Imperial College London

Professor Christoph Lees, MD FRCOG

Faculty of MedicineDepartment of Metabolism, Digestion and Reproduction

Professor of Obstetrics
 
 
 
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Contact

 

c.lees

 
 
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Assistant

 

Ms Rocio Lale-Montes +44 (0)20 7594 2104

 
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Location

 

Queen Charlottes and Chelsea HospitalHammersmith Campus

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Summary

 

Publications

Publication Type
Year
to

331 results found

Mullins E, Hudak ML, Banerjee J, Getzlaff T, Townson J, Barnette K, Playle R, Bourne T, Lees C, PAN-COVID investigators and the National Perinatal COVID-19 Registry Study Groupet al., 2021, Pregnancy and neonatal outcomes of COVID-19: co-reporting of common outcomes from PAN-COVID and AAP SONPM registries, Ultrasound in Obstetrics and Gynecology, Vol: 57, Pages: 5733-581, ISSN: 0960-7692

OBJECTIVE: Few large cohort studies have reported data on maternal, fetal, perinatal and neonatal outcomes associated with SARS-CoV-2 infection in pregnancy. We report the outcome of infected pregnancies from a collaboration formed early during the pandemic between the investigators of two registries, the UK and global Pregnancy and Neonatal outcomes in COVID-19 (PAN-COVID) study and the US American Academy of Pediatrics Section on Neonatal Perinatal Medicine (AAP SONPM) National Perinatal COVID-19 Registry. METHODS: This was an analysis of data from the PAN-COVID registry (January 1st to July 25th 2020), which includes pregnancies with suspected or confirmed maternal SARS-CoV-2 infection at any stage in pregnancy, and the AAP SONPM National Perinatal COVID-19 registry (April 4th to August 8th 2020), which includes pregnancies with positive maternal testing for SARS-CoV-2 from 14 days before delivery to 3 days after delivery. The registries collected data on maternal, fetal, perinatal and neonatal outcomes. The PAN-COVID results are presented both overall for pregnancies with suspected or confirmed SARS-CoV-2 infection and separately in those with confirmed infection. RESULTS: We report on 4005 pregnant women with suspected or confirmed SARS-CoV-2 infection (1606 from PAN-COVID and 2399 from AAP SONPM). For obstetric outcomes, in PAN-COVID overall, those with confirmed infection in PAN-COVID and AAP SONPM, respectively, maternal death occurred in 0.5%, 0.5% and 0.2% of cases, early neonatal death in 0.2%, 0.3% and 0.3% of cases and stillbirth in 0.5%, 0.6% and 0.4% of cases. Delivery was pre-term (<37 weeks' gestation) in 12.0% of all women in PAN-COVID, in 16.2% of those women with confirmed infection in PAN-COVID and in 15.7% of women in AAP SONPM. Extremely preterm delivery (< 27 weeks' gestation) occurred in 0.5% of cases in PAN-COVID and 0.3% in AAP SONPM. Neonatal SARS-CoV-2 infection was reported in 0.8% of all deliver

Journal article

Relph S, Elstad M, Coker B, Vieira MC, Moitt N, Gutierrez WM, Khalil A, Sandall J, Copas A, Lawlor DA, Pasupathy D, DESIGN Trial teamet al., 2021, Using electronic patient records to assess the effect of a complex antenatal intervention in a cluster randomised controlled trial-data management experience from the DESiGN Trial team., Trials, Vol: 22

BACKGROUND: The use of electronic patient records for assessing outcomes in clinical trials is a methodological strategy intended to drive faster and more cost-efficient acquisition of results. The aim of this manuscript was to outline the data collection and management considerations of a maternity and perinatal clinical trial using data from electronic patient records, exemplifying the DESiGN Trial as a case study. METHODS: The DESiGN Trial is a cluster randomised control trial assessing the effect of a complex intervention versus standard care for identifying small for gestational age foetuses. Data on maternal/perinatal characteristics and outcomes including infants admitted to neonatal care, parameters from foetal ultrasound and details of hospital activity for health-economic evaluation were collected at two time points from four types of electronic patient records held in 22 different electronic record systems at the 13 research clusters. Data were pseudonymised on site using a bespoke Microsoft Excel macro and securely transferred to the central data store. Data quality checks were undertaken. Rules for data harmonisation of the raw data were developed and a data dictionary produced, along with rules and assumptions for data linkage of the datasets. The dictionary included descriptions of the rationale and assumptions for data harmonisation and quality checks. RESULTS: Data were collected on 182,052 babies from 178,350 pregnancies in 165,397 unique women. Data availability and completeness varied across research sites; each of eight variables which were key to calculation of the primary outcome were completely missing in median 3 (range 1-4) clusters at the time of the first data download. This improved by the second data download following clarification of instructions to the research sites (each of the eight key variables were completely missing in median 1 (range 0-1) cluster at the second time point). Common data management challenges were harmonising a

