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

343 results found

Sande R, Jenderka K-V, Moran CM, Marques S, Jimenez Diaz JF, Ter Haar G, Marsal K, Lees C, Abramowicz JS, Salvesen KÅ, Miloro P, Dall'Asta A, Brezinka C, Kollmann Cet al., 2021, Safety Aspects of Perinatal Ultrasound., Ultraschall Med

Ultrasound safety is of particular importance in fetal and neonatal scanning. Fetal tissues are vulnerable and often still developing, the scanning depth may be low, and potential biological effects have been insufficiently investigated. On the other hand, the clinical benefit may be considerable. The perinatal period is probably less vulnerable than the first and second trimesters of pregnancy, and ultrasound is often a safer alternative to other diagnostic imaging modalities. Here we present step-by-step procedures for obtaining clinically relevant images while maintaining ultrasound safety. We briefly discuss the current status of the field of ultrasound safety, with special attention to the safety of novel modalities, safety considerations when ultrasound is employed for research and education, and ultrasound of particularly vulnerable tissues, such as the neonatal lung. This CME is prepared by ECMUS, the safety committee of EFSUMB, with contributions from OB/GYN clinicians with a special interest in ultrasound safety.

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., 2021, Uterine Transplantation: Review of Livebirths and Reproductive Implications, TRANSPLANTATION, Vol: 105, Pages: 1695-1707, ISSN: 0041-1337

Journal article

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

Journal article

Bhide A, Acharya G, Baschat A, Bilardo CM, Brezinka C, Cafici D, Ebbing C, Hernandez-Andrade E, Kalache K, Kingdom J, Kiserud T, Kumar S, Lee W, Lees C, Leung KY, Malinger G, Mari G, Prefumo F, Sepulveda W, Trudinger Bet al., 2021, ISUOG Practice Guidelines (updated): use of Doppler velocimetry in obstetrics, ULTRASOUND IN OBSTETRICS & GYNECOLOGY, Vol: 58, Pages: 331-339, ISSN: 0960-7692

Journal article

Kyriacou C, Roper L, Mappouridou S, Lees C, Prior Tet al., 2021, Contemporary experience of polyhydramnios: A single-centre experience, Australasian Journal of Ultrasound in Medicine, Vol: 24, Pages: 137-142, ISSN: 1836-6864

Introduction: Polyhydramnios is common; the majority of cases are idiopathic, but maybe associated with fetal abnormality. Literature suggests the volume of amniotic fluid discriminates idiopathic from pathological polyhydramnios but is not unanimous. We assessed fetal anomaly incidence amongst women with polyhydramnios and the role of discriminatory variables in identifying pathological cases. Methods: Retrospective observational cohort study at an inner-city London fetal medicine centre. Records for patients referred and/or diagnosed with polyhydramnios were reviewed as well as maternal/fetal demographics, amongst singleton pregnancies using the Astraia™ database from January 2015–2016. Estimated fetal weight was calculated using the Hadlock model (biometry undertaken at diagnosis). Student's t-test/one-way ANOVA compared means; chi-squared tests compared proportions. Results: 120 cases were identified. 36 (30%) had fetal abnormality. There was no difference in AFI between fetuses with an abnormality and without (26.7 vs 25.2 cm, P = 0.22). AFI was normalised for weight (AFI (cm)/estimated fetal weight (kg)): AFI/kg was significantly different between cases with fetal abnormality and without (24.4 vs 16.7 cm/kg, P < 0.001) – incidence of abnormality increased with increasing AFI/kg (P = 0.007). Early gestational diagnosis was associated with higher rates of anomaly (P = 0.004). Differences in AFI/kg between those with and without abnormality were not significant when adjusted for gestation. AFI was significantly higher in cases of abnormality diagnosed at later gestation (P = 0.005). Conclusion: Excess volume of amniotic fluid alone does not denote abnormality. Earlier gestations and higher AFI/kg corresponded with significantly increased rates of anomaly. However, the latter is a result of confounding by gestation, which is closely correlated with fetal weight.

Journal article

Shaw CJ, Paramasivam G, Vacca C, Lees CCet al., 2021, Expectant management versus multifetal pregnancy reduction in dichorionic triamniotic (DCTA) triplets: Single centre experience., Eur J Obstet Gynecol Reprod Biol, Vol: 264, Pages: 200-205

