Publications
396 results found
Shaw CJ, Rivens I, Civale J, et al., 2017, High Intensity Focused Ultrasound (HIFU): A method of non-invasive placental vascular occlusion, RCOG Congress, Publisher: WILEY, Pages: 5-5, ISSN: 1470-0328
Shaw CJ, Rivens I, Civale J, et al., 2017, Technical and safety considerations for High Intensity Focused Ultrasound (HIFU) non-invasive placental vascular occlusion, RCOG World Congress, Publisher: WILEY, Pages: 5-5, ISSN: 1470-0328
Itani N, Shaw CS, Allison BJ, et al., 2017, Late-Onset Chronic Hypoxia Abolishes Adrenomedullary but Sensitises Adrenocortical Plasma Responses to Acute Stress in Fetal Sheep., 64th Annual Scientific Meeting of the Society-for-Reproductive-Investigation (SRI), Publisher: SAGE PUBLICATIONS INC, Pages: 73A-73A, ISSN: 1933-7191
Lees C, 2017, Most cases of cerebral palsy are associated with antenatal events., BMJ, Vol: 356, ISSN: 0959-8138
Dall'Asta A, Schievano S, Bruse JL, et al., 2017, Quantitative analysis of fetal facial morphology using 3D ultrasound and statistical shape modeling: a feasibility study., American Journal of Obstetrics and Gynecology, Vol: 217, Pages: 76.e1-76.e8, ISSN: 1097-6868
BACKGROUND: The antenatal detection of facial dysmorphism using 3-dimensional ultrasound may raise the suspicion of an underlying genetic condition but infrequently leads to a definitive antenatal diagnosis. Despite advances in array and noninvasive prenatal testing, not all genetic conditions can be ascertained from such testing. OBJECTIVES: The aim of this study was to investigate the feasibility of quantitative assessment of fetal face features using prenatal 3-dimensional ultrasound volumes and statistical shape modeling. STUDY DESIGN: Thirteen normal and 7 abnormal stored 3-dimensional ultrasound fetal face volumes were analyzed, at a median gestation of 29(+4) weeks (25(+0) to 36(+1)). The 20 3-dimensional surface meshes generated were aligned and served as input for a statistical shape model, which computed the mean 3-dimensional face shape and 3-dimensional shape variations using principal component analysis. RESULTS: Ten shape modes explained more than 90% of the total shape variability in the population. While the first mode accounted for overall size differences, the second highlighted shape feature changes from an overall proportionate toward a more asymmetric face shape with a wide prominent forehead and an undersized, posteriorly positioned chin. Analysis of the Mahalanobis distance in principal component analysis shape space suggested differences between normal and abnormal fetuses (median and interquartile range distance values, 7.31 ± 5.54 for the normal group vs 13.27 ± 9.82 for the abnormal group) (P = .056). CONCLUSION: This feasibility study demonstrates that objective characterization and quantification of fetal facial morphology is possible from 3-dimensional ultrasound. This technique has the potential to assist in utero diagnosis, particularly of rare conditions in which facial dysmorphology is a feature.
