Cerclage After Full Dilatation Caesarean Section

An Investigation Into the Role of Previous in Labour Caesarean Section in Future Preterm Birth Risk and Management Strategies

CRAFT-OBS: Observational Study; To evaluate subsequent pregnancy risk of preterm birth in women with a history of previous caesarean in established labour. This prospective study using clinically acquired cervical length and quantitative fetal fibronectin data will help establish a predictive model of preterm birth <34 weeks and <37 weeks.

CRAFT-RCT: Randomised controlled trial arm; To assess treatment for short cervix in women at high risk of preterm birth following a caesarean section at full dilatation

CRAFT-IMG: Imaging sub-study; To aid understanding of micro and macrostructural features within the cervix which predisposes to preterm birth in women with a previous full dilatation caesarean section. This will use MRI and an advanced transvaginal ultrasound protocol and to assess if structural changes can be visualised in the cervix.

CRAFT-OBS

Inclusion Criteria:

• Pregnant women under 23+6 weeks gestation with a history of previous caesarean section in labour.
• Singleton pregnancy.
• Willing and able to give informed consent (with or without interpreter).

Exclusion Criteria:

• Under 16 years of age.
• Inability to give informed consent.
• Previous caesarean section carried out before labour.
• Women who have been commenced on management with progesterone, a cerclage or arabin pessary as part of their care or another research study

CRAFT-RCT:

Inclusion criteria:

• Pregnant women up to 23+6 weeks gestation with a history of FDCS.
• Short cervix (<=25mm) on transvaginal ultrasound scan.

Exclusion criteria:

• Women with persistent fresh vaginal bleeding evident on speculum examination.
• Women with visible fetal membranes evident on speculum examination or open cervix on ultrasound scan.
• Women with severe abdominal pain/evidence of sepsis (as judged by attending clinician).
• Known significant congenital or structural or chromosomal fetal abnormality.
• Suspected or proven rupture of the fetal membranes at the time of recruitment.

CRAFT-IMG

Inclusion criteria:

• Pregnant women between 14+0 and 23+6 weeks gestation with a history of FDCS.

Exclusion criteria:

• Contraindications to MRI, e.g. claustrophobia, BMI >40 kg/m2 (due to technical limitations of scanner) or a women with a non-MRI compatible metallic implant.