OBJECTIVES: In trichorionic triplet pregnancies, multifetal pregnancy reduction (MFPR) reduces the risk of preterm birth, neonatal morbidity and mortality without increasing miscarriage. A similar benefit has been suggested in dichorionic triamniotic (DCTA) pregnancy, but multiple methods are currently used. This study investigates if the method of reduction used in DCTA triplet pregnancy influences the evidence of benefit from MFPR. METHODS: This is a retrospective cohort study of DCTA pregnancies between 2010 and 2019 who attended a single UK fetal medicine tertiary referral center. Cohorts were defined based on MFPR decision and method. The primary outcome was offspring survival until neonatal discharge. The secondary outcomes included miscarriage, preterm birth, livebirth, rates of small for gestational age (SGA) neonates, ans maternal morbidity. To evaluate the differences in neonatal survival until discharge we used Cox proportional regression to calculate hazard rates (HR) and 95% confidence intervals (CI). Differences in secondary outcomes were compared using univariate analysis. RESULTS: The study reports the outcomes for 83 DCTA pregnancies. MFPR to DCDA twins was chosen in 19 pregnancies (14 radiofrequency ablation, RFA; 5 intrafetal laser, IFL); in 9 pregnancies selective reduction to a singleton was performed by KCl injection. The rate of pregnancies in with ≥ 1 fetus born alive was not different between groups (p = 0.90). However, the number of expected neonates alive at discharge from hospital was highest in the RFA group (89%, HR 0.28, 95% CI 0.21-0.87, p = 0.02). Rates of premature delivery before 32 weeks (p = 0.02), low birth weight (p < 0.001) and birthweight < 10th percentile (p = 0.01) were all elevated in the expectant management group, compared to women who opted for reduction. There was no difference in miscarriage between groups. CONCLUSIONS: Our study sugge

Journal article

Hafiz N, Allison BJ, Itani N, Botting KJ, Niu Y, Lees CC, Shaw CJ, Giussani DAet al., 2021, Impaired Autonomic Control of Heart Rate Variability during Acute Stress in the Chronically Hypoxic Fetus., SRI Conference 2021, Publisher: SPRINGER HEIDELBERG, Pages: 71A-71A, ISSN: 1933-7191

Conference paper

Salvesen K, Abramowicz J, Ter Haar G, Miloro P, Sinkovskaya E, Dall'Asta A, Maršál K, Lees C, Board of the International Society of Ultrasound in Obstetrics and Gynecology ISUOGet al., 2021, ISUOG statement on the non-diagnostic use of ultrasound in pregnancy., Ultrasound Obstet Gynecol, Vol: 58, Pages: 147-147

Journal article

Ng J, Loukogeorgakis S, Sanna E, Derwig I, Yu C, Paramasivam G, Lees C, Farrugia M-Ket al., 2021, Postnatal outcome of prenatally-detected "simple" renal cysts: Are they really simple?, EARLY HUMAN DEVELOPMENT, Vol: 157, ISSN: 0378-3782

Journal article

Lees C, Stampalija T, Hecher K, 2021, Diagnosis and management of fetal growth restriction: the ISUOG guideline and comparison with the SMFM guideline, ULTRASOUND IN OBSTETRICS & GYNECOLOGY, Vol: 57, Pages: 884-887, ISSN: 0960-7692

Journal article

Hafiz N, Shaw C, Allison B, Itani N, Botting K, Niu Y, Giussani D, Lees Cet al., 2021, Potential mechanisms underlying poorer outcomes for chronically hypoxic fetuses during acute stress, RCOG Congress 2021, Publisher: WILEY, Pages: 49-50, ISSN: 1470-0328

Conference paper

Masini G, Foo LF, Tay J, Wilkinson IB, Valensise H, Gyselaers W, Lees CCet al., 2021, Preeclampsia has 2 phenotypes which require different treatment strategies, American Journal of Obstetrics and Gynecology, ISSN: 0002-9378

Journal article

Salvesen K, Abramowicz J, Ter Haar G, Miloro P, Sinkovskaya E, Dall'Asta A, Maršál K, Lees Cet al., 2021, ISUOG statement on the safe use of Doppler for fetal ultrasound examination in the first 13 + 6 weeks of pregnancy (updated), Ultrasound in Obstetrics & Gynecology, Vol: 57, Pages: 1020-1020, ISSN: 0960-7692

Journal article

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, Pages: 195-195, ISSN: 1745-6215

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

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

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

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

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, Vol: 29, Pages: 73-82, 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, Pages: 1-10, ISSN: 2077-0383

We investigate the relationship between maternal cardiovascular (CV) function and fetal Doppler changes in healthy pregnancies and those with pre-eclampsia (PE), small for gestational age (SGA) or fetal growth restriction (FGR). This was a three-centre prospective study, where CV assessment was performed using inert gas rebreathing, continuous Doppler or impedance cardiography. Maternal cardiac output (CO) and peripheral vascular resistance (PVR) were analysed in relation to the uterine artery, umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PI, expressed as z-scores by gestational week) using polynomial regression analyses, and in relation to the presence of absent/reversed end diastolic (ARED) flow in the UA. We included 81 healthy controls, 47 women with PE, 65 with SGA/FGR and 40 with PE + SGA/FGR. Maternal CO was inversely related to fetal UA PI and positively related to MCA PI; the opposite was observed for PVR, which was also positively associated with increased uterine artery impedance. CO was lower (z-score 97, p = 0.02) and PVR higher (z-score 2.88, p = 0.02) with UA ARED flow. We report that maternal CV dysfunction is associated with fetal vascular changes, namely raised impedance in the fetal-placental circulation and low impedance in the fetal cerebral vessels. These findings are most evident with critical UA Doppler changes and represent a potential mechanism for therapeutic intervention.

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

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

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, 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

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