Professor Coomarasamy pursues clinical and applied aspects of translational research including clinical trials, evidence synthesis and mixed methodology research.
•First trimester progesterone therapy in women with a history of unexplained recurrent miscarriages (PROMISE)
The recently completed PROMISE trial tested whether treatment with progesterone in the first trimester of pregnancy can reduce the risk of miscarriage in women with a previous history of unexplained recurrent loss. The study took place in approximately 40 hospitals across the UK and the Netherlands.
•A randomised, double blind, multi-centre, placebo-controlled study to evaluate the efficacy, safety, and tolerability of NT100 in pregnant women with a history of unexplained recurrent pregnancy loss (RESPONSE)
The RESPONSE trial recently completed recruitment to test the efficacy, safety, and tolerability of NT100 in pregnant women with a history of unexplained recurrent pregnancy loss, at study sites throughout the UK.
•Effectiveness of progesterone to prevent miscarriage in women with early pregnancy bleeding: a randomised placebo-controlled trial (PRISM)
PRISM tests whether progesterone hormone treatment for women with bleeding in early pregnancy can reduce their risk of miscarriage. The study is conducted at more than 30 study sites across the UK PROMISE network.
•A multicentre placebo-controlled randomised trial of levothyroxine to reduce miscarriage risk in euthyroid women with thyroid auto-antibodies (TABLET)
TABLET seeks to evaluate the effects of thyroxine to prevent miscarriage in women with thyroid antibodies but normal thyroid function. The trial is operating in more than 30 centres across the UK, with several thousand screens to randomise 900 participants.
•Effectiveness of antibiotic prophylaxis during surgical evacuation of the uterus for miscarriage management in low income countries (AIMS)
The AIMS (Antibiotics in Miscarriage Surgery) project proposes that antibiotics given just before miscarriage surgery could reduce the chances of infection, and tests the hypothesis through a large clinical trial in Malawi, Tanzania, Uganda and Pakistan. The study is endorsed by the WHO, FIGO and RCOG.
•Carbetocin RTS for preventing postpartum haemorrhage: a randomised non-inferiority controlled trial
The Carbetocin RTS trial was commissioned by the WHO to test carbetocin RTS for preventing postpartum haemorrhage. The project brings together 12 participating centres from around the globe (Argentina, Brazil, Egypt, India, Kenya, Nigeria, Pakistan, Singapore, South Africa, Thailand and Uganda in addition to the UK).
•Selection of sperm for assisted reproductive treatment by prior hyaluronic acid binding: increasing live birth outcomes and reducing miscarriage rates – multicentre randomised controlled, blinded trial (HABSelect)
Professor Coomarasamy is a co-applicant to the HABSelect project, testing a new method to select sperm for injection into the egg by their ability to stick to hyaluronan, a naturally occurring substance in the female tract. This is important because studies indicate that less than a quarter of all fertilised eggs implant to the womb and develop normally.
•A multicentre trial of outpatient hysteroscopy before IVF, after recurrent IVF failures (TROPHY)
Professor Coomarasamy also supported the TROPHY trial of whether or not it may be useful to perform an outpatient hysteroscopy prior to the commencement of an IVF cycle, to improve the likelihood of achieving a live birth in women who have previously experienced between two and four IVF implantation failures. Located across three fertility centres in the UK, two sites in Belgium, two facilities in Italy and a clinic in the Czech Republic, the pan-European recruitment programme was recently completed with a total of 700 patients.
Professor Coomarasamy has accumulated significant expertise in the meta-analysis of effectiveness and test accuracy data, including advanced literature searching and data synthesis skills such as meta-regression, bivariate meta-analysis, pooling of receiver operating characteristics curves and funnel plot analysis. His work with Professor Zamora (Madrid, Spain) achieved the first and most comprehensive data analysis software (Metadisc) and it was made available free of charge to researchers worldwide. The software has been cited in the Lancet, JAMA, BMJ and other journal articles more than 880 times. Professor Coomarasamy is now collaborating to produce the next version of the product, with a facility for bivariate meta-analysis.
Postpartum Haemorrhage (PPH) is the leading cause of maternal mortality in the developing world and contributes to nearly a quarter of all maternal deaths globally. Professor Coomarasamy is conducting a systematic review and network meta-analysis to evaluate the most effective uterotonic agents for preventing the condition. The study already promises to reap important findings for international policy development.
MIXED METHODOLOGY RESEARCH
•United Kingdom Early Pregnancy Surveillance Service (UKEPSS)
Professor Coomarasamy is the chief investigator of the UKEPSS programme which employs observational, cohort, case-control, qualitative and health economic studies to investigate serious conditions of early pregnancy and emergency gynaecology. The UKEPSS programme has established an extensive network of more than 80 Early Pregnancy Units across the UK.