Transperineal ultrasound in labour
INTRAPARTUM ULTRASOUND: SONO-VE STUDY
Currently, all women admitted to delivery units throughout the world undergo internal digital vaginal examination (digital VE) when they are thought to be in labour. The digital VE though an age-honoured practice is an uncomfortable experience for the labouring woman is subjective and agreement between observers is frequently poor. Multiple examinations have been linked to infection to the mother or fetus reducing the time to delivery in preterm labour. It has recently become possible to make assessments more objectively using transperineal ultrasound. We are carrying out the Sono-VE Study: Assessing the acceptability and feasibility of transperineal ultrasound and based on the sonopartogram, developing a predictive model for labour outcome. This is a prospective observational study of 700 women using transperineal ultrasound between 24-42 weeks gestation and a prospective longitudinal observational study in all term (37-42 weeks) labouring women.
Our European Collaborators include KU Leuven in Belgium (data analytical and statistical support) and the Norwegian University of Science and Technology at Trondheim. Funding sources include a BMA Helen Lawson fellowship for Dr Sana Usman who is the research fellow dedicated to the project.
The sonopartogram-an ultrasound based representation of labour progress:
Hassan WA, Eggebo T, Ferguson M, Gillett A, Studd J, Pasupathy D, Lees CC. The sonopartogram: a novel method for recording progress of labor by ultrasound. Ultrasound in Obstetrics & Gynecology. 2014;43(2):189a??194.
Maternal cardiovascular adaptation to pregnancy
The CONCEIVE study is a unique longitudinal study investigating whether and how cardiovascular and metabolic changes from pre-conception and through pregnancy are associated with adverse pregnancy outcomes, specifically, the development of preeclampsia and/or small for gestational age babies. Currently, the pathogenesis of pre-eclampsia remains elusive. The most common hypothesis is that impaired trophoblastic invasion leads to release of placental factors into maternal circulation, from which subsequently arise endothelial dysfunction. However, up to 40% of normal pregnancies show poor trophoblastic invasion. Our aim is to investigate whether differences in cardiovascular adaptation very early in pregnancy predispose to pre-eclampsia or small for gestational age babies. We are recruiting 600 women prior to pregnancy and following them all the way through and into the postnatal period with simple non-invasive cardiovascular assessment and blood and urine tests.
Funding for for Dr Lin Foo, research fellow and Alice Gautreau, research midwife has been provided by the Biomedical Research Centre (BRC) at Imperial College Healthcare NHS Trust, Imperial College Healthcare NHS Trust Charities and Imperial College London and the project is a collaboration with the Department of Clinical Pharmacology, Cambridge University.
Cardiovascular function in pre-eclampsia and fetal growth restriction
The PRECEPT study's aim is to assess maternal cardiovascular changes in established uteroplacental insufficiency. The study recruits women after 24 weeks gestation whose pregnancies are affected by pre-eclampsia and/or fetal growth restriction and women with normal pregnancies and compares their cardiovascular status, namely cardiac output, augmentation index, pulse wave velocity, peripheral vascular resistance and central blood pressure from diagnosis until post-delivery, to characterize changes in relation to time of diagnosis and therapy whilst assessing fetal circulatory changes using Doppler. The metabonomic and cardiovascular biomarker profiles will be investigated in relation to maternal cardiovascular function.
Funding for this study is provided by Imperial NHS Trust and Imperial College London for Dr Jasmine Tay and the project is a collaboration with the Department of Clinical Pharmacology, Cambridge University.
Non invasive fetal therapy: HIFU
DEVELOPING A NON-INVASIVE TREATMENT FOR TWIN-TWIN TRANSFUSION SYNDROME AND FETAL VASCULAR TUMOURS USING HIGH INTENSITY FOCUSED ULTRASOUND
Twin-Twin Transfusion Syndrome (TTTS) affects 10-15% of twins which share a placenta and is a result of abnormal connections between the blood vessels in the shared placenta. It may have serious consequences including premature delivery, permanent handicap or death for babies affected. More severe cases are currently treated by keyhole surgery, where a hole is made in the womb and a laser is used to burn away the abnormal blood vessels. Making even a small hole in the womb carries a risk of bleeding, infection and miscarriage or preterm delivery. Our research aims to develop an alternative treatment for TTTS which could still burn away blood vessels, but without the need for invasive surgery. The new treatment, called High intensity Focused Ultrasound (HIFU) can target sound waves very accurately so they destroy tissue and has been used in humans to treat cancer growths without the need for surgery. However research has not been done in pregnancy to show the effects of blocking blood vessels in the placenta with HIFU. We are currently in laboratory stages of developing and testing the safety and effectiveness of this new system to use on placental blood vessels, and if these tests are successful we hope to develop a clinical trial to use HIFU in human pregnancy.