Ganzevoort W, Mensing van Charante N, Thilaganathan B, et al., 2017, How to monitor pregnancies complicated by fetal growth restriction and delivery below 32 weeks: a post-hoc sensitivity analysis of the TRUFFLE-study., Ultrasound in Obstetrics and Gynecology, Vol: 49, Pages: 769-777, ISSN: 0960-7692
OBJECTIVES: In the recent TRUFFLE study it appeared that, in pregnancies complicated by fetal growth restriction (FGR) between 26 and 32 weeks, monitoring of the ductus venosus (DV) combined with computerised cardiotocography (cCTG) as a trigger for delivery, increased the chance of infant survival without neurological impairment. However, concerns in interpretation were raised as DV monitoring appeared associated with a non-significant increase in fetal death, and part of the infants were delivered after 32 weeks, after which the study protocol was no longer applied. This secondary sensitivity analysis focuses on women who delivered before 32 completed weeks, and analyses fetal death cases in detail. METHODS: We analysed the monitoring data of 317 women who delivered before 32 weeks, excluding women with absent infant outcome data or inevitable perinatal death. The association of the last monitoring data before delivery and infant outcome was assessed by multivariable analysis. RESULTS: The primary outcome (two year survival without neurological impairment) occurred more often in the two DV groups (both 83%) than in the CTG-STV group (77%), however the difference was not statistically significant (p = 0.21). Nevertheless, in surviving infants 93% was free of neurological impairment in the DV groups versus 85% in the CTG-STV group (p = 0.049). All fetal deaths (n = 7) occurred in women allocated to DV monitoring, which explains this difference. Assessment of the monitoring parameters that were obtained shortly before fetal death in these 7 cases showed an abnormal CTG in only one. Multivariable regression analysis of factors at study entry demonstrated that higher gestational age, larger estimated fetal weight 50th percentile ratio and lower U/C ratio were significantly associated with the (normal) primary outcome. Allocation to the DV groups had a smaller effect, but remained in the model (p < 0.1). Assessm
Dall'Asta A, Brunelli V, Prefumo F, et al., 2017, Early onset fetal growth restriction, Maternal Health, Neonatology and Perinatology, Vol: 3, ISSN: 2054-958X
Fetal growth restriction (FGR) diagnosed before 32 weeks is identified by fetal smallness associated with Doppler abnormalities and is associated with significant perinatal morbidity and mortality and maternal complications. Recent studies have provided new insights into pathophysiology, management options and postnatal outcomes of FGR. In this paper we review the available evidence regarding diagnosis, management and prognosis of fetuses diagnosed with FGR before 32 weeks of gestation.
Stampalija T, Arabin B, Wolf H, et al., 2017, Is middle cerebral artery Doppler related to neonatal and 2-year infant outcome in early fetal growth restriction?, American Journal of Obstetrics and Gynecology, Vol: 216, Pages: 521.e1-521.e13, ISSN: 1097-6868
BACKGROUND: Reduced fetal middle cerebral artery Doppler impedance is associated with hypoxemia in fetal growth restriction. It remains unclear as to whether this finding could be useful in timing delivery, especially in the third trimester. In this regard there is a paucity of evidence from prospective studies. OBJECTIVES: The aim of this study was to determine whether there is an association between middle cerebral artery Doppler impedance and its ratio with the umbilical artery in relation to neonatal and 2 year infant outcome in early fetal growth restriction (26(+0)-31(+6) weeks of gestation). Additionally we sought to explore which ratio is more informative for clinical use. STUDY DESIGN: This is a secondary analysis from the Trial of Randomized Umbilical and Fetal Flow in Europe, a prospective, multicenter, randomized management study on different antenatal monitoring strategies (ductus venosus Doppler changes and computerized cardiotocography short-term variation) in fetal growth restriction diagnosed between 26(+0) and 31(+6) weeks. We analyzed women with middle cerebral artery Doppler measurement at study entry and within 1 week before delivery and with complete postnatal follow-up (374 of 503). The primary outcome was survival without neurodevelopmental impairment at 2 years corrected for prematurity. Neonatal outcome was defined as survival until first discharge home without severe neonatal morbidity. Z-scores were calculated for middle cerebral artery pulsatility index and both umbilicocerebral and cerebroplacental ratios. Odds ratios of Doppler parameter Z-scores for neonatal and 2 year infant outcome were calculated by multivariable logistic regression analysis adjusted for gestational age and birthweight p50 ratio. RESULTS: Higher middle cerebral artery pulsatility index at inclusion but not within 1 week before delivery was associated with neonatal survival without severe morbidity (odds ratio, 1.24; 95% confidence interval, 1.02-1.52