Journal article

Wolf H, Stampalija T, Lees CC, TRUFFLE study groupet al., 2021, Fetal cerebral blood flow redistribution: an analysis of Doppler reference charts and the association of different thresholds with adverse perinatal outcome., Ultrasound Obstet Gynecol

OBJECTIVES: The objectives of the study were: 1) to compare published Doppler reference charts of the ratios of the middle cerebral and umbilical arteries, the cerebro-placental or the umbilical- cerebral ratio; and 2) to assess the association of thresholds of these charts with short-term composite adverse neonatal outcome in a cohort of women considered at risk of late preterm fetal growth restriction. METHODS: 1) Reference charts for the cerebro-placental or umbilical-cerebral ratio were searched in PubMed. Algorithms for plotting the median and the 10th or the 90th percentile against gestational age were extracted from the publication or calculated from published tables. 2) Data from a prospective European multicenter observational cohort study of singleton pregnancies at risk of fetal growth restriction at 32+0 to 36+6 weeks of gestation (n=856) were used to compare the charts for their association with composite adverse outcome. Composite adverse outcome comprised both abnormal condition at birth and major neonatal morbidity. Fetal arterial Doppler measurements were collected longitudinally during this study. RESULTS: 1) Ten studies with reference charts for the cerebro-placental or the umbilical-cerebral ratio were retrieved. The 10th or the 90th percentiles showed large differences, while median values were more similar. In the range of 28 - 36 weeks there was no relation between UCR - CPR and gestational age. 2) Comparison of percentile thresholds, multiple of the median (MoM) values as calculated from these charts, or absolute values, showed a similar association with the composite adverse study outcome, both after univariable analysis and after adjustment for gestational age, estimated fetal weight and preeclampsia. The adjusted odds ratio for the composite adverse outcome of an absolute umbilical-cerebral ratio ≥0.9 (≥1.75 MoM) or an absolute cerebro-placental ratio <1.1 was 3.3 (95% CI 1.7 - 6.4), and of an absolute umbilical-cerebral ra

Journal article

Dall'Asta A, Forlani F, Shah H, Paramasivam G, Yazbek J, Bourne T, Cali G, Lees Cet al., 2021, Evaluation of the Tramline Sign in the Prediction of Placenta Accreta Spectrum and Perioperative Outcomes in Anterior Placenta Previa, ULTRASCHALL IN DER MEDIZIN, ISSN: 0172-4614

Journal article

Stephens KJ, Kaza N, Shaw CJ, Lees CCet al., 2021, Fetal weight change close to term is proportional to the birthweight percentile, EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY, Vol: 257, Pages: 84-87, ISSN: 0301-2115

Journal article

Fratelli N, Prefumo F, Wolf H, Hecher K, Visser GHA, Giussani D, Derks JB, Shaw CJ, Frusca T, Ghi T, Ferrazzi E, Lees CC, TRUFFLE Group, TRUFFLE Group authors, TRUFFLE Group collaborating authorset al., 2021, Effects of antenatal betamethasone on fetal doppler indices and short term fetal heart rate variation in early growth restricted fetuses, European Journal of Ultrasound / Ultraschall in der Medizin, Vol: 42, Pages: 56-64, ISSN: 0172-4614