The work is being performed between Imperial College, the Department of Physiology, Development and Neuroscience, University of Cambridge, and Royal Marsden Hospital by Dr Caroline Shaw. Funders include Action Medical Research, The Isaac Newton Trust and Genesis at Imperial College.
The TRUFFLE 2 Study
The TRUFFLE 2 study follows on from the successful multicentre European TRUFFLE collaboration (2002-2015) which investigated the optimal monitoring and timing of delivery in severely growth restricted babies at 26-32 weeks.
The TRUFFLE 2 study will investigate whether in small babies or those whose growth is slowing, slightly earlier delivery based on fetal cerebral artery Doppler improves perinatal outcome compared to waiting until conventional measures would lead to delivery. This is a 36 centre European, UK and Scandinavian collaboration planned to start in Q2 2019. For more details visit www.truffle-study.org
3D facial and brain morphology in prenatal diagnosis
This study is funded by the Imperial BRC and Imperial Healthcare NHS Trust, in collaboration with Great Ormond Street, University College London and the Institute for Child Health in London. The project aims to develop automatic analysis algorithms to detect subtle differences in fetal brain and facial morphology that could be associated with genetic conditions, in order to facilitate counselling and planning of delivery and in the neonatal period.
Co-Founders:Antonino Barbera, USA / ItalyTorbjørn Eggebo, NorwayTullio Ghi, ItalyWolfgang Henrich, BerlinKarim Kalache, QatarWailam Lau, Hong KongChristoph Lees, LondonPatrick Rozenberg, FranceBoris Tutschek, Switzerland, Co-Founder of ISLANDS (International Study Group on Labor and Delivery Sonography), 2019
Gail Ter Haar, Ian Rivens, Dino Giussani, Institute for Cancer Research and University of Cambridge, HIFU Study on Twin-Twin Transfusion Syndrome, 2018
Co-Founder of International Working Group in Maternal Haemodynamics, 2012
Founder of TRUFFLE Group, 50 TRUFFLE Centres across UK and Europe, 2002
Controversies in late IUGR & TRUFFLE Study 2, International Workshop on Fetal Health and Growth, Naples, Italy, 2106
Management of early and late-onset growth restriction, SGA Study Day, Online, 2020
Late FGR, ISUOG Congress, London (online), 2020
How to use ultrasound in the labor ward: theory, ISUOG Congress, London (online), 2020
Avoiding COVID-19: practical steps for the sonologist, ISUOG Congress, London (online), 2020
PAN-COVID, ISUOG Congress, London (online), 2020
Update on Late FGR, University of Trieste, Trieste, Italy (online), 2020
Clinical Challenges in Labor and Delivery, 6th Virtual Birth Congress, Alicante, Spain (online), 2020
The Sonopartogram, Virtual Birth Congress, Alicante, Spain (Online), 2020
COVID-19: An update for obstetricians and gyanecologists, RCOG, Egyptian Representative Committee, Egypt (online), 2020
Small babies and the mother's circulation, Imperial College London Inaugural Lecture, London, 2020
Expanding our horizons with placenta accrete and vasa praevia - The clinician's view, BMUS Conference, Harrogate, 2019
Second trimerter scan 2020, International symposium standards in fetal medicine, Zurich, Germany, 2019
Physiology of antenatal fetal heart rate variation and changes with hypoxaemia, St George's Hospital Antenatal CTG Study Day, London, 2019
Grand Round Lecture: “Fetal Growth Restriction: how to monitor and when to deliver”, Department of Obstetrics & Gynaecology Truman Medical Center, Kansas, USA, 2019
Workplace challenges - what has worked well: Case study large unit, RCOG Council, London, 2019
IUGR How to monitor and when to deliver, Finnish Medical Ultrasound Society, Finland, 2019
Cerebral redistribution data from the TRUFFLE 2 feasibility study, World Congress Ultrasound Obstetrics & Gynaecology (ISUOG), Berlin, Germany, 2019
Maternal Haemodynamics: has the time come for routine implementation?, World Congress Ultrasound Obstetrics & Gynaecology (ISUOG), Berlin, Germany, 2019
Early FGR Management, Fetal Medicine World Congress, Alicante, Spain, 2019