Ghossein-Doha C, Khalil A, Lees CC, 2017, Maternal hemodynamics: a 2017 update, Ultrasound in Obstetrics & Gynecology, Vol: 49, Pages: 10-14, ISSN: 1469-0705
Mahendru AA, Foo FL, McEniery CM, et al., 2017, Change in maternal cardiac output from pre-conception to mid-pregnancy is associated with birth weight in healthy pregnancies, Ultrasound in Obstetrics & Gynecology, Vol: 49, Pages: 78-84, ISSN: 1469-0705
OBJECTIVE: Birth weight (BW) is thought to be determined by maternal health, and genetic, nutritional and placental factors; the latter being influenced by anatomical development and perfusion. Maternal cardiovascular changes contribute to uteroplacental perfusion, however they have not been investigated in relation to fetal growth/BW. Our aim was to explore the relationship between maternal cardiovascular adaptation, fetal growth and BW in healthy pregnancies. METHODS: This was a longitudinal prospective study of women planning to conceive a pregnancy. Maternal cardiac output (CO), cardiac index (CI), pulse-wave velocity, aortic augmentation index (AIx), central blood pressure and peripheral vascular resistance (PVR) were assessed prior to pregnancy and at 6, 23 and 33 weeks' gestation. Fetal growth was assessed by serial ultrasound measurements of biometry. RESULTS: In total, 143 women volunteered to participate and were eligible for study inclusion. One hundred and one women conceived within 18 months and there were 64 live births with normal pregnancy outcome. There were positive correlations between BW and the prepregnancy-to-second trimester changes in CO (ρ = 0.4, P = 0.004), CI (ρ = 0.3, P = 0.02) and PVR (ρ = 0.3, P = 0.02). There were significant associations between third-trimester estimated fetal weight gain and the prepregnancy-to-second trimester increase in CO (Δ, 0.8 ± 1.2 L/min; ρ = 0.3, P = 0.02) and CI (Δ, 0.4 ± 0.6 L/min/m(2) ; ρ = 0.3, P = 0.04) and reduction in AIx (Δ, -10 ± 9%; ρ = -0.3, P = 0.04). CONCLUSIONS: In healthy pregnancy, third-trimester fetal growth and BW are associated with incremental changes in maternal CO in early pregnancy. It is plausible that this association is causative, as changes predate third-trimester fetal growth and eventual BW.
Usman S, Foo L, Tay J, et al., 2017, Use of magnesium sulfate in preterm deliveries for neuroprotection of the neonate, Obstetrician and Gynaecologist, Vol: 19, Pages: 21-28, ISSN: 1744-4667
Key content The prevalence of preterm birth is increasing and owing to advances in neonatal care, more infants are surviving. However, in parallel with this, the incidence of cerebral palsy (CP) is also rising. Magnesium sulfate (MgSO4) is currently recommended for use in women who are at risk of giving birth at less than 30–32 weeks of gestation for neuroprotection of their infants. The exact mechanism of action remains unclear. Meta‐analyses report encouraging results that are consistent with a modest but tangible benefit for the use of MgSO4, and suggest a number needed to treat (NNT) to prevent one in 46 cases of CP in infants born preterm before 30 weeks of gestation and one in 63 cases of CP in infants born preterm before 34 weeks of gestation.Learning objectives To gain an understanding of the risk of neurodisability in infants delivered preterm. To become familiar with the main studies assessing the use of MgSO4 for neuroprotection in preterm deliveries. To become aware of the relevant international guidelines.Ethical issues Concerns have been raised regarding the higher number of perinatal deaths reported with the use of MgSO4 in the MagNET study. This was not substantiated in the Cochrane review. Given that MgSO4 is a safe, readily available and inexpensive drug, even if there were only to be modest benefits from its use, the risk–benefit ratio is in favour of its use.
Dall'Asta AA, Paramasivam G, Lees C, 2016, Qualitative evaluation of Crystal Vue rendering technology in the assessment of fetal lip and palate, Ultrasound in Obstetrics and Gynecology, Vol: 49, Pages: 549-552, ISSN: 0960-7692
Facial clefts of the lip and alveolar ridge are usually evaluated with conventional ultrasound imaging. However, assessment of the extension of the defect into the palate and the detection of isolated clefts of the secondary palate is often not always possible due to poor acoustic windows. Nevertheless, knowledge of the extent of the cleft has significant prognostic implications in terms of pregnancy choices, surgical and functional outcome. Newly developed three-dimensional (3D) technologies offer the opportunity to develop novel imaging techniques for the evaluation of the secondary palate, although these have not been objectively compared. Crystal Vue (CV) is a recently developed ultrasound 3D post processing rendering technology based on image-contrast enhancement which is capable of preserving context and surface information. In this study we qualitatively describe its performance in the assessment of the fetal lip and palate and compare our findings to those reported using other 3D methods.
