• Reference Number: HEY-1400-2023
• Departments: Maternity Services
• Last Updated: 1 November 2023

Introduction

This leaflet has been produced to give you information about your clinic appointment. Most of your questions should be answered by this leaflet but it is not intended to replace the discussion between you and your Doctor or Midwife, but may act as a starting point for discussion. If after reading this you have any concerns or require further explanation, please discuss this with a member of the healthcare team. 

What is the Pre-term  Birth Clinic?

It is a dedicated specialist clinic which has been set up in Hull University Teaching Hospitals NHS Trust which monitors and treats women who are at a higher risk of premature birth (before 34 weeks of pregnancy) or have a history of late second trimester miscarriages.  The clinic is led by Consultants and supported by Midwives in the Antenatal Outpatient Department.  

Why have I been referred here?

You have one or more risk factors for premature birth or late miscarriage in your current pregnancy such as:

• One or more spontaneous previous preterm deliveries or late miscarriage;
• Premature rupture of membranes (waters) in a previous pregnancy;
• Previous surgeries to the cervix (LLETZ/knife cone biopsy);
• Known uterine variant (unusual shaped uterus);
• Previous Caesarean section at full dilatation (10 cms);
• Previous use of a cervical suture; 
• History of cervical cancer.

If you have one or more of these risk factors, it does not necessarily mean you will have a premature birth or late miscarriage.  

What does the Pre-term Prevention Clinic do? 

This service is aimed at reducing your chance of preterm birth or late miscarriage. In the clinic we will discuss your current and previous pregnancies, and any test results, with you and a consultant obstetrician, if you are high risk and whether you are likely to benefit from treatment or interventions. We will discuss your individual care plan with you, perform an antenatal check and offer support during what may be an anxious time. We will see you in this clinic (frequency depends on your specific risk factors) and you will be discharged at 24 weeks to you named consultant or community midwifery team. 

What tests will I have? 

We will offer you one or more of these investigations depending on your risk factors:

• A urine test (MSU) to check for infection; 
• A vaginal swab to check for infection; 
• A vaginal swab for fetal fibronectin (fFn) – a specific chemical that is from the neck of the womb .This test might be required in some instances, not always. The lower the concentration of fFn the less likely you are to go into labour. The results take about 10 minutes to process;
• A transvaginal scan, where the Consultant will need to insert a sterile ultrasound probe into your vagina to measure the length of the cervix. You need an empty bladder to have this test. It is very safe and doesn’t cause any problems to your pregnancy.

Do the tests have any risks?

All of these tests are safe for you and your baby.

What treatment may I be offered?

You may be offered one or more of these treatments:

• Cervical Cerclage, where a stitch is put around the neck of your womb. 
• Progesterone (hormone) pessaries put into your vagina until 34 weeks. 
• Antibiotics can be prescribed to treat any infection found on our urine/swab test. 
• All treatments will be discussed fully with you before they are included in your plan of care.

Should I still attend my community antenatal appointments?

Yes, you should attend all other appointments in addition to visiting us. The Preterm birth prevention clinic is extra care for women at a higher risk of having a preterm birth. 

When to seek advice  

Sometimes there are signs that you may be going into labour. Often these signs may not lead to premature birth but it is important to let your midwife or doctor know so you can get advice, do not wait until your next appointment. 

• Period pains or cramps that come and go 
• Bleeding from the vagina 
• Leaking fluid from the vagina 

Single access number to Hull Women’s and Children’s Hospital 01482 311500 and select Triage

Useful sources of information 

Tommy’s: Funding research into stillbirth, premature birth and miscarriage-providing information for parents to be. 

www.tommys.org    

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.