Imperial College London

Professor Christoph Lees, MD FRCOG

Faculty of MedicineDepartment of Metabolism, Digestion and Reproduction

Professor of Obstetrics
 
 
 
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Contact

 

+44 (0)20 7594 5770c.lees

 
 
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Assistant

 

Ms Hazel Blackman +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

394 results found

Hanidu A, Djongianto TU, Kovalenko M, Gupta E, Jansen M, Usman S, Joash K, Challacombe FL, Lees Cet al., 2024, Determining psychological impact of delivery mode prediction using ultrasound and clinical assessment., Ultrasound Obstet Gynecol

Journal article

Mylrea-Foley B, Napolitano R, Gordijn S, Wolf H, Stampalija T, Lees CCet al., 2024, All fetal growth restriction definitions fall short., Am J Obstet Gynecol MFM, Vol: 6

Journal article

Mylrea-Foley B, Napolitano R, Gordijn S, Wolf H, Lees CC, Stampalija T, TRUFFLE-2 Feasibility Study Authorset 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

Journal article

Dall'Asta A, Figueras F, Rizzo G, Zegarra RR, Morganelli G, Giannone M, Cancemi A, Mappa I, Lees C, Frusca T, Ghi Tet al., 2023, Uterine artery Doppler in early labor and perinatal outcome in low-risk term pregnancy: prospective multicenter study, ULTRASOUND IN OBSTETRICS & GYNECOLOGY, Vol: 62, Pages: 219-225, ISSN: 0960-7692

Journal article

Mansfield R, Cecula P, Pedraz CT, Zimianiti I, Elsaddig M, Zhao R, Sathiyamurthy S, McEniery CM, Lees C, Banerjee Jet al., 2023, Impact of perinatal factors on biomarkers of cardiovascular disease risk in preadolescent children., Journal of Hypertension, Vol: 41, Pages: 1059-1067, ISSN: 0263-6352

BACKGROUND: This review aims to summarize associations of the perinatal environment with arterial biophysical properties in childhood, to elucidate possible perinatal origins of adult cardiovascular disease (CVD). METHODS: A systematic search of PubMed database was performed (December 2020). Studies exploring associations of perinatal factors with arterial biophysical properties in children 12 years old or less were included. Properties studied included: pulse wave velocity; arterial stiffness or distensibility; augmentation index; intima-media thickness of aorta (aIMT) or carotids; endothelial function (laser flow Doppler, flow-mediated dilatation). Two reviewers independently performed study selection and data extraction. RESULTS: Fifty-two of 1084 identified records were included. Eleven studies explored associations with prematurity, 14 explored maternal factors during pregnancy, and 27 explored effects of low birth weight, small-for-gestational age and foetal growth restriction (LBW/SGA/FGR). aIMT was consistently higher in offspring affected by LBW/SGA/FGR in all six studies examining this variable. The cause of inconclusive or conflicting associations found with other arterial biophysical properties and perinatal factors may be multifactorial: in particular, measurements and analyses of related properties differed in technique, equipment, anatomical location, and covariates used. CONCLUSION: aIMT was consistently higher in LBW/SGA/FGR offspring, which may relate to increased long-term CVD risk. Larger and longer term cohort studies may help to elucidate clinical significance, particularly in relation to established CVD risk factors. Experimental studies may help to understand whether lifestyle or medical interventions can reverse perinatal changes aIMT. The field could be advanced by validation and standardization of techniques assessing arterial structure and function in children.

Journal article

Fantasia I, Ciardo C, Bracalente G, Filippi E, Murru FM, Spezzacatene A, Bin M, Mendez Quintero O, Montaguti E, Lees C, Papanikolaou K, Pilu G, Prefumo F, Thilaganathan B, Stampalija Tet al., 2023, Obliterated cavum septi pellucidi: Clinical significance and role of fetal magnetic resonance, ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, Vol: 102, Pages: 744-750, ISSN: 0001-6349

Journal article

Usman S, Hanidu A, Kovalenko M, Hassan WA, Lees Cet al., 2023, The sonopartogram, AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, Vol: 228, Pages: S997-S1016, ISSN: 0002-9378

Journal article

Relph S, Vieira MC, Copas A, Alagna A, Page L, Winsloe C, Shennan A, Briley A, Johnson M, Lees C, Lawlor DA, Sandall J, Khalil A, Pasupathy Det al., 2023, Characteristics associated with antenatally unidentified small-for-gestational-age fetuses: prospective cohort study nested within DESiGN randomized controlled trial, ULTRASOUND IN OBSTETRICS & GYNECOLOGY, Vol: 61, Pages: 356-366, ISSN: 0960-7692

