To give every baby the best chance of being born healthy, this charity work to fund medical research into the causes of premature birth, stillbirth and miscarriage.
Find out more about Tommy’s.
Well being of women
A charity dedicated to improving the health of women and babies
Find out more about Well being of women.
The NIHR provides the support and facilities the NHS needs for first-class research by funding a range of infrastructure.
NIHR Biomedical Research Centres
NIHR Biomedical Research Centres (BRCs), partnerships between England’s leading NHS organisations and universities, conduct translational research to transform scientific breakthroughs into life-saving treatments. The following BRCs undertake research in reproductive health and childbirth:
NIHR Applied Research Collaborations
NIHR Applied Research Collaborations (ARCs) support applied health and care research that responds to, and meets, the needs of local populations and local health and care systems. The following ARCs undertake research in reproductive health and childbirth:
Work with our infrastructure
All of the NIHR facilities and centres are opening to working with the public, charities, industry and other partners. If you are interested in collaborating with the NIHR please contact the NIHR Office for Clinical Research infrastructure: firstname.lastname@example.org
Our experts in the NIHR Clinical Research Network (National Specialty Leads) can advise on delivering your reproductive health and childbirth study in the NHS.
Mr Nigel Simpson
Mr Nigel Simpson is the NIHR Clinical Research Network National Specialty Lead for Reproductive Health and Childbirth.
Mr Nigel Simpson is a Consultant Obstetrician and Gynaecologist at the Leeds Teaching Hospital NHS Trust and Senior Lecturer at the University of Leeds
He has a particular clinical and research interest in the causes and prevention of preterm birth. His work on the Reproduction and Perinatal Health Research Group at the University of Leeds focuses on unravelling the cellular mechanisms regulating normal and abnormal pregnancy, and the health and well-being of the newborn infant.