PURPOSE:  To investigate the effects of the antenatal administration of betamethasone on fetal Doppler and short term fetal heart rate variation (CTG-STV) in early growth restricted (FGR) fetuses. MATERIALS AND METHODS:  Post hoc analysis of data derived from the TRUFFLE study, a prospective, multicenter, randomized management trial of severe early onset FGR. Repeat Doppler and CTG-STV measurements between the last recording within 48 hours before the first dose of betamethasone (baseline value) and for 10 days after were evaluated. Multilevel analysis was performed to analyze the longitudinal course of the umbilico-cerebral ratio (UC ratio), the ductus venosus pulsatility index (DVPIV) and CTG-STV. RESULTS:  We included 115 fetuses. A significant increase from baseline in CTG-STV was found on day + 1 (p = 0.019) but no difference thereafter. The DVPIV was not significantly different from baseline in any of the 10 days following the first dose of betamethasone (p = 0.167). Multilevel analysis revealed that, over 10 days, the time elapsed from antenatal administration of betamethasone was significantly associated with a decrease in CTG-STV (p = 0.045) and an increase in the DVPIV (p = 0.001) and UC ratio (p < 0.001). CONCLUSION:  Although steroid administration in early FGR has a minimal effect on increasing CTG-STV one day afterwards, the effects on Doppler parameters were extremely slight with regression coefficients of small magnitude suggesting no clinical significance, and were most likely related to the deterioration with time in FGR. Hence, arterial and venous Doppler assessment of fetal health remains informative following antenatal steroid administration to accelerate fetal lung maturation.

Journal article

Banerjee J, Mullins E, Townson J, Playle R, Shaw C, Kirby N, Munnery K, Bourne T, Teoh TG, Dhanjal M, Poon L, Wright A, Lees Cet al., 2021, Pregnancy and Neonatal Outcomes in COVID-19: Study protocol for a global registry of women with suspected or confirmed SARS-CoV-2 infection in pregnancy and their neonates, understanding natural history to guide treatment and prevention, BMJ Open, Vol: 11, Pages: 1-6, ISSN: 2044-6055

Introduction: Previous novel coronavirus pandemics, Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), observed an association of infection in pregnancy with pre-term delivery, stillbirth and increased maternal mortality. Coronavirus disease2019(COVID-19), caused by SARS-CoV-2 infection, is the largest pandemic in living memory. Rapid accrual of robust case data on women in pregnancy and their babies affected by suspectedCOVID-19or confirmed SARS-CoV-2 infection will inform clinical management and preventative strategies in the current pandemic and future outbreaks. Methods and analysis: The Pregnancy And Neonatal outcomes in COVID-19 (PAN-COVID) registry is an observational study collecting focussed data on outcomes of pregnant mothers who have had suspected COVID-19 in pregnancy or confirmed SARS-CoV-2 infection and their neonatesvia a web-portal. Amongst the women recruited to the PAN-COVID registry, the study will evaluate the incidence of:1. Miscarriage and pregnancy loss2. FGR and stillbirth 3. Pre-term delivery 4. Vertical transmission(suspected or confirmed) and early-onset neonatal SARS-CoV-2 infection Data will be centre based and collected on individual women and their babies. Verbal consent will be obtained, to reduce face-to-face contact in the pandemic whilst allowing identifiable data collection for linkage. Statistical analysis of the data will be carried out on a pseudonymised dataset by the study statistician. Regular reports will be distributed to collaborators on the study research questions. Ethics and dissemination: This study has received research ethics approval in the UK. For international centres, evidence of appropriate local approval will be required to participate, prior to entry of data to the database. The reports will be published regularly. The outputs of the study will be regularly disseminated to 4participants and collaborators on the study

Journal article

Jones BP, Kasaven L, Vali S, Saso S, Jalmbrant M, Bracewell-Milnes T, Thum M-Y, Quiroga I, Friend P, Diaz-Garcia C, Ghaem-Maghami S, Yazbek J, Lees C, Testa G, Johannesson L, Jones B, Smith JRet al., 2020, Uterine Transplantation; Review of Livebirths and Reproductive Implications., Transplantation

Uterine transplantation (UTx) is a fertility restoring treatment for women with absolute uterine factor infertility. At a time when there is no question of the procedure's feasibility, and as the number of livebirths begins to increase exponentially, various important reproductive, fetal and maternal medicine implications have emerged. Detailed outcomes from 17 livebirths following UTx are now available, which are reviewed herein, along with contextualized extrapolation from pregnancy outcomes in other solid organ transplants. Differences in recipient demographics and reproductive aspirations between UTx and other transplant recipients make extrapolating management strategies and outcomes in other solid organ transplants inappropriate. Whereas preterm delivery remains prominent, small for gestational age or hypertensive disorders do not appear to be as prevalent following UTx when compared to other solid organ transplants. Given the primary objective of undertaking UTx is to achieve a livebirth, publication of reproductive outcomes is essential at this early stage, to reflect upon and optimize the management of future cases.