Journal article

Smith ER, Oakley E, Grandner GW, Rukundo G, Farooq F, Ferguson K, Baumann S, Waldorf KA, Afshar Y, Ahlberg M, Ahmadzia H, Akelo V, Aldrovandi G, Bevilacqua E, Bracero N, Brandt JS, Broutet N, Carrillo J, Conry J, Cosmi E, Crispi F, Crovetto F, Gil MDM, Delgado-López C, Divakar H, Driscoll AJ, Favre G, Buhigas IF, Flaherman V, Gale C, Godwin CL, Gottlieb S, Gratacós E, He S, Hernandez O, Jones S, Joshi S, Kalafat E, Khagayi S, Knight M, Kotloff K, Lanzone A, Longo VL, Le Doare K, Lees C, Litman E, Lokken EM, Madhi SA, Magee LA, Martinez-Portilla RJ, Metz TD, Miller ES, Money D, Moungmaithong S, Mullins E, Nachega JB, Nunes MC, Onyango D, Panchaud A, Poon LC, Raiten D, Regan L, Sahota D, Sakowicz A, Sanin-Blair J, Stephansson O, Temmerman M, Thorson A, Thwin SS, Tippett Barr BA, Tolosa JE, Tug N, Valencia-Prado M, Visentin S, von Dadelszen P, Whitehead C, Wood M, Yang H, Zavala R, Tielsch JMet al., 2023, Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: A sequential, prospective meta-analysis, American Journal of Obstetrics and Gynecology, Vol: 228, Pages: 161-177, ISSN: 0002-9378

OBJECTIVE: This sequential, prospective meta-analysis (sPMA) sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to: disease severity, maternal morbidities, neonatal mortality and morbidity, adverse birth outcomes. DATA SOURCES: We prospectively invited study investigators to join the sPMA via professional research networks beginning in March 2020. STUDY ELIGIBILITY CRITERIA: Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area. STUDY APPRAISAL AND SYNTHESIS METHODS: We included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and outcomes were constructed. Duplicate cases were removed. Pooled estimates for the absolute and relative risk of adverse outcomes comparing those with and without each risk factor were generated using a two-stage meta-analysis. RESULTS: We collected data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection in pregnancy or postpartum. We found that women with comorbidities (pre-existing diabetes, hypertension, cardiovascular disease) versus those without were at higher risk for COVID-19 severity and pregnancy health outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% CI: 1.12, 2.71) more likely to be admitted to the ICU. Pregnant women who were underweight before pregnancy were at higher risk of ICU admission (RR 5.53, 95% CI: 2.27, 13.44), ventilation (RR 9.36, 95% CI: 3.87, 22.63), and pregnancy-related death (RR 14.10, 95% CI: 2.83, 70.36). Pre-pregnancy obesity was also a risk factor for severe COVID-19 outcomes including ICU admission (RR 1.81, 95% CI: 1.26,2.60), ventilation (RR 2.05, 95% CI: 1.20,3.51), any critical care (RR 1.89, 95% CI: 1.28,2.77), and pneumonia (RR 1.66, 95% CI: 1.18,2.33). Anemic pregnant women with COVID-19 also had in

Journal article

Dall'Asta A, Melito C, Morganelli G, Lees C, Ghi Tet al., 2023, Determinants of placental insufficiency in fetal growth restriction, ULTRASOUND IN OBSTETRICS & GYNECOLOGY, Vol: 61, Pages: 152-157, ISSN: 0960-7692

Journal article

Valensise H, Farsetti D, Pometti F, Vasapollo B, Novelli GP, Lees Cet al., 2023, The cardiac-fetal-placental unit: fetal umbilical vein flow rate is linked to the maternal cardiac profile in fetal growth restriction., Am J Obstet Gynecol, Vol: 228, Pages: 222.e1-222.e12

