Ask to take part

Contact the study team using the details below to take part. If there are no contact details below please ask your doctor in the first instance.

Contact Information:

Dr Laura van der Krogt
laura.c.van_der_krogt@kcl.ac.uk


Prof Andrew Shennan
andrew.shennan@kcl.ac.uk


Dr Jenny Carter
jenny.carter@kcl.ac.uk


Study Location:

Find another location


Questions to ask
Skip to Main Content
English | Cymraeg
Be Part of Research - Trial Details - ABOVE: Cerclage after Caesarean
Back

ABOVE: Cerclage after Caesarean

Recruiting

Open to: Female

Age: Mixed

Birmingham Newcastle upon Tyne Coventry London London Liverpool Barnet London Bath Sunderland St. Leonards-on-sea Manchester

Medical Conditions

Preterm birth secondary to caesarean section

This information is provided directly by researchers, and we recognise that it isn't always easy to understand. We are working with researchers to improve the accessibility of this information. In some summaries, you may come across links to external websites. These websites will have more information to help you better understand the study.


Recent studies have shown that if a woman has had a caesarean section in labour (when the cervix is opening) she is more likely to have a premature baby in a future pregnancy. In women who have had an in-labour caesarean section there is a 5-10% chance of a preterm birth in a subsequent pregnancy.
For women who have had an in-labour caesarean section, which was then followed by a preterm birth or mid-trimester loss, early birth is even more likely in subsequent pregnancies. Currently it is not known which treatments are most effective to stop this happening.
These women should be referred to specialist preterm clinics, which will offer them ultrasound monitoring of the length of their cervix, and they may or may not also be offered a cervical cerclage, although there are currently no national guidelines about this. This is a small surgical procedure where a stitch is placed around the cervix through the vagina (transvaginal cerclage). A cerclage can also be placed higher up, through an abdominal procedure involving a cut in the tummy (transabdominal cerclage). This procedure is a longer operation with more recovery time and means that any future babies will need to be born by caesarean section.
Both types of cerclage are offered as standard care to women at high risk of preterm birth. Although transvaginal cerclages are more straightforward, transabdominal cerclages might be more effective because they are above any damage that might have been caused during a previous caesarean section.

Start dates may differ between countries and research sites. The research team are responsible for keeping the information up-to-date.  

The recruitment start and end dates are as follows:

01 Jul 2024 01 May 2027

Participants will be allocated to one of two treatments: a vaginally-placed cervical stitch or an abdominally-placed cervical stitch, performed before 14 weeks of pregnancy. Some women will join the study before pregnancy, in this group the abdominally-placed stitch will be sited before they get pregnant and the vaginal stitch before 14 weeks in the next pregnancy.
With both stitches participants are followed up in a prematurity clinic with regular transvaginal scanning. If the cervix becomes short participants may be admitted to hospital or offered other treatments (such as a steroid injection to help the baby’s lungs mature, and/or putting in an additional stitch if the cervix opens). These may be offered if there is a high chance the baby may be born very early.
The researchers will ask your permission to look at participants' medical notes after delivery to find out what happened. They may also save some scan images of the cervix taken in the prematurity clinic.
In addition to evaluating the two cerclages, we are inviting women who have not been randomised in this study to take part in this observational group. We will be asking if they are happy for us to collect information about what happens to them in this pregnancy and their baby after birth.


Recent studies have shown that if a woman has had a caesarean section in labour (when the cervix is opening) she is more likely to have a premature baby in a future pregnancy. In women who have had an in-labour caesarean section there is a 5-10% chance of a preterm birth in a subsequent pregnancy.
For women who have had an in-labour caesarean section, which was then followed by a preterm birth or mid-trimester loss, early birth is even more likely in subsequent pregnancies. Currently it is not known which treatments are most effective to stop this happening.
These women should be referred to specialist preterm clinics, which will offer them ultrasound monitoring of the length of their cervix, and they may or may not also be offered a cervical cerclage, although there are currently no national guidelines about this. This is a small surgical procedure where a stitch is placed around the cervix through the vagina (transvaginal cerclage). A cerclage can also be placed higher up, through an abdominal procedure involving a cut in the tummy (transabdominal cerclage). This procedure is a longer operation with more recovery time and means that any future babies will need to be born by caesarean section.
Both types of cerclage are offered as standard care to women at high risk of preterm birth. Although transvaginal cerclages are more straightforward, transabdominal cerclages might be more effective because they are above any damage that might have been caused during a previous caesarean section.