Journal article

Kasaven LS, Saso S, Barcroft J, Yazbek J, Joash K, Stalder C, Nagi JB, Smith JR, Lees C, Bourne T, Jones BPet al., 2020, Authors' reply Re: Implications for the future of Obstetrics and Gynaecology following the COVID-19 pandemic: a commentary, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 128, Pages: 616-617, ISSN: 1470-0328

Journal article

Clarke A, Biffi B, Sivera R, Dall'Asta A, Fessey L, Wong T-L, Paramasivam G, Dunaway D, Schievano S, Lees Cet al., 2020, Developing and testing an algorithm for automatic segmentation of the fetal face from 3D ultrasound images, Royal Society Open Science, Vol: 7, ISSN: 2054-5703

Fetal craniofacial abnormalities are challenging to detect and diagnose on prenatal ultrasound (US). Image segmentation and computer analysis of three-dimensional US volumes of the fetal face may provide an objective measure to quantify fetal facial features and identify abnormalities. We have developed and tested an atlas-based partially automated facial segmentation algorithm; however, the volumes require additional manual segmentation (MS), which is time and labour intensive and may preclude this method from clinical adoption. These manually refined segmentations can then be used as a reference (atlas) by the partially automated segmentation algorithm to improve algorithmic performance with the aim of eliminating the need for manual refinement and developing a fully automated system. This study assesses the inter- and intra-operator variability of MS and tests an optimized version of our automatic segmentation (AS) algorithm. The manual refinements of 15 fetal faces performed by three operators and repeated by one operator were assessed by Dice score, average symmetrical surface distance and volume difference. The performance of the partially automatic algorithm with difference size atlases was evaluated by Dice score and computational time. Assessment of the manual refinements showed low inter- and intra-operator variability demonstrating its suitability for optimizing the AS algorithm. The algorithm showed improved performance following an increase in the atlas size in turn reducing the need for manual refinement.

Journal article

Kasaven LS, Saso S, Barcroft J, Yazbek J, Joash K, Stalder C, Ben Nagi J, Richard Smith JR, Lees C, Bourne T, Jones BPet al., 2020, Implications for the future of obstetrics and gynaecology following the COVID-19 pandemic: a commentary., BJOG: an International Journal of Obstetrics and Gynaecology, Vol: 127, Pages: 1318-1323, ISSN: 1470-0328

In March 2020, the World Health Organization (WHO) declared COVID-19 a global pandemic. At the time of writing, more than 261,184 cases of COVID-19 have been confirmed in the UK resulting in over 36,914 directly attributable deaths.1 The National Health Service (NHS) has been confronted with the unprecedented task of dealing with the enormity of the resultant morbidity and mortality. In addition, the workforce has been depleted as a direct consequence of the disease, in most cases temporarily, but in some tragic cases permanently.

Journal article

Smith SF, Miloro P, Axell R, ter Haar G, Lees Cet al., 2020, In vitro characterisation of ultrasound-induced heating effects in the mother and fetus: A clinical perspective, ULTRASOUND, ISSN: 1742-271X

Journal article

Masini G, Tay J, McEniery CM, Wilkinson IB, Valensise H, Tiralongo GM, Farsetti D, Gyselaers W, Vonck S, Lees CCet al., 2020, Maternal Cardiovascular Dysfunction is Associated with Hypoxic Cerebral and Umbilical Doppler Changes, JOURNAL OF CLINICAL MEDICINE, Vol: 9