BACKGROUND: The functional maternal-fetal hemodynamic unit includes fetal umbilical vein flow and maternal peripheral vascular resistance. OBJECTIVE: This study investigated the relationships between maternal and fetal hemodynamics in a population with suspected fetal growth restriction. STUDY DESIGN: This was a prospective study of normotensive pregnancies referred to our outpatient clinic for a suspected fetal growth restriction. Maternal hemodynamics measurement was performed, using a noninvasive device (USCOM-1A) and a fetal ultrasound evaluation to assess fetal biometry and velocimetry Doppler parameters. Comparisons among groups were performed with 1-way analysis of variance with Student-Newman-Keuls correction for multiple comparisons and with Kruskal-Wallis test where appropriate. The Spearman rank coefficient was used to assess the correlation between maternal and fetal hemodynamics. Pregnancies were observed until delivery. RESULTS: A total of 182 normotensive pregnancies were included. After the evaluation, 54 fetuses were classified as growth restricted, 42 as small for gestational age, and 86 as adequate for gestational age. The fetus with fetal growth restriction had significantly lower umbilical vein diameter (P<.0001), umbilical vein velocity (P=.02), umbilical vein flow (P<.0001), and umbilical vein flow corrected for fetal weight (P<.01) than adequate-for-gestational-age and small-for-gestational-age fetuses. The maternal hemodynamic profile in fetal growth restriction was characterized by elevated systemic vascular resistance and reduced cardiac output. The umbilical vein diameter was positively correlated to maternal cardiac output (rs=0.261), whereas there was a negative correlation between maternal systemic vascular resistance (rs=-0.338) and maternal potential energy-to-kinetic energy ratio (rs=-0267). The fetal umbilical vein time averaged max velocity was positively correlated to maternal cardiac output (rs=0.189) and maternal inotr

Journal article

Familiari A, Napolitano R, Visser GHA, Lees C, Wolf H, Prefumo Fet 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

Journal article

Oyelese Y, Lees CC, Jauniaux E, 2023, The case for screening for vasa previa: time to implement a life-saving strategy, ULTRASOUND IN OBSTETRICS & GYNECOLOGY, Vol: 61, Pages: 7-11, ISSN: 0960-7692

Journal article

Stampalija T, Wolf H, Mylrea-Foley B, Marlow N, Stephens KJ, Shaw CJ, Lees CCet 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

Journal article

Smith ER, Oakley E, Grandner GW, Ferguson K, Farooq F, Afshar Y, Ahlberg M, Ahmadzia H, Akelo V, Aldrovandi G, Barr BAT, Bevilacqua E, Brandt JS, Broutet N, Buhigas IF, Carrillo J, Clifton R, Conry J, Cosmi E, Crispi F, Crovetto F, Delgado-Lopez C, Divakar H, Driscoll AJ, Favre G, Flaherman VJ, Gale C, Gil MM, Gottlieb SL, Gratacos E, Hernandez O, Jones S, Kalafat E, Khagayi S, Knight M, Kotloff K, Lanzone A, Le Doare K, Lees C, Litman E, Lokken EM, Laurita Longo V, Madhi SA, Magee LA, Martinez-Portilla RJ, McClure EM, Metz TD, Miller ES, Money D, Moungmaithong S, Mullins E, Nachega JB, Nunes MC, Onyango D, Panchaud A, Poon LC, Raiten D, Regan L, Rukundo G, Sahota D, Sakowicz A, Sanin-Blair J, Soderling J, Stephansson O, Temmerman M, Thorson A, Tolosa JE, Townson J, Valencia-Prado M, Visentin S, von Dadelszen P, Waldorf KA, Whitehead C, Yassa M, Tielsch JMet al., 2023, Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis, BMJ Global Health, Vol: 8, Pages: 1-19, ISSN: 2059-7908

Introduction Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies.Methods We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale.Results We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.Pregnant women with SARS-CoV-2 infection—as compared with uninfected pregnant women—were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias.Conclusions This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth r

Journal article

Fantasia I, Zamagni G, Lees C, Mylrea-Foley B, Monasta L, Mullins E, Prefumo F, Stampalija Tet 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

Journal article

Zielinska AP, Mullins E, Magni E, Zamagni G, Kleprlikova H, Adams O, Stampalija T, Monasta L, Lees Cet al., 2022, Remote multimodality monitoring of maternal physiology from the first trimester to postpartum period: study results., Journal of Hypertension, Vol: 40, Pages: 2280-2291, ISSN: 0263-6352