Shaw C, Rivens I, Civale J, et al., 2016, OP21.10 Technical and safety considerations for high intensity focused ultrasound (HIFU) non-invasive placental vascular occlusion, ISUOG World Congress 2016, Publisher: Wiley, Pages: 121-122, ISSN: 0960-7692
Shaw C, Rivens I, Civale J, et al., 2016, OC15.02 Obstetric outcomes following non-invasive high intensity focused ultrasound (HIFU) occlusion of sheep placental vasculature, ISUOG World Congress 2016, Publisher: Wiley, Pages: 27-28, ISSN: 0960-7692
Nawathe A, Lees C, 2016, Early onset fetal growth restriction, Best Practice & Research Clinical Obstetrics & Gynaecology, Vol: 38, Pages: 24-37, ISSN: 1521-6934
Fetal growth restriction remains a challenging entity with significant variations in clinical practice around the world. The different etiopathogenesis of early and late fetal growth restriction with their distinct progression of fetal severity and outcomes, compounded by doctors and patient anxiety adds to the quandary involving its management. This review summarises the literature around diagnosing and monitoring early onset fetal growth restriction (early onset FGR) with special emphasis on optimal timing of delivery as guided by recent research advances.
Kindinger LM, MacIntyre DA, Lee YS, et al., 2016, Relationship between vaginal microbial dysbiosis, inflammation and pregnancy outcomes in cervical cerclage, Science Translational Medicine, Vol: 8, ISSN: 1946-6242
Preterm birth, the leading cause of death in children under five, may be caused by inflammation triggered by ascending vaginal infection. About two million cervical cerclages are performed annually to prevent preterm birth. The procedure is thought to provide structural support and maintain the endocervical mucus plug as a barrier to ascending infection. Two types of suture material are used for cerclage: monofilament or multifilament braided. Braided sutures are most frequently used, though no evidence exists to favor them over monofilament sutures. In this study we assessed birth outcomes in a retrospective cohort of 678 women receiving cervical cerclage in 5 UK university hospitals and showed that braided cerclage was associated with increased intrauterine death (15% v 5%, P = 0.0001) and preterm birth (28% v 17%, P = 0.0006) compared to monofilament suture. To understand the potential underlying mechanism, we performed a prospective, longitudinal study of the vaginal microbiome in women at risk of preterm birth because of short cervical length (≤25 mm) who received braided (n=25) or monofilament (n=24) cerclage under otherwise comparable circumstances. Braided suture induced a persistent shift towards vaginal microbiome dysbiosis characterized by reduced Lactobacillus spp. and enrichment of pathobionts. Vaginal dysbiosis was associated with inflammatory cytokine and interstitial collagenase excretion into cervicovaginal fluid and premature cervical remodeling. Monofilament suture had comparatively minimal impact upon the vaginal microbiome and its interactions with the host. These data provide in vivo evidence that a dynamic shift of the human vaginal microbiome toward dysbiosis correlates with preterm birth.
Mahendru AA, Wilhelm-Benartzi CS, Wilkinson IB, et al., 2016, Gestational length assignment based on last menstrual period, first trimester crown-rump length, ovulation, and implantation timing, Archives of Gynecology and Obstetrics, Vol: 294, Pages: 867-876, ISSN: 0932-0067
PURPOSE: Understanding the natural length of human pregnancy is central to clinical care. However, variability in the reference methods to assign gestational age (GA) confound our understanding of pregnancy length. Assignation from ultrasound measurement of fetal crown-rump length (CRL) has superseded that based on last menstrual period (LMP). Our aim was to estimate gestational length based on LMP, ultrasound CRL, and implantation that were known, compared to pregnancy duration assigned by day of ovulation. METHODS: Prospective study in 143 women trying to conceive. In 71 ongoing pregnancies, gestational length was estimated from LMP, CRL at 10-14 weeks, ovulation, and implantation day. For each method of GA assignment, the distribution in observed gestational length was derived and both agreement and correlation between the methods determined. RESULTS: Median ovulation and implantation days were 16 and 27, respectively. The gestational length based on LMP, CRL, implantation, and ovulation was similar: 279, 278, 276.5 and 276.5 days, respectively. The distributions for observed gestational length were widest where GA was assigned from CRL and LMP and narrowest when assigned from implantation and ovulation day. The strongest correlation for gestational length assessment was between ovulation and implantation (r = 0.98) and weakest between CRL and LMP (r = 0.88). CONCLUSIONS: The most accurate method of predicting gestational length is ovulation day, and this agrees closely with implantation day. Prediction of gestational length from CRL and known LMP are both inferior to ovulation and implantation day. This information could have important implications on the routine assignment of gestational age.
