Tests and treatment options

There are two core tests that may be carried out:

• a transvaginal scan
• a swab test

You may be offered a transvaginal scan. This is an internal scan where a probe is gently inserted into your vagina.

A transvaginal scan checks the length of the neck of the womb.

This scan does not increase the risk of you having a miscarriage or going into preterm labour.

Why may I be offered a transvaginal scan?

Research has shown that some people who go on to have premature babies, had a shortening of the cervix (the neck of your womb), several weeks or days before going into labour.

Performing a transvaginal scan enables us to take a measurement of the length of your cervix. This can help decide your risk of preterm birth.

When would the scan take place?

A transvaginal scan is usually offered in the second trimester onwards (after 14 weeks).

Although, this will depend upon your risk. A transvaginal scan may be offered slightly later in your pregnancy, if we feel that you are at risk of having your baby early due to a short cervix.

Is a transvaginal scan uncomfortable?

It is understandable if you feel anxious about this scan. You may experience some discomfort or pain. Overall, the scan is generally, well tolerated. 

Can a scan through the tummy (an abdominal scan) not provide the same information?

A transvaginal scan is the only way to accurately measure the length of your cervix.\

An abdominal scan cannot measure the neck of the womb accurately.

Before the scan please let us know if you have any allergies, particularly to latex.

Will the scan need to be repeated?

You may only require a transvaginal scan, once. It may need to be repeated every two to four weeks, until around 24 weeks. This varies across patients. 

If you are at risk of premature birth, a doctor or midwife may carry out a vaginal swab test, such as a fetal fibronectin test.

This can help predict if you are at higher risk of giving birth prematurely.

Fetal fibronectin is a protein made by babies’ cells in the womb. It acts as a 'glue'; keeping the amniotic sac attached to the lining of the womb.

If you are likely to give birth early, fetal fibronectin may be released into the vagina. Here, it can be measured using a swab.

We can use the results of this test (alongside any other risk factors you have) to estimate the likelihood that you will give birth prematurely. 

There are a number of options that may be discussed with you in the clinic, if you are at risk of premature birth.

Most women and pregnant people. who attend the clinic do not need any treatment. We can offer to see you regularly, in order to monitor the length of the cervix for those who have an increased risk of a preterm labour.

If you have risk factors for preterm birth in your medical history, we will offer you regular scans, in order to check the length of your cervix as pregnancy progresses.

If the length of your cervix is found to be short, we may discuss a procedure called a cervical stitch (sometimes called a suture or cerclage).

A cervical stich is usually carried out under a light spinal anaesthetic (an injection in your back that makes the bottom half of your body go numb, for a short time).

Then, we insert a stitch around your cervix to try to keep it tightly closed. This aims to prevent early birth in some women who are at higher risk - however, it does not work for everyone.

The stitch is removed when you go into labour or at 36 to 37 weeks; whichever comes first. If a cervical stitch is an option for you, we will give you more information and help you decide if you want to go ahead with the procedure. 

Progesterone is a hormone that plays a role in maintaining pregnancy.

There is some evidence to support the use of progesterone for a cervix which is shortening.

If you are more than 24 weeks pregnant and we think that there is a very high chance that you may deliver in the following week, you will be advised to stay in hospital.

You may be offered a course of two steroid injections - usually over a 24 hour period - to help support your baby’s development.

Steroids help to reduce the likelihood of health complications caused by being born early. 

As medicine can not yet understand why many premature births occur, if  there is an ongoing research study, we may ask you to take part in it.

This is optional and your care will not be affected if you choose not to take part.