Who can participate?
Women who have had a preterm birth or mid-trimester loss (a loss between 14 and 24 weeks of pregnancy) after a previous caearean section in labour

You can take part if:



You may not be able to take part if:


Potential participants will not be eligible for the trial if:1. They are more than 14+0 weeks pregnant at the time of randomisation (as insertion of TAC is associated with higher risk beyond this gestation)2. They already have a cerclage or (Arabin) pessary in situ3. They are not planning another pregnancy4. They have a history of preterm birth (spontaneous/iatrogenic) prior to the term emergency section5. They are pregnant and expecting more than one baby (multiple pregnancy)


Below are the locations for where you can take part in the trial. Please note that not all sites may be open.

  • Birmingham Women's and Children's NHS Foundation Trust
    Steelhouse Lane
    Birmingham
    B4 6NH
  • The Royal Victoria Infirmary
    Queen Victoria Road
    Newcastle upon Tyne
    TS1 4LP
  • University Hospital Coventry
    Clifford Bridge Road
    Coventry
    CV2 2DX
  • Uclh
    250 Euston Road
    London
    NW1 2PQ
  • St Thomas' Hospital
    Westminster Bridge Road
    London
    SE1 7EH
  • Liverpool Womens Hospital
    Crown Street
    Liverpool
    L8 7SS
  • Barnet Hospital
    Wellhouse Lane
    Barnet
    EN5 3DJ
  • Royal London Hospital
    Whitechapel
    London
    E1 1BB
  • Royal United Hospital
    Combe Park
    Bath
    BA1 3NG
  • South Tyneside and Sunderland NHS Foundation Trust
    Sunderland Royal Hospital Kayll Road
    Sunderland
    SR4 7TP
  • Conquest Hospital
    The Ridge
    St. Leonards-on-sea
    TN37 7RD
  • Manchester University Hospital NHS Ft (hq)
    Oxford Road
    Manchester
    M13 9WL

Taking part in the study may not have any direct benefit to participants now. However, the results of this study might help to improve care in any future pregnancies as well as other women, and to reduce the number of babies being born too early.
Having a cervical stitch inserted is a relatively common procedure and is known to help some women. Risks of both treatments include post-operative pain, infection and bleeding. The uncommon risks (occurring in 1 out of 1000) include tearing of the cervix or bladder. The obstetrician would generally be able to repair any tearing to the cervix immediately. A tear to the bladder would require another operation by a urologist (a medical doctor with specialist training in problems of the urinary tract). Both would require a few extra days in hospital. If the doctor is worried about infection, a swab may be taken from the vagina and, if there is evidence of infection, participants may be given a course of antibiotics. While it is likely that either of the cerclages will reduce the chance of miscarriage or preterm birth, they will not entirely eliminate the possibility.

Prof Andrew Shennan
andrew.shennan@kcl.ac.uk


Dr Laura van der Krogt
laura.c.van_der_krogt@kcl.ac.uk


Dr Jenny Carter
jenny.carter@kcl.ac.uk



The study is sponsored by King's College London and funded by Action Medical Research; Grant Codes: GN2967; Borne.



We'd like your feedback

Your feedback is important to us. It will help us improve the quality of the study information on this site. Please answer both questions.


Is this study information helpful?

What will you do next?
Read full details for Trial ID: ISRCTN10977996

Or CPMS 59777

Last updated 21 January 2026

This page is to help you find out about a research study and if you may be able to take part

You can print or share the study information with your GP/healthcare provider or contact the research team directly.   

Back to the top