Journal article

Di Mascio D, Khalil A, Thilaganathan B, Rizzo G, Buca D, Liberati M, Celentano C, Melchiorre K, Caulo M, Pilu G, Salsi G, Toni F, Stampalija T, Fantasia I, Luise G, Gregori M, Volpe P, Olivieri C, Giancotti A, D'Ambrosio V, Brunelli R, Panici PB, Manganaro L, Antonelli A, Ercolani G, Pasquini L, Masini G, Di Maurizio M, Lees C, Bracalente G, Morales-Rosello J, Loscalzo G, Saccone G, Carbone L, Sarno L, Maruotti GM, Zullo F, Ghi T, Frusca T, Dall'Asta A, Volpe N, Ormitti F, Buongiorno S, De Santis M, D'Oria L, Lanzone A, Prefumo F, Pinelli L, Bertucci E, Sileo FG, Flacco ME, Manzoli L, Giangiordano I, Mastricci L, Meccariello G, Vasciaveo L, Nappi L, Familiari A, Scambia G, Berghella V, D'Antonio Fet al., 2020, Role of prenatal magnetic resonance imaging in fetuses with isolated mild or moderate ventriculomegaly in the era of neurosonography: international multicenter study, ULTRASOUND IN OBSTETRICS & GYNECOLOGY, Vol: 56, Pages: 340-347, ISSN: 0960-7692

Journal article

Foo L, Johnson S, Marriott L, Bourne T, Bennett P, Lees Cet al., 2020, Peri-implantation urinary hormone monitoring distinguishes between types of first-trimester spontaneous pregnancy loss, Paediatric and Perinatal Epidemiology, Vol: 34, Pages: 495-503, ISSN: 0269-5022

BackgroundLutenising hormone (LH) and human chorionic gonadotropin (hCG) hormone are useful biochemical markers to indicate ovulation and embryonic implantation, respectively. We explored “point‐of‐care” LH and hCG testing using a digital home‐testing device in a cohort trying to conceive.ObjectiveTo determine conception and spontaneous pregnancy loss rates, and to assess whether trends in LH‐hCG interval which are known to be associated with pregnancy viability could be identified with point‐of‐care testing.MethodsWe recruited healthy women aged 18‐44 planning a pregnancy. Participants used a home monitor to track LH and hCG levels for 12 menstrual cycles or until pregnancy was conceived. Pregnancy outcomes (viable, clinical miscarriage, or biochemical pregnancy loss) were recorded. Monitor data were analysed by a statistician blinded to pregnancy outcome.ResultsFrom 387 recruits, there were 290 pregnancies with known outcomes within study timeline. Adequate monitor data for analysis were available for 150 conceptive cycles. Overall spontaneous first‐trimester pregnancy loss rate was 30% with clinically recognised miscarriage rate of 17%. The difference to LH‐hCG interval median had wider spread for biochemical losses (0.5‐8.5 days) compared with clinical miscarriage (0‐5 days) and viable pregnancies (0‐6 days). Fixed effect hCG profile change distinguished between pregnancy outcomes from as early as day‐2 post‐hCG rise from baseline.ConclusionThe risk of first‐trimester spontaneous pregnancy loss in our prospective cohort is comparable to studies utilising daily urinary hCG collection and laboratory assays. A wider LH‐hCG interval range is associated with biochemical pregnancy loss and may relate to late or early implantation. Although early hCG changes discriminate between pregnancies that will miscarry from viable pregnancies, this point‐of‐care testing model is not sufficiently developed to be predictive.

Journal article

Clark AE, Shaw CJ, Bello F, Chalouhi GE, Lees CCet al., 2020, Quantitating skill acquisition with optical ultrasound simulation, Australasian Journal of Ultrasound in Medicine, Vol: 23, Pages: 183-193, ISSN: 1836-6864

ObjectiveTo investigate and compare the effect of simulator training on quantitative scores for ultrasound‐related skills for trainees with novice level ultrasound experience and expert ultrasound operators.MethodsThree novice (comprising of 11, 32, 23 participants) and one expert (10 participants) subgroups undertook an ultrasound simulation training session. Pre‐ and post‐training test scores were collected for each subgroup. Outcome measures were as follows: mean accuracy score for obtaining the correct anatomical plane, percentage of correctly acquired target planes, mean number of movements, time to achieve image, distance travelled by probe and accumulated angling of the probe.ResultsThe novices showed improvement in image acquisition after completion of the simulation training session with an improvement in the rate of correctly acquired target planes from 28–57% to 39–83%. This was not replicated in the experts. The novice’s individual ratios based on pre‐ vs. post‐training metrics improved between 1.7‐ and 4.3‐fold for number of movements, 1.9‐ and 6.7‐fold for distance, 2.0‐ and 5.2‐fold for time taken and 1.8‐ and 7.3‐fold for accumulated angling. Among the experts, there was no relationship between pre‐training simulator metrics and years of ultrasound experience.ConclusionsThe individual simulation metrics suggest the sessions were delivered at an appropriate level for basic training as novice trainees were able to show demonstrable improvements in both efficiency and accuracy on the simulator. Experts did not improve after the simulation modules, and the novice scores post‐training were similar to those of experts, suggesting the exercises were valid in testing ultrasound skills at novice but not expert level.