Shaw CJ, Civale J, Botting KJ, et al., 2016, Noninvasive high-intensity focused ultrasound treatment of twin-twin transfusion syndrome: a preliminary in vivo study, Science Translational Medicine, Vol: 8, Pages: 1-11, ISSN: 1946-6242
We investigated the efficacy, maternofetal responses, and safety of using high-intensity focused ultrasound (HIFU) for noninvasive occlusion of placental vasculature compared to sham treatment in anesthetized pregnant sheep. This technique for noninvasive occlusion of placental vasculature may be translatable to the treatment of conditions arising from abnormal placental vasculature, such as twin-twin transfusion syndrome (TTTS). Eleven pregnant sheep were instrumented with maternal and fetal arterial catheters and time-transit flow probes to monitor cardiovascular, acid-base, and metabolic status, and then exposed to HIFU (n = 5) or sham (n = 6) ablation of placental vasculature through the exposed uterine surface. Placental vascular flow was occluded in 28 of 30 targets, and histological examination confirmed occlusion in 24 of 30 targets. In both HIFU and sham exposures, uterine contact reduced maternal uterine artery flow, but delivery of oxygen and glucose to the fetal brain remained normal. HIFU can consistently occlude in vivo placental vessels and ablate blood flow in a pregnant sheep model. Cardiovascular and metabolic fetal responses suggest that the technique is safe in the short term and potentially translatable to human pregnancy.
Lai J, Nowlan N, Vaidyanathan R, et al., 2016, Fetal movements as a predictor of health, Acta Obstetricia et Gynecologica Scandinavica, Vol: 95, Pages: 968-975, ISSN: 1600-0412
The key determinant to a fetus maintaining its health is through adequate perfusion and oxygen transfer mediated by the functioning placenta. When this equilibrium is distorted, a number of physiological changes including reduced fetal growth occur to favour survival. Technologies have been developed to monitor these changes with a view to prolong intrauterine maturity whilst reducing the risks of stillbirth. Many of these strategies involve complex interpretation, for example Doppler ultrasound for fetal blood flow and computerisedcomputerized analysis of fetal heart rate changes. However, even with these modalities of fetal assessment to determine the optimal timing of delivery, fetal movements remain integral to clinical decision making. In high risk cohorts with fetal growth restriction, the manifestation of a reduction in perceived movements may warrant an expedited delivery. Despite this, there remains has been little evolution in the development of technologies to objectively define evaluate normal fetal movement behavior for behavior, and where there has, there has been no linkage to clinical useapplication. In tThis review we is an attempt to understand synthesize currently available literature on the value of fetal movement analysis as a method of assessing fetal wellbeing, and show how interdisciplinary developments in this area may aid in improvements to clinical outcomes.
Lawin O'Brien A, Dall'Asta A, Tapon D, et al., 2016, Gestation related karyotype, QF-PCR and CGH-array failure rates in diagnostic amniocentesis, Prenatal Diagnosis, Vol: 36, Pages: 708-713, ISSN: 1097-0223
BACKGROUND: Few data exist describing laboratory related failure rates in prenatal diagnosis. The aim of this study is to assess the laboratory associated failure rate for karyotype, QF-PCR and CGH-array following amniocentesis in relation to gestation. METHODS: Retrospective database study of amniocenteses performed 2004-2014 comparing laboratory failure rate for karyotype, QF-PCR and CGH-array between 16 + 0 and 40 + 0 weeks' gestation. RESULTS: A total of 10 484 amniotic fluid test results were collected in three databases. Karyotype failed in 41/1797 (2.3%) tests; failure rate was significantly greater with advancing gestation reaching 43% at 36-40 weeks. QF-PCR failed in 132/5715 tests (2.3%) and was significantly greater with advancing gestation reaching 7% at 36-40 weeks. For CGH-array, 10/298 tests (3.4%) failed analysis. In one case, no result was obtainable by any technique. CONCLUSIONS: These data provide gestation specific laboratory failure rates for amniocentesis enabling informed decisions about the timing and laboratory technique most applicable to the clinical situation. Before 20 weeks, karyotype is least likely to fail of the three techniques. However, in the late third trimester, QF-PCR and, in particular, karyotyping are more likely to fail than CGH-array. Although there is some overlap between the three different tests, they may be preferentially offered in different clinical scenarios. © 2016 John Wiley & Sons, Ltd.
