Publications
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Mylrea-Foley B, Napolitano R, Gordijn S, et al., 2024, All fetal growth restriction definitions fall short., Am J Obstet Gynecol MFM, Vol: 6
Mylrea-Foley B, Napolitano R, Gordijn S, et al., 2023, Do differences in diagnostic criteria for late fetal growth restriction matter?, Am J Obstet Gynecol MFM, Vol: 5
BACKGROUND: Criteria for diagnosis of fetal growth restriction differ widely according to national and international guidelines, and further heterogeneity arises from the use of different biometric and Doppler reference charts, making the diagnosis of fetal growth restriction highly variable. OBJECTIVE: This study aimed to compare fetal growth restriction definitions between Delphi consensus and Society for Maternal-Fetal Medicine definitions, using different standards/charts for fetal biometry and different reference ranges for Doppler velocimetry parameters. STUDY DESIGN: From the TRUFFLE 2 feasibility study (856 women with singleton pregnancy at 32+0 to 36+6 weeks of gestation and at risk of fetal growth restriction), we selected 564 women with available mid-pregnancy biometry. For the comparison, we used standards/charts for estimated fetal weight and abdominal circumference from Hadlock, INTERGROWTH-21st, and GROW and Chitty. Percentiles for umbilical artery pulsatility index and its ratios with middle cerebral artery pulsatility index were calculated using Arduini and Ebbing reference charts. Sensitivity and specificity for low birthweight and adverse perinatal outcome were evaluated. RESULTS: Different combinations of definitions and reference charts identified substantially different proportions of fetuses within our population as having fetal growth restriction, varying from 38% (with Delphi consensus definition, INTERGROWTH-21st biometric standards, and Arduini Doppler reference ranges) to 93% (with Society for Maternal-Fetal Medicine definition and Hadlock biometric standards). None of the different combinations tested appeared effective, with relative risk for birthweight <10th percentile between 1.4 and 2.1. Birthweight <10th percentile was observed most frequently when selection was made with the GROW/Chitty charts, slightly less with the Hadlock standard, and least frequently with the INTERGROWTH-21st standard. Using the Ebbing Doppler reference
Familiari A, Napolitano R, Visser GHA, et al., 2023, Antenatal corticosteroids and perinatal outcome in late fetal growth restriction: analysis of prospective cohort, ULTRASOUND IN OBSTETRICS & GYNECOLOGY, Vol: 61, Pages: 191-197, ISSN: 0960-7692
Stampalija T, Wolf H, Mylrea-Foley B, et al., 2023, Reduced fetal growth velocity and weight loss are associated with adverse perinatal outcome in fetuses at risk of growth restriction, AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, Vol: 228, Pages: 710-710000000000, ISSN: 0002-9378
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Fantasia I, Zamagni G, Lees C, et al., 2022, Current practice in the diagnosis and management of fetal growth restriction: An international survey, Acta Obstetricia et Gynecologica Scandinavica, Vol: 101, Pages: 1431-1439, ISSN: 0001-6349
IntroductionThe aim of this survey was to evaluate the current practice in respect of diagnosis and management of fetal growth restriction among obstetricians in different countries.Material and methodsAn e-questionnaire was sent via REDCap with “click thru” links in emails and newsletters to obstetric practitioners in different countries and settings with different levels of expertise. Clinical scenarios in early and late fetal growth restriction were given, followed by structured questions/response pairings.ResultsA total of 275 participants replied to the survey with 87% of responses complete. Participants were obstetrician/gynecologists (54%; 148/275) and fetal medicine specialists (43%; 117/275), and the majority practiced in a tertiary teaching hospital (56%; 153/275). Delphi consensus criteria for fetal growth restriction diagnosis were used by 81% of participants (223/275) and 82% (225/274) included a drop in fetal growth velocity in their diagnostic criteria for late fetal growth restriction. For early fetal growth restriction, TRUFFLE criteria were used for fetal monitoring and delivery timing by 81% (223/275). For late fetal growth restriction, indices of cerebral blood flow redistribution were used by 99% (250/252), most commonly cerebroplacental ratio (54%, 134/250). Delivery timing was informed by cerebral blood flow redistribution in 72% (176/244), used from ≥32 weeks of gestation. Maternal biomarkers and hemodynamics, as additional tools in the context of early-onset fetal growth restriction (≤32 weeks of gestation), were used by 22% (51/232) and 46% (106/230), respectively.ConclusionsThe diagnosis and management of fetal growth restriction are fairly homogeneous among different countries and levels of practice, particularly for early fetal growth restriction. Indices of cerebral flow distribution are widely used in the diagnosis and management of late fetal growth restriction, whereas maternal biomarkers and hemodynam
Mylrea-Foley B, Thornton JG, Mullins E, et al., 2022, Perinatal and 2-year neurodevelopmental outcome in late preterm fetal compromise: the TRUFFLE 2 randomised trial protocol, BMJ Open, Vol: 12, Pages: 1-8, ISSN: 2044-6055