OBJECTIVES: Current antenatal care largely relies on widely spaced appointments, hence only a fraction of the pregnancy period is subject to monitoring. Continuous monitoring of physiological parameters could represent a paradigm shift in obstetric care. Here, we analyse the data from daily home monitoring in pregnancy and consider the implications of this approach for tracking pregnancy health. METHODS: Prospective feasibility study of continuous home monitoring of blood pressure, weight, heart rate, sleep and activity patterns from the first trimester to 6 weeks postpartum. RESULTS: Fourteen out of 24 women completed the study (58%). Compared to early pregnancy [week 13, median heart rate (HR) 72/min, interquartile range (IQR) 12.8], heart rate increased by week 35 (HR 78/min, IQR 16.6; P = 0.041) and fell postpartum (HR 66/min, IQR 11.5, P = 0.021). Both systolic and diastolic blood pressure were lower at mid-gestation (week 20: SBP 103 mmHg, IQR 6.6; DPB 63 mmHg, IQR 5.3 P = 0.005 and P = 0.045, respectively) compared to early pregnancy (week 13, SBP 107 mmHg, IQR 12.4; DPB 67 mmHg, IQR 7.1). Weight increased during pregnancy between each time period analyzed, starting from week 15. Smartwatch recordings indicated that activity increased in the prepartum period, while deep sleep declined as pregnancy progressed. CONCLUSION: Home monitoring tracks individual physiological responses to pregnancy in high resolution that routine clinic visits cannot. Changes in the study protocol suggested by the study participants may improve compliance for future studies, which was particularly low in the postpartum period. Future work will investigate whether distinct adaptative patterns predate obstetric complications, or can predict long-term maternal cardiovascular health.

Journal article

Relph S, Vieira MC, Copas A, Coxon K, Alagna A, Briley A, Johnson M, Page L, Peebles D, Shennan A, Thilaganathan B, Marlow N, Lees C, Lawlor DA, Khalil A, Sandall J, Pasupathy D, Healey Aet al., 2022, Improving antenatal detection of small-for-gestational-age fetus: economic evaluation of Growth Assessment Protocol, ULTRASOUND IN OBSTETRICS & GYNECOLOGY, Vol: 60, Pages: 620-631, ISSN: 0960-7692

Journal article

Dennehy N, Lees C, 2022, Preeclampsia: Maternal cardiovascular function and optimising outcomes, EARLY HUMAN DEVELOPMENT, Vol: 174, ISSN: 0378-3782

Journal article

Rizzo G, Ghi T, Henrich W, Tutschek B, Kamel RAM, Lees CC, Mappa I, Kovalenko M, Lau W, Eggebo T, Achiron R, Sen Cet al., 2022, Ultrasound in labor: clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation, JOURNAL OF PERINATAL MEDICINE, Vol: 50, Pages: 1007-1029, ISSN: 0300-5577

Journal article

Morton VH, Toozs-Hobson P, Moakes CA, Middleton L, Daniels J, Simpson NAB, Shennan A, Israfil-Bayli F, Ewer AK, Gray J, Slack M, Norman JE, Lees C, Tryposkiadis K, Hughes M, Brocklehurst P, Morris RKet al., 2022, Monofilament suture versus braided suture thread to improve pregnancy outcomes after vaginal cervical cerclage (C-STICH): a pragmatic randomised, controlled, phase 3, superiority trial, LANCET, Vol: 400, Pages: 1426-1436, ISSN: 0140-6736

Journal article

Relph S, Coxon K, Vieira MC, Copas A, Healey A, Alagna A, Briley A, Johnson M, Lawlor DA, Lees C, Marlow N, McCowan L, McMicking J, Page L, Peebles D, Shennan A, Thilaganathan B, Khalil A, Pasupathy D, Sandall Jet al., 2022, Effect of the Growth Assessment Protocol on the DEtection of Small for GestatioNal age fetus: process evaluation from the DESiGN cluster randomised trial, IMPLEMENTATION SCIENCE, Vol: 17, ISSN: 1748-5908

Journal article

Jaspal R, Allen M, Cornette J, Rizopoulos D, Lees Cet al., 2022, Validation of non-invasive measurements of cardiac output: using whole body bio-impedance versus inert gas rebreathing in healthy women undergoing in vitro fertilisation, Artery Research, Vol: 28, Pages: 100-104, ISSN: 1872-9312