Journal article

Wolf H, Stampalija T, Monasta L, Lees CCet al., 2020, Re: Ratio of umbilical and cerebral artery pulsatility indices in assessment of fetal risk: numerator and denominator matter Reply, ULTRASOUND IN OBSTETRICS & GYNECOLOGY, Vol: 56, Pages: 292-+, ISSN: 0960-7692

Journal article

Wolf H, Stampalija T, Monasta L, Lees CCet al., 2020, The ratio of umbilical and cerebral artery pulsatility index in the assessment of fetal risk: numerator and denominator matter., Ultrasound in Obstetrics and Gynecology, Vol: 56, Pages: 163-165, ISSN: 0960-7692

Linked article: There is a comment on this article by Kalafat et al. Click here (https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.22139) to view the Correspondence.

Journal article

Stampalija T, Thornton J, Marlow N, Napolitano R, Bhide A, Pickles T, Bilardo CM, Gordijn SJ, Gyselaers W, Valensise H, Hecher K, Sande RK, Lindgren P, Bergman E, Arabin B, Breeze AC, Wee L, Ganzevoort W, Richter J, Berger A, Brodszki J, Derks J, Mecacci F, Maruotti GM, Myklestad K, Lobmaier SM, Prefumo F, Klaritsch P, Calda P, Ebbing C, Frusca T, Raio L, Visser GHA, Krofta L, Cetin I, Ferrazzi E, Cesari E, Wolf H, Lees CCet 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

Journal article

, 2020, ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction, ULTRASOUND IN OBSTETRICS & GYNECOLOGY, Vol: 56, Pages: 298-312, ISSN: 0960-7692

Journal article

Mylrea-Foley B, Bhide A, Mullins E, Thornton J, Marlow N, Stampalija T, Napolitano R, Lees Cet 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

Journal article

Shaw CJ, Botting KJ, Niu Y, Lees CC, Giussani DAet al., 2020, Maternal and fetal cardiovascular and metabolic effects of intra-operative uterine handling under general anesthesia during pregnancy in sheep, Scientific Reports, Vol: 10, ISSN: 2045-2322

A cohort study of 6,500,000 human pregnancies showed an increased risk of adverse fetal outcomes following abdominal but not non-abdominal surgery under general anesthesia. This may be the consequence of uterine handling during abdominal surgery. However, there are no data on any effects on the cardiometabolic physiology of the fetus or mother in response to uterine manipulation in otherwise healthy pregnancy. Consequently, 9 sheep in late gestation were anesthetized with isofluorane and maternal and fetal catheters and flow probes were implanted to determine cardiovascular and metabolic changes during uterine handling. Uterine handling led to an acute increase in uterine artery vascular resistance, fetal peripheral vasoconstriction, a reduction in oxygen delivery to the femoral circulation, worsening fetal acidosis. There was no evidence of systemic fetal hypoxia, or changes in fetal heart rate, carotid blood flow or carotid oxygen delivery. Therefore, the data support that uterine handling during abdominal surgery under general anesthesia can impact adversely on fetal cardiometabolic health. This may provide a potential explanation linking adverse fetal outcomes in abdominal compared with non-abdominal surgery during pregnancy. The data have important implications for human fetal surgery where the uterus is handled, as operative procedures during late gestation under general maternal anesthesia become more prevalent.