Lobmaier SM, Mensing van Charante N, Ferrazzi E, et al., 2016, Phase-rectified signal averaging method to predict perinatal outcome in infants with very preterm fetal growth restriction- a secondary analysis of TRUFFLE-trial., American Journal of Obstetrics and Gynecology, Vol: 215, Pages: 630.e1-630.e7, ISSN: 1097-6868
BACKGROUND: Phase-rectified signal averaging, an innovative signal processing technique, can be used to investigate quasi-periodic oscillations in noisy, nonstationary signals that are obtained from fetal heart rate. Phase-rectified signal averaging is currently the best method to predict survival after myocardial infarction in adult cardiology. Application of this method to fetal medicine has established significantly better identification than with short-term variation by computerized cardiotocography of growth-restricted fetuses. OBJECTIVE: The aim of this study was to determine the longitudinal progression of phase-rectified signal averaging indices in severely growth-restricted human fetuses and the prognostic accuracy of the technique in relation to perinatal and neurologic outcome. STUDY DESIGN: Raw data from cardiotocography monitoring of 279 human fetuses were obtained from 8 centers that took part in the multicenter European "TRUFFLE" trial on optimal timing of delivery in fetal growth restriction. Average acceleration and deceleration capacities were calculated by phase-rectified signal averaging to establish progression from 5 days to 1 day before delivery and were compared with short-term variation progression. The receiver operating characteristic curves of average acceleration and deceleration capacities and short-term variation were calculated and compared between techniques for short- and intermediate-term outcome. RESULTS: Average acceleration and deceleration capacities and short-term variation showed a progressive decrease in their diagnostic indices of fetal health from the first examination 5 days before delivery to 1 day before delivery. However, this decrease was significant 3 days before delivery for average acceleration and deceleration capacities, but 2 days before delivery for short-term variation. Compared with analysis of changes in short-term variation, analysis of (delta) average acceleration and deceleration capacities bett
Shaw CJ, Rivens I, Civale J, et al., 2016, High intensity focused ultrasound: A method of non-invasive placental vascular occlusion, BJOG - An International Journal of Obstetrics and Gynaecology, Vol: 123, Pages: 7-7, ISSN: 1470-0328
Shaw CJ, Civale J, Botting KJ, et al., 2016, High intensity focused ultrasound (HIFU) ablation of placental vasculature: Feasibility, fetal and maternal safety, BJOG - An International Journal of Obstetrics and Gynaecology, Vol: 123, Pages: 20-21, ISSN: 1470-0328
Usman S, Hirst C, Oliveira M, et al., 2016, Acceptability of transabdominal and transperineal ultrasound compared to vaginal examinations peri-delivery, BJOG - An International Journal of Obstetrics and Gynaecology, Vol: 123, Pages: 165-166, ISSN: 1470-0328
Lawin-O'Brien AR, Dall'Asta A, Knight C, et al., 2016, Short-term outcome of periviable small-for-gestational-age babies: is our counseling up to date?, Ultrasound in Obstetrics and Gynecology, Vol: 48, Pages: 636-641, ISSN: 0960-7692
OBJECTIVE: There are limited data for counseling on and management of periviable small-for-gestational-age (SGA) fetuses. We therefore aimed to investigate the short-term outcome of periviable SGA fetuses in relation to the likely underlying cause. METHODS: This was a retrospective study of data from three London tertiary fetal medicine centers obtained between 2000 and 2015. We included viable singleton pregnancies with a severely small fetus, defined as those with an abdominal circumference ≤ 3(rd) percentile, identified between 22 + 0 and 25 + 6 weeks' gestation. Data obtained included fetal biometry, presence of placental anomalies, uterine and fetal Doppler and neonatal outcome. We excluded cases with structural abnormalities, proven or suspected abnormal karyotype or genetic syndromes. Cases were classified according to the suspected underlying cause of the small fetal size into one of the following categories: uteroplacental insufficiency, evidence of placental damage with normal uterine artery Doppler, viral infection, or unclassied. RESULTS: There were 245 cases included in the study. Of these, at diagnosis of SGA, 201 (82%) were categorized as uteroplacental cause, 13 (5%) as suspected placental cause, one (0.4%) as suspected viral cause and 30 (12%) could not be assigned to any of these categories. Overall, 101 (41%) cases survived the neonatal period; 89 (36%) underwent in-utero fetal demise, 22 (9%) died neonatally and 33 (14%) pregnancies were terminated. The diagnosis-to-delivery interval was 8.1 weeks in those that survived and 4.5 weeks in those that died neonatally. CONCLUSIONS: Almost 90% of periviable SGA cases are associated with uteroplacental insufficiency or intraplacental damage. Survival is related to gestational age at delivery, with outcomes better than might be assumed at diagnosis and some pregnancies reaching term.
