Project to investigate womb relaxation and what triggers contractions with a view to understanding how to prevent premature labour
Dr A López Bernal
Nuffield Dept of Obstetrics & Gynecology, John Radcliffe Hospital, Oxford

The usual length of human gestation is 40 weeks and the last trimester of pregnancy is essential for the fetal organs to mature in preparation for life outside the womb. If this process is interrupted prematurely the survival of the newborn baby may be compromised. Although progress is being made in the understanding of the factors which allow the womb muscle to remain relaxed throughout pregnancy and initiate contractions at the onset of labour, there is still much that is not known. An increased understanding of this process will enable developments to be made in the treatment for premature labour.

Project looking at the establishment of pregnancy and blood vessel development in the womb
Miss M Rees et al.
John Radcliffe Hospital, Oxford

This project is looking at the development of blood vessels in the womb during the early days of pregnancy. A substance called adrenomedullin has been identified and its presence in the womb proved. It is thought to be important in setting up a blood supply to the baby, and the research team will study this substance to assess how it acts on different types of cells.

The intention of the project is to study the way in which adrenomedullin acts, through the use of laboratory-based models of separate cell types from the placenta and the blood vessels of the womb. Results obtained will form the basis of future studies in abnormal pregnancies, such as pre-eclampsia and intrauterine growth retardation, where the blood supply to the placenta does not develop normally and may lead to premature birth.

PREMET: Multicentre clinical trial to test if metronidazole (an antibiotic) can cure suspected infection and prevent preterm delivery
Prof L Poston, Mr A Shennan
Guy's, King's and St Thomas' Hospitals, London

To read about this research trial please click here

Saliva progesterone levels in women who go into premature labour
Miss G Lachelin
University College London

This is a collaborative project with PREMET. The aim is to measure levels of the hormone progesterone in women who are at risk of going into premature labour, in order to evaluate the hormone's importance in predicting labour. The theory, based on what happens in pregnant sheep, is that the onset of labour is preceded by a rise in the oestrogen/progesterone ratio. This study will help to improve the ability to predict premature labour. Ultimately, the aim is to develop treatments for the prevention of premature birth.

Project to study the role of inflammation, particularly the chemical IL-8 in premature labour
Dr C Elliot & Prof P Bennett
Queen Charlotte's Hospital, London

Labour resembles a large inflammatory response. In other words, the underlying processes that trigger contractions are very similar to those which occur when a part of the body becomes inflamed. A family of important inflammatory substances, prostaglandins, have been found to be increased in labour.

This study will examine another inflammatory chemical found in the uterus, interleukin-8, which is known to be responsible for the softening of the cervix at labour. By understanding more about how this chemical is controlled in the womb, it is believed that they will have a much greater understanding of premature labour. The results of this research should lead to improvements in our ability to both predict and prevent preterm delivery.

The role of the hormone CRH in premature labour
Dr E Linton, Prof C Redman
John Radcliffe Hospital, Oxford

This study will investigate the role of a particular hormone CRH (corticotrophin releasing hormone) in triggering labour. This hormone is produced by the placenta, and has been found to be high in women who give birth prematurely and low in women who are overdue. As a result, researchers believe that it could be an accurate marker of how long a pregnancy will last, and may act as a 'clock' controlling the length of a pregnancy. In cases of premature birth, it may be that this 'clock' is running too fast. The idea initially proposed was that CRH may stimulate the production of womb-contracting substances, but it was unknown whether it was the CRH in the mother's blood or the CRH produced by the placenta involved in the timing of birth. A better understanding of the processes involved will increase the ability of future studies to predict and prevent premature delivery of the baby.

The role of ion channels in triggering premature labour
Dr R Khan et al.
Derby City General Hospital/University of Aberdeen

Currently, it is difficult to stop a woman from having a baby when she goes into labour as we do not fully understand the processes involved. There are many different signals involved in indicating when the time has arrived for a baby to be born. We know that the muscle of the womb must contract before a baby can be born, and it is thought that special pores (ion channels) in the lining of the muscle cells of the womb allow chemicals to flow in and out, thereby causing the muscle to contract powerfully.

The fact that some women do not go into labour whilst others go into labour too early shows that there may be something wrong with the signals that cause muscle contraction. The team is studying the properties of the ion channels in order to gain more detailed knowledge of human pregnancy and labour, and why these processes sometimes go wrong.

So far, the team have found that a distinct part of the pore structure is reduced in number after labour compared with non-pregnant and pre-labour tissue. The process of labour makes a big difference to the protein signal, and has been found to be reduced by about 60% in term labour.

Since this research has shown a significant reduction in the numbers of ion channels present after labour has started, this may turn out to be a key feature in preparing the womb for childbirth. It may also hold true that problems in this process may lead to preterm labour.

Hopefully, the results of this research will enable investigators to design better treatments and medicines for those individuals affected by premature delivery.

Investigating the cause and prevention of Bacterial Vaginosis
Dr J Soothill & Dr T Johnson
Manchester Royal Infirmary, Manchester

Pregnant women with Bacterial Vaginosis (BV) are more likely to go into premature labour. In this condition bacteria normally present in the vagina are overwhelmed by bacteria not normally present, but the reason for this is not known. Some of these bacteria produce enzymes that can degrade cervical mucus, and BV is frequently, although not always, associated with the activity of these enzymes. This project aims to find out whether the activity of these enzymes is a better predictor of premature birth than BV. Some of the organisms comprising BV are likely to be pathogenic (i.e. produce mucus-degrading enzymes); therefore, it is the activity of the enzymes that may be more likely to identify a poor outcome, such as premature birth, than a diagnosis of BV on its own. This work will hopefully lead to the development of long-term preventative treatments for BV, therefore cutting the rate of prematurity.

Investigating the enzyme Sialidase as a predictor of premature labour
Prof P Soothill et al.
St Michael's Hospital, Bristol

Researchers at St Michael's Hospital in Bristol are studying an enzyme produced by bacteria in pregnant women that may be responsible for many premature births. The team, under Professor Soothill at the University of Bristol, have used their knowledge to develop a test, recently patented, which they hope will be able to predict who is at risk of going into premature labour. The enzyme being studied by Professor Soothill is known as sialidase and is often found in pregnant women who have the infection bacterial vaginosis (BV), which in turn means they are more likely to go into labour prematurely.

Professor Soothill believes that high levels of sialidase may be the best indicator of premature birth. If this study shows we can use it to identify women who are most at risk of prematurity, we will be a step closer to preventing the loss of so many tiny lives caused by premature birth. Initial results indicate that there is a link between phage (viruses that infect and kill bacteria) and BV. Further work will be needed to confirm this association and investigate the nature of the link, but it may be that this is an important initial step in treating BV, thereby reducing the incidence of preterm birth.

Research to improve the understanding and prevention of premature labour
Research on understanding and preventing stillbirth and miscarriage
Research to improve the understanding and prevention of pre-eclampsia
Research to prevent health problems in small or premature babies