Investigating burnout, wellbeing and defensive medical practice amongst obstetricians ad gynaecologists in the UK, RCOG World Congress, London, 2019
Management of Fetal Growth Restriction, World Congress of Maternal Fetal Neonatal Medicine, London, 2019
Hypertensive disorders of pregnancy: the importance of maternal cardiovascular evaluation, Perinatal Medicine of the Future - from Research to Healthcare, Trieste, Italy, 2019
Growth Restriction, what have we learned and what is there still to do?, RCOG World Congress, London, 2019
Late IUGR: data from TRUFFLE 2 observational study, Perinatal Medicine of the Future - from Research to Healthcare, Trieste, Italy, 2019
Results of an observational study in late IUGR, Symposium on diabetes, hypertension in pregnancy, Florence, Italy, 2019
Pre-pregnancy and Pregnancy haemodynamics in hypertension disorders of pregnancy, World Congress of Maternal Fetal Neonatal Medicine, London, 2019
Ultrasound in the labour ward, tricks and tips, RCOG World Congress, London, 2019
How to manage IUGR pregnancies, Dexeus Forum Update in Obstetrics Gynaecology and Reproductive Medicine, Barcelona, Spain, 2018
Repeated measurements and the sonopartogram, Birth, Clinical challenges in labor and Delivery Congress, Venice, Italy, 2018
Vascular Doppler Imaging in Obstetrics, Canon Advanced Obstetrics & Gynaecology Study Day, UK, 2018
ISUOG guidelines: use of Doppler in obstetrics, ASUM Congress, Australia, 2018
Fetal compromise in the third trimester: the planned TRUFFLE 2 study, European Workshop on Fetal Growth Restriction, Milan, Italy, 2018
Fetal compromise in the third trimester: the planned TRUFFLE 2 study, European Workshop on Fetal Growth Restriction, Milan, Italy, 2018
The fetal and maternal circulations are linked, University of Missouri-Kansas City, Kansas, USA, 2018
What I have observed and learnt over 15 years mentoring doctors through complaints, disputes and GMC investigations, RCOG Clinical Directors Leadership Forum, London, 2018
Placenta Accreta Imaging, Imperial Fetal Medicine Study Evenings, London, 2018
Management of early IUGR: Results of TRUFFLE 1 Study, NNFM Meeting, Iceland, 2018
Doppler changes and maternal cardiovascular function, International Congress Maternal Haemodynamics, Cambridge, 2018
Physiology of antenatal fetal heart rate variation and changes with hypoxaemia, St George's University Hospital Antenatal CTG Study Day, London, 2018
Early vs late-onset pre-eclampsia: new concepts in pathophysiology and management, 5th International Symposium Global State of the Art Concepts and Game Changers, Phillipines, 2018
Evidence-based approach in the management of early-onset intrauterine growth restriction, 5th International Symposium Global State of the Art Concepts and Game Changers, Phillipines, 2018
Intrapartum ultrasound: predicting the mode of delivery, 5th International Symposium Global State of the Art Concepts and Game Changers, Phillipines, 2018
I risultati dello Studio TRUFFLE e timing del parto, Convegno Internazionale Hot Topics in Medicina Fetale, Palazzo San Giorgio, Italy, 2017
TRUFFLE and beyond, Perinatale Entscheidungsfindung, Justus-Liebig-Universitat Giessen, Germany, 2017
Is medical regulation fit for purpose: Lessons from UK, Medical Advocates, Dublin, 2017
Easy diagnosis - difficult management (Lesson learned from TRUFFLE study), ISSHP European Congress, Berlin, Germany, 2017
Customised Growth Charts - must we use them?, ISSHP European Congress, Berlin, Germany, 2017
Ultrasound to evaluate labor progress, ECIC 2017: European Congress on Intrapartum Care, Karolinska, Sweden, 2017
Physiology of antenatal fetal heart rate variation and changes with hypoxaemia, St George's University Hospital Trust CTG Study Day, London, 2017
Screening and diagnostic methods for the investigation of cardiovascular function in pregnancy, Maternal Cardiovascular System, Milan, Italy, 2017
Lessons from the TRUFFLE 1 Study, International Workshop on Fetal Health and Growth, Naples, Italy, 2016
Fetal Growth Restriction, China-British Summit Forum in Ob/gyn ultrasound, China, 2016
Revisiting Severe Periviable SGA, Imperial Expert Fetal Medicine, London, 2016