Translational Research in O&G
Our research embraces investigations into the beginning of life, from family genetics to ovum and sperm through fetal life to the neonatal period and beyond. There is a focus on improving the clinical management of common reproductive problems in women, especially polycystic ovary syndrome, recurrent miscarriage, uterine fibroids and urinary incontinence, and there are many examples of where this has already had a major impact. These issues are complementary and highly relevant to women’s health and family life, as well as ensuring the health of the next generation.
Research covers the six main areas of:
- Reproductive Medicine
- Surgical Gynaecology
- Maternal Medicine
- Preterm Labour
- Fetal Medicine
- Gynaecological Oncology
Examples of how research findings in O&G have translated into improvements in healthcare and/or public health locally, nationally, or internationally over the last 10 years include:
Management of recurrent miscarriage
Over a decade’s clinical research has established the evidence-base for both the investigation and treatment of women presenting with recurrent miscarriage. The St Mary’s protocols have been adopted nationally and internationally (UK, US and European Colleges of O&G Guidelines). As part of this, Professor Regan’s team has determined the optimal treatment for antiphospholipid syndrome in pregnant women, setting the standard of care, and resulting in international recognition of the importance of inherited and acquired prothrombotic disorders in determining pregnancy outcome. The resultant long-term health implications of prothrombotic tendencies we have identified in women are being translated into measures to prevent cardiovascular disease
Mobile epidurals for women in labour
Epidural
Combined spinal epidurals (CSEs) for labour were developed at Queen Charlotte’s. This new method comprised three modifications to the standard technique: (a) an initial spinal dose, (b) addition of an opioid to the local anaesthetic dose, (c) a reduction in the concentration of local anaesthetic used epidurally. They achieve rapid analgesia and minimise motor block. CSEs allow women to walk during labour, in contrast to the dense motor block with conventional techniques, and in many cases to avoid the previously ubiquitous urinary catheterisation. Since our original report, CSEs have been taken up worldwide. In many US centres, as in the UK, CSEs are now standard. They have also been extended to caesarean section, where general anaesthesia is now rare and CSEs are commonplace.
Fetal analgesia
Historically, the fetus was thought too immature to be capable of nociception, and no analgesia was considered for fetal medical and surgical interventions. Professors Glover and Fisk’s research showing that the human fetus was capable of sizeable hormonal and circulatory stress responses to invasive procedures from 16-20 weeks’ gestation was followed by a controlled trial showing that intravenous opioid analgesia ablated the fetal stress response to invasive procedures. This catalysed a major change in clinical practice, opening the door to an entirely new field of fetal anaesthesia. Administration of analgesia has since become standard of care internationally during fetal interventions (catheter shunts, endoscopic or open fetal surgery).
Minimally-invasive uterine fibroid ablation
The use of minimally invasive magnetic resonance-guided thermo-ablative therapy for women with symptomatic uterine fibroids was pioneered at St Mary’s. After first-in-man and proof-of-concept studies, the first clinical series of percutaneous laser ablation of focussed-ultrasound of uterine fibroids showed that both these techniques are safe, effective, and can be offered as day-case procedures with enormous health care savings to the NHS.
Cervical cancer tumour volume using magnetic resonance imaging
Cervical cancer is usually treated with radical hysterectomy and pelvic lymph node dissection if the tumour is felt confined to the cervix. Studies of imaging of cervical tumours and correlation with clinico-pathological data carried out at Hammersmith have shown a clear and independent relationship between tumour volume at presentation and long-term survival after treatment. Larger tumours are more likely to have a poorer prognosis and thus would benefit from upfront radical chemoradiation rather than radical hysterectomy. These criteria are now widely used in clinical practice when making decisions regarding accurate choice of treatment in patients with cervical cancer. This has the advantage of reducing the number of women who would undergo two radical treatment modalities with all the associated complications.
Image: A small cervical tumor using sagittal T2-weighted fast spin-echo images (4500/96 msec (TR/pseudoTE)) with an endovaginal coil (A) and a conventional phased array coil (B). A 0.6-cm3 bean-shaped tumor is seen in the endocervical canal anteriorly (A, arrow) which cannot be detected in B. Transverse T2- weighted image (C) and whole histology specimen (D) show the small tumor in the endocervical canal (arrows).There is excellent anatomic correlation between C and D.