Journal article

Lai J, Nowlan NC, Vaidyanathan R, Visser GHA, Lees CCet al., 2020, The use of actograph in the assessment of fetal well-being, Journal of Maternal-Fetal and Neonatal Medicine, Vol: 33, Pages: 2116-2121, ISSN: 1476-4954

PURPOSE: Third trimester maternal perception of fetal movements is often used to assess fetal well-being. However, its true clinical value is unknown, primarily because of the variability in subjective quantification. The actograph, a technology available on most cardiotocograph machines, quantifies movements, but has never previously been investigated in relation to fetal health and existing monitoring devices. The objective of this study was to quantify actograph output in healthy third trimester pregnancies and investigate this in relation to other methods of assessing fetal well-being. METHODS: Forty-two women between 24 and 34 weeks of gestation underwent ultrasound scan followed by a computerized cardiotocograph (CTG). Post capture analysis of the actograph recording was performed and expressed as a percentage of activity over time. The actograph output results were analyzed in relation to Doppler, ultrasound and CTG findings expressed as z-score normalized for gestation. RESULTS: There was a significant association between actograph output recording and estimated fetal weight Z-score (R = 0.546, p ≤ .005). This activity was not related to estimated fetal weight. Increased actograph activity was negatively correlated with umbilical artery pulsatility index Z-score (R = -0.306, p = .049) and middle cerebral artery pulsatility index Z-score (R = -0.390, p = .011). CONCLUSION: Fetal movements assessed by the actograph are associated both with fetal size in relation to gestation and fetoplacental Doppler parameters. It is not the case that larger babies move more, however, as the relationship with actograph output related only to estimated fetal weight z-score. These findings suggest a plausible link between the frequency of fetal movements and established markers of fetal health. RATIONALE The objective of this study was to quantify actograph output in healthy third trimester pregnancies and investigate this in relation to other methods of assess

Journal article

Abramowicz JS, Basseal JM, Brezinka C, Dall'Asta A, Deng J, Harrison G, Lee JCS, Lim A, Maršal K, Miloro P, Poon LC, Salvesen KÅ, Sande R, Ter Haar G, Westerway SC, Xie MX, Lees Cet al., 2020, ISUOG safety committee position statement on use of personal protective equipment and hazard mitigation in relation to SARS-CoV-2 for practitioners undertaking obstetric and gynecological ultrasound, Ultrasound in Obstetrics and Gynecology, Vol: 55, Pages: 886-891, ISSN: 0960-7692

Journal article

Gyselaers W, Lees C, Valensise H, Thilaganathan Bet al., 2020, Preeclampsia: the role of persistent endothelial cells in uteroplacental arteries. Brosens I, Brosens JJ, Muter J, Puttemans P, Benagiano G. Am J Obstet Gynecol 2019;221:219-26., American Journal of Obstetrics and Gynecology, Vol: 222, Pages: 633-633, ISSN: 0002-9378

Journal article

Fujitake E, Jaspal R, Monasta L, Stampalija T, Lees Cet al., 2020, Acute cardiovascular changes in women undergoing in vitro fertilisation (IVF), a systematic review and meta-analysis, EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY, Vol: 248, Pages: 245-251, ISSN: 0301-2115

Journal article

Poon LC, Abramowicz JS, Dall'Asta A, Sande R, Ter Haar G, Maršal K, Brezinka C, Miloro P, Basseal J, Westerway SC, Abu-Rustum RS, Lees Cet al., 2020, ISUOG safety committee position statement: safe performance of obstetric and gynecological scans and equipment cleaning in the context of COVID-19, Ultrasound in Obstetrics and Gynecology, Vol: 55, Pages: 709-712, ISSN: 0960-7692

Journal article

DallAsta A, Calì G, Forlani F, Paramasivam G, Girardelli S, Yazbek J, DAntonio F, Bhide A, Lees CCet al., 2020, Evaluation of perioperative complications using a newly described staging system for placenta accreta spectrum, European Journal of Obstetrics & Gynecology and Reproductive Biology, ISSN: 0301-2115

Journal article

Hafiz N, Allison BJ, Itani N, Botting KJ, Niu Y, Lees CC, Shaw CJ, Giussani DAet al., 2020, Impaired Autonomic Control of Heart Rate Variability During Acute Stress in the Chronically Hypoxic Fetus., 67th Annual Scientific Meeting of the Society-for-Reproductive-Investigation (SRI), Publisher: SPRINGER HEIDELBERG, Pages: 322A-322A, ISSN: 1933-7191

Conference paper

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