Background:Haemodynamic assessment in and before pregnancy is becoming increasingly important in relation to pregnancy complications and outcomes. Different methodologies exist but there is no gold-standard technique for non-invasive measurement of cardiac output (CO). We sought to assess two methods of CO measurement in healthy women undergoing In Vitro Fertilisation Cycles (IVF). This was a prospective longitudinal study of 71 women aged 18-44yrs planning IVF undergoing CO measurements obtained via Inert Gas rebreathing (IGR) using InnocorTM and whole-body bio-impedance (WBI) using NicasTM in order to assess the reproducibility between the methods. Four visits occurred at which both techniques were used: initial assessment, embryo transfer, day of pregnancy test and 4 weeks post transfer (regardless of whether conception occurred).Cross-sectional agreement of the methods was assessed using the calculation of bias, percentage error and Limits of Agreement (LOA) via the Bland-Altman analysis. Longitudinal agreement of the methods was assessed using a 4-quadrant plot with concordance rate, angular bias and radial limits of agreement (%).Results:113 measurements from 44 participants were suitable for cross-sectional (Bland-Altman) analysis. IGR (InnocorTM) Mean CO was 4.61 L/min and 5.05 L/min with WBI (NicasTM). The bias was 0.44L/min. The percentage error was 76% and intra-correlation coefficient was 0.135 (95%CI -0.43 – 0.306).59 measurements from 28 participants were suitable for longitudinal (4Q-plot) analysis. The concordance rate was 64.4 %, angular bias -0.14, radial limits of agreement +- 13.25°.Conclusions:There was poor cross-sectional and longitudinal agreement between inert gas rebreathing and whole-body bio- impedance techniques. These techniques cannot be used interchangeably when measuring CO in women undergoing IVF, and these results may be more generalizable.

Journal article

Khalil A, Samara A, O'Brien P, Morris E, Draycott T, Lees C, Ladhani Set al., 2022, Monkeypox vaccines in pregnancy: lessons must be learned from COVID-19, The Lancet Global Health, Vol: 10, Pages: e1230-e1231, ISSN: 2214-109X

Journal article

Zohra N, Munim S, Ijaz S, Baqai S, Yasmin H, Korejo R, Lees CCet al., 2022, Society of Obstetricians and Gynecologists Pakistan Guideline on Second Trimester Anomaly Scan, PAKISTAN JOURNAL OF MEDICAL SCIENCES, Vol: 38, Pages: 2039-2042, ISSN: 1682-024X

Journal article

Mullins E, Perry A, Banerjee J, Townson J, Grozeva D, Milton R, Kirby N, Playle R, Bourne T, Lees C, PAN-COVID Investigatorset al., 2022, Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study., European Journal of Obstetrics Gynecology and Reproductive Biology, Vol: 276, Pages: 161-167, ISSN: 0301-2115

OBJECTIVE: To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection. METHODS: Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant. RESULTS: Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021. Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants. Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering ≥ 2 weeks after infection (95 % CI 0.3-1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies. Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2. CONCLUSIONS: Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering ≥ 2 weeks after infection. We suggest that clinicians' thresh

Journal article

Zielinska A, Mullins E, Lees C, 2022, The feasibility of multi-modality remote monitoring of maternal physiology during pregnancy, Medicine, Vol: 101, ISSN: 0025-7974

Objectives: Gestational hypertension affects 10% of pregnancies, may occur without warning and has wide ranging effects on maternal, fetal and infant health. Antenatal care largely relies on in-person appointments, hence only <4% of the pregnancy period is subject to routine clinical monitoring. Home monitoring offers a unique opportunity to collect granular data and identify trends in maternal physiology that could predict pregnancy compromise. Our objective was to investigate the feasibility of remote multi-domain monitoring of maternal cardiovascular health both in and after pregnancy. Methods: Prospective feasibility study of continuous remote monitoring of multiple modalities indicative of cardiovascular health from the first trimester to six weeks post-partum.Results: Twenty-four pregnant women were asked to monitor body weight, heart rate, blood pressure, activity levels and sleep patterns daily. Study participants took on average 4.3 (SD= 2.20) home recordings of each modality per week across the three trimesters and 2.0 post-partum (SD= 2.41), out of a recommended maximum of 7. Participant retention was 58.3%. Wearing a smartwatch daily was reported as feasible (8.6/10, SD= 2.3) and data could be entered digitally with ease (7.7/10, SD= 2.4). Conclusion: Remote digital monitoring of cardiovascular health is feasible for research purposes and hence potentially so for routine clinical care throughout and after pregnancy. 58% of women completed the study. Multiple modalities indicative of cardiovascular health can be measured in parallel, giving a global view that is representative of the whole pregnancy period in a way that current antenatal care is not.

Journal article

Khalil A, Samara A, O'Brien P, Morris E, Draycott T, Lees C, Ladhani Set al., 2022, Monkeypox and pregnancy: what do obstetricians need to know?, ULTRASOUND IN OBSTETRICS & GYNECOLOGY, Vol: 60, Pages: 22-27, ISSN: 0960-7692

Journal article

Masini G, Foo LF, Tay J, Wilkinson IB, Valensise H, Gyselaers W, Lees CCet al., 2022, Reply: Preeclampsia has 2 phenotypes that require different treatment strategies, AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, Vol: 227, Pages: 114-115, ISSN: 0002-9378

Journal article

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