To find out more about current Reproductive health studies you can view a list of studies on the NIHR Clinical Research Network Portfolio Database.
The NIHR Clinical Research Network Reproductive health has been enormously successful in integrating clinical research into NHS clinical service provision, and both developing and delivering a large practice changing portfolio of clinical trials.
As the most integrated clinical research system in the world, the NIHR supports research studies through our funding programmes, training and supporting health researchers, and providing world-class research facilities. We also support dialogue between the life sciences industry and charities to benefit all, and facilitate the involvement of patients and the public to make research more effective.
Last year (2017/2018) the NIHR supported 279 studies on reproductive health and childbirth. The NIHR supported these studies through our funding programmes and our research schools and units. We also support reproductive health and childbirth research through our research infrastructure and our training and career development awards for researchers.
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.
There are about 700,000 live births each year in England and Wales. Continuous electronic monitoring during labour is not routinely used in the UK for all women. But it is used widely when changes to a baby’s heart rate are detected from manual checks, or when women have a higher risk of complications. This selective use aims to detect any abnormalities early, so that clinicians can intervene to speed up the birth or undertake caesarean section to improve outcomes. However, there are sometimes difficulties in interpreting the electronic outputs, and it has been suggested that decision-support software could help.
Programs such as INFANT analyse 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. Up until now, there have not been any studies assessing the use of such decision-support systems and whether they improve neonatal outcomes.
Using a computerised decision-support system to interpret the outputs of continuous electronic fetal monitoring during labour does not show any advantages over clinicians interpreting the outputs themselves. This is the first trial to assess decision support of this kind.
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
In this large NIHR-funded trial, rates of poor neonatal outcomes, caesarean sections and assisted deliveries were not affected by whether clinicians were alerted to potential problems by the decision-support system or by their own interpretation of the data. Developmental outcomes at two years of age were not affected either.
The system used in the trial only looked at fetal heart rate patterns, and didn’t use other data about the labour (which may affect how a clinician manages the labour). This suggests that maternity units should focus on other ways of improving recognition of problems and decision making when they are detected rather than investing in such decision-support systems at this time.
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.
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.
You can find out more about Reproductive Health and Childbirth studies in your area through the UK Clinical Trials Gateway.