Kindinger L, MacIntyre D, Lee Y, et al., 2016, Cervical cerclage using braided suture induces vaginal dysbiosis, inflammation, and is associated with increased preterm birth, British Maternal & Fetal Medicine Society (BMFMS) 18th Annual Conference 2016, Publisher: Wiley, Pages: 8-8, ISSN: 1470-0328
Usman S, Lees C, 2016, The acceptability of intrapartum ultrasound, British Maternal & Fetal Medicine Society (BMFMS) 18th Annual Conference 2016, Publisher: Wiley, Pages: 102-102, ISSN: 1471-0528
Foo L, Gautreau A, Bennett P, et al., 2016, Gestation of pregnancy loss in an observational prospective preconception cohort, British Maternal & Fetal Medicine Society (BMFMS) 18th Annual Conference 2016, Publisher: WILEY-BLACKWELL, Pages: 58-58, ISSN: 1470-0328
Jessop FA, Lees CC, Pathak S, et al., 2016, Funisitis is associated with adverse neonatal outcome in low-risk unselected deliveries at or near term, Virchows Archiv, Vol: 468, Pages: 503-507, ISSN: 1432-2307
This study aimed to determine the incidence and clinical outcomes for varying patterns of placental histological inflammation (consistent with fetal or maternal inflammatory response) in an unselected population of >1000 women with a singleton pregnancy resulting in live birth delivering at or near term. One thousand one hundred nineteen cases were studied in a blind, prospective, unselected study with placentas categorized into five histological subgroups reflecting underlying maternal or fetal inflammatory response. Clinical outcomes studied included interventional delivery, an Apgar score <7 at 1 min, neonatal acidosis (pH < 7.2) and admission to neonatal special care. One hundred eighty-eight placentas (17 %) showed histological evidence of acute inflammation: 64 with funisitis (with or without other inflammation; 6 %); 16 with extensive acute inflammation across the chorionic plate, free membranes and subchorionic fibrin (1 %); 28 with acute inflammation restricted to the chorionic plate (2 %); 12 with acute inflammation restricted to the free membranes (1 %) and 68 with acute inflammation restricted to the subchorionic fibrin (6 %). Features of extensive acute inflammation were significantly associated with increased rate of interventional delivery (assisted vaginal delivery or emergency caesarean section; P < 0.01). The presence of funisitis was significantly associated with interventional delivery and other adverse outcomes including an Apgar score <7 at 1 min, clinical evidence of sepsis and admission to the neonatal intensive care unit (P < 0.05 for all). The data represent a quantitative rather than purely qualitative analysis of the contribution of histological lesions related to inflammation on short-term adverse neonatal outcomes and interventional delivery. Funisitis and extensive inflammation are associated with adverse clinical outcomes, but the precise mechanism underlying these remains to
Lazaridis A, Lees CC, 2016, Adjunctive use of intrapartum foetal ST-segment analysis (STAN) confers no benefit over conventional foetal heart rate monitoring, Evidence-Based Medicine, Vol: 21, Pages: 105-106, ISSN: 1473-6810
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