Introduction Following the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late delivery are potentially important yet practice varies widely around the world, with abnormal findings from fetal heart rate monitoring invariably leading to delivery. Indices derived from fetal cerebral Doppler examination may guide such decisions although there are few studies in this area. We propose a randomised, controlled trial to establish the optimum method of timing delivery between 32 weeks and 36 weeks 6 days of gestation. We hypothesise that delivery on evidence of cerebral blood flow redistribution reduces a composite of perinatal poor outcome, death and short-term hypoxia-related morbidity, with no worsening of neurodevelopmental outcome at 2 years.Methods and analysis Women with non-anomalous singleton pregnancies 32+0 to 36+6 weeks of gestation in whom the estimated fetal weight or abdominal circumference is <10th percentile or has decreased by 50 percentiles since 18–32 weeks will be included for observational data collection. Participants will be randomised if cerebral blood flow redistribution is identified, based on umbilical to middle cerebral artery pulsatility index ratio values. Computerised cardiotocography (cCTG) must show normal fetal heart rate short term variation (≥4.5 msec) and absence of decelerations at randomisation. Randomisation will be 1:1 to immediate delivery or delayed delivery (based on cCTG abnormalities or other worsening fetal condition). The primary outcome is poor condition at birth and/or fetal or neonatal death and/or major neonatal morbidity, the secondary non-inferiority outcome is 2-year infant general health and neurodevelopmental outcome based on the Parent Report of Children’s Abilities-Revised questionnaire.Ethics and dissemination The Study Coordination Centre has obtaine
Mylrea-Foley B, Wolf H, Stampalija T, et al., 2021, Longitudinal Doppler Assessments in Late Preterm Fetal Growth Restriction, ULTRASCHALL IN DER MEDIZIN, ISSN: 0172-4614
Mylrea-Foley B, Lees C, 2021, Clinical monitoring of late fetal growth restriction, MINERVA OBSTETRICS AND GYNECOLOGY, Vol: 73, Pages: 462-470, ISSN: 2724-606X
Stampalija T, Thornton J, Marlow N, et al., 2020, Fetal cerebral Doppler changes and outcome in late preterm fetal growth restriction: prospective cohort study, Ultrasound in Obstetrics and Gynecology, Vol: 56, Pages: 173-181, ISSN: 0960-7692
ObjectivesTo explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction.MethodsThis was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC) < 10th percentile, abnormal arterial Doppler and/or a fall in AC growth velocity of more than 40 percentile points from the 20‐week scan. Composite adverse outcome comprised both immediate adverse birth outcome and major neonatal morbidity. Using a range of cut‐off values, the association of MCA pulsatility index and umbilicocerebral ratio (UCR) with composite adverse outcome was explored.ResultsThe study population comprised 856 women. There were two (0.2%) intrauterine deaths. Median gestational age at delivery was 38 (interquartile range (IQR), 37–39) weeks and birth weight was 2478 (IQR, 2140–2790) g. Compared with infants with normal outcome, those with composite adverse outcome (n = 93; 11%) were delivered at an earlier gestational age (36 vs 38 weeks) and had a lower birth weight (1900 vs 2540 g). The first Doppler observation of MCA pulsatility index < 5th percentile and UCR Z‐score above gestational‐age‐specific thresholds (1.5 at 32–33 weeks and 1.0 at 34–36 weeks) had the highest relative risks (RR) for composite adverse outcome (RR 2.2 (95% CI, 1.5–3.2) and RR 2.0 (95% CI, 1.4–3.0), respectively). After adjustment for confounders, the association between UCR Z‐score and composite adverse outcome remained significa
Mylrea-Foley B, Bhide A, Mullins E, et al., 2020, Building consensus: thresholds for delivery in the TRUFFLE 2 randomized intervention study., Ultrasound in Obstetrics and Gynecology, Vol: 56, Pages: 285-287, ISSN: 0960-7692
MylreaFoley B, Shaw CJ, Harikumar N, et al., 2019, Early‐onset twin–twin transfusion syndrome: case series and systematic review, Australasian Journal of Ultrasound in Medicine, Vol: 22, Pages: 286-294, ISSN: 1836-6864
IntroductionData on the outcomes of early‐onset twin–twin transfusion syndrome (TTTS), diagnosed before 18 weeks gestational age (GA), are sparse. We aimed to review the diagnosis, management and outcomes of early‐onset TTTS.Material and methodsPregnancy records at a single referral unit 2010‐6 were reviewed. In early‐onset TTTS cases, data for pregnancy characteristics, interventions and outcomes were collected. PubMed and Scopus databases were searched for studies including pregnant women with early‐onset TTTS. The primary outcome measure was livebirths.ResultsCase series: 58 cases of early‐onset TTTS 2010‐6, with full outcome data in 44. Diagnostic criteria were variable. Median GA at intervention was 17+4 (range 15+0‐28+1); 67% of patients had laser therapy (39/58). Overall survival: 60% (53/88). At least one livebirth: 86% (38/44), Two livebirths: 34% (15/44); No survivors: 14% (6/44). GA at delivery was 32+1.5 (range 16+2‐37+4). Systematic review: 16 studies included (n = 171 pregnancies). Diagnostic criteria varied widely: 79% of studies used Quintero staging. Most offered laser (89%) at median 17+0 weeks (range 16+0‐21+6). GA at delivery was 23+0‐39+5 weeks. Overall survival: 69% (129/186). At least one livebirth: 74% (127/171). Two livebirths: 59% (55/93). No survivors: 26% (44/171).ConclusionsIn comparison with the commonly accepted overall survival for TTTS treated after 18 weeks of 60–90%, outcomes in early‐onset TTTS were at the lower bound of this range. Gestational age at intervention is similar to that of later onset TTTS, indicating a lack of therapeutic options when a diagnosis is made before 18 weeks.
Mylrea-Lowndes B, Harikumar N, Shaw C, et al., 2017, OP26.02 A systematic review of diagnosis, management and outcomes for twin-twin transfusion syndrome (TTTS) diagnosed before 18 weeks' gestation, ISUOG World Congress 2017, Publisher: Wiley, Pages: 132-132, ISSN: 0960-7692
Mylrea-Lowndes B, Legg S, Shaw C, et al., 2017, OP26.01 A case series of the characteristics, course and outcomes for twin-twin transfusion syndrome (TTTS) diagnosed before 18 weeks' gestation, ISUOG World Congress 2017, Publisher: Wiley, Pages: 132-132, ISSN: 0960-7692
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