Imperial College London

Professor Christoph Lees, MD FRCOG

Faculty of MedicineDepartment of Metabolism, Digestion and Reproduction

Professor of Obstetrics







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




Queen Charlottes and Chelsea HospitalHammersmith Campus




Transperineal ultrasound in labour


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.Sonopartogram

Maternal cardiovascular adaptation to pregnancy

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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.conceive poster

Cardiovascular function in pre-eclampsia and fetal growth restriction

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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

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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

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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 

3D facial and brain morphology in prenatal diagnosis

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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

Guest Lectures

Controversies in late IUGR & TRUFFLE Study 2, International Workshop on Fetal Health and Growth, Naples, Italy, 2106

Hypertension Disorders and pre-conceptional haemodynamics, Mangiagalli Journal Club, Italy, 2022

COVID-19 and pregnancy: lessons from 2020, Neonatal Update 2021, London, 2021

Management of FGR/SGA and the TRUFFLE study, London Maternity Clinical Network Optimising SGS Detection Webinar, London, 2021

Obstetrics and Gynaecology Ultrasound Webinar Series, East Meets West Series, Samsung, Korea, 2021

Big data of COVID-19: Lessons for other perinatal infections, ISUOG, London, 2021

Diagnosis & Management of SGA fetus and FGR, ISUOG, London, 2021

Becoming a clinical researcher, where do I start, ISUOG, London, 2021

Ultrasound in the Labour Ward Introduction, ISUOG, London, 2021

Maternal Haemodynamics, Congresso Nazionale Agora SIMP, Rome, 2021

Management of Early FGR, APCMFM, Hong Kong, 2021

Hypertension in Pregnancy, ISUOG, London, 2021

Fetal Growth Restriction - All you need to know, Samsung/ICL Consultants Webinar, 2021

Can we predict and Prevent Fetal Growth Restriction?, ISUOG Webinar, London, 2021

Supporting our Doctors: Typical Example in Practice, RCOG Workplace Behaviour, London, 2021

The problem with Caesarean Scars: Scar pregnancy and abnormally invasive placenta - imaging and management, Samsung Webinar, Korea, 2021

Cerebral blood flow redistribution, which indices?, World Congress Perinatal Medicine, Turkey, 2021

Maternal haemodynamics before conception: is there space for prevention?, World Congress Perinatal Medicine, Turkey, 2021

Prediction of Vaginal Delivery, World Congress Perinatal Medicine, Turkey, 2021

USS and assisted vaginal birth, RCOG Management of the Labour Ward, London, 2021

HIFU for Twin to Twin Transfusion Syndrome, FOGSI: East Zone Yuva, India, 2021

A common sense approach to cCTGs, Imperial College NHS Trust, London, 2021

the influence of the pregnancy on maternal circulation, Practical Gynecology and Perinatology Forum, Poland, 2021

Fetal Growth Restriction Management, Practical Gynaecology and Perinatology Forum, Poland, 2021

Update on antenatal fetal assessment, Mid Essex NHS Foundation Trust, Essex, 2021

Obstetrics & Gynaecology Ultrasound Webinar Series: Neurosonology, Samsung: East Meets West, Korea, 2021

The Psychological Impact of Early Pregnancy Loss, Catholic University Rome, MARATHON FOR SOLIDARITY meeting to raise money for COVID relief in India, 2021

Ultrasound in the delivery suite, Trieste Masters for Midwives, Italy, 2021

Fetal Growth Restriction Guidelines: discussing the differences in North America vs Europe, GE Healthcare, 2021

Twin Perils of the monochroionic placenta, ICHT Grand Round, London, 2021

Fetal Growth and Health, ISUOG Symposium, London, 2021

Early Onset Fetal Growth Restrictions: NST and Doppler, 18th Congress on Perinatal Medicine, 2021

What have we learned from the large registry studies: PANCOVID and beyond, ISUOG Webinar, London, 2021

Fetal Medicine, Imperial College O&G Conference, London, 2021

Cardiovascular Optimisation in Pregnancy, Sandwell & West Birmingham Hospitals, Birmingham, 2021

Predicting Labour Outcome, WSPM Ultrasound in Labor, Turkey, 2021

Management of early and late-onset growth restriction, SGA Study Day, Online, 2020

How to use ultrasound in the labor ward: theory, ISUOG Congress, London (online), 2020

Late FGR, 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

Investigating burnout, wellbeing and defensive medical practice amongst obstetricians ad gynaecologists in the UK, RCOG World Congress, London, 2019

Early FGR Management, Fetal Medicine World Congress, Alicante, Spain, 2019

Maternal Haemodynamics: has the time come for routine implementation?, World Congress Ultrasound Obstetrics & Gynaecology (ISUOG), Berlin, Germany, 2019

Cerebral redistribution data from the TRUFFLE 2 feasibility study, World Congress Ultrasound Obstetrics & Gynaecology (ISUOG), Berlin, Germany, 2019

Ultrasound in the labour ward, tricks and tips, RCOG World Congress, London, 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

Hypertensive disorders of pregnancy: the importance of maternal cardiovascular evaluation, 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

Management of Fetal Growth Restriction, World Congress of Maternal Fetal Neonatal Medicine, London, 2019

Pre-pregnancy and Pregnancy haemodynamics in hypertension disorders of pregnancy, World Congress of Maternal Fetal Neonatal Medicine, 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

Intrapartum ultrasound: predicting the mode of delivery, 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

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

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

Research Staff