Imperial College London

DrCarolineShaw

Faculty of MedicineDepartment of Metabolism, Digestion and Reproduction

Clinical Lecturer
 
 
 
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c.shaw13

 
 
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Queen Charlottes and Chelsea HospitalHammersmith Campus

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Summary

 

Publications

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33 results found

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

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

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

Allison BJ, Brain KL, Niu Y, Kane AD, Herrera EA, Thakor AS, Botting KJ, Cross CM, Itani N, Shaw CJ, Skeffington KL, Beck C, Giussani DAet al., 2020, Altered Cardiovascular Defense to Hypotensive Stress in the Chronically Hypoxic Fetus, HYPERTENSION, Vol: 76, Pages: 1195-1207, ISSN: 0194-911X

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

Skeffington KL, Beck C, Itani N, Niu Y, Shaw CJ, Giussani DAet al., 2020, Hypertension Programmed in Adult Hens by Isolated Effects of Developmental Hypoxia In Ovo, Hypertension, Vol: 76, Pages: 533-544, ISSN: 0194-911X

<jats:p> In mammals, pregnancy complicated by chronic hypoxia can program hypertension in the adult offspring. However, mechanisms remain uncertain because the partial contributions of the challenge on the placenta, mother, and fetus are difficult to disentangle. Here, we used chronic hypoxia in the chicken embryo—an established model system that permits isolation of the direct effects of developmental hypoxia on the cardiovascular system of the offspring, independent of additional effects on the mother or the placenta. Fertilized chicken eggs were exposed to normoxia (N; 21% O <jats:sub>2</jats:sub> ) or hypoxia (H; 13.5%–14% O <jats:sub>2</jats:sub> ) from the start of incubation (day 0) until day 19 (hatching, ≈day 21). Following hatching, all birds were maintained under normoxic conditions until ≈6 months of adulthood. Hypoxic incubation increased hematocrit (+27%) in the chicken embryo and induced asymmetrical growth restriction (body weight, −8.6%; biparietal diameter/body weight ratio, +7.5%) in the hatchlings (all <jats:italic>P</jats:italic> &lt;0.05). At adulthood (181±4 days), chickens from hypoxic incubations remained smaller (body weight, −7.5%) and showed reduced basal and stimulated in vivo NO bioavailability (pressor response to NG-nitro-L-arginine methyl ester, −43%; phenylephrine pressor response during NO blockade, −61%) with significant hypertension (mean arterial blood pressure, +18%), increased cardiac work (ejection fraction, +12%; fractional shortening, +25%; enhanced baroreflex gain, +456%), and left ventricular wall thickening (left ventricular wall volume, +36%; all <jats:italic>P</jats:italic> &lt;0.05). Therefore, we show that chronic hypoxia can act directly on a developing embryo to program hypertension, cardiovascular dysf

Journal article

Shaw CJ, Botting KJ, Niu Y, Lees CC, Giussani DAet al., 2020, Maternal and fetal cardiovascular and metabolic effects of intra-operative uterine handling under general anesthesia during pregnancy in sheep, Scientific Reports, Vol: 10, ISSN: 2045-2322

A cohort study of 6,500,000 human pregnancies showed an increased risk of adverse fetal outcomes following abdominal but not non-abdominal surgery under general anesthesia. This may be the consequence of uterine handling during abdominal surgery. However, there are no data on any effects on the cardiometabolic physiology of the fetus or mother in response to uterine manipulation in otherwise healthy pregnancy. Consequently, 9 sheep in late gestation were anesthetized with isofluorane and maternal and fetal catheters and flow probes were implanted to determine cardiovascular and metabolic changes during uterine handling. Uterine handling led to an acute increase in uterine artery vascular resistance, fetal peripheral vasoconstriction, a reduction in oxygen delivery to the femoral circulation, worsening fetal acidosis. There was no evidence of systemic fetal hypoxia, or changes in fetal heart rate, carotid blood flow or carotid oxygen delivery. Therefore, the data support that uterine handling during abdominal surgery under general anesthesia can impact adversely on fetal cardiometabolic health. This may provide a potential explanation linking adverse fetal outcomes in abdominal compared with non-abdominal surgery during pregnancy. The data have important implications for human fetal surgery where the uterus is handled, as operative procedures during late gestation under general maternal anesthesia become more prevalent.

Journal article

MylreaFoley B, Shaw CJ, Harikumar N, Legg S, Meher S, Lees CCet al., 2019, Early‐onset twin–twin transfusion syndrome: case series and systematic review, Australasian Journal of Ultrasound in Medicine, Vol: 22, Pages: 286-294, ISSN: 1836-6864

IntroductionData on the outcomes of early‐onset twin–twin transfusion syndrome (TTTS), diagnosed before 18 weeks gestational age (GA), are sparse. We aimed to review the diagnosis, management and outcomes of early‐onset TTTS.Material and methodsPregnancy records at a single referral unit 2010‐6 were reviewed. In early‐onset TTTS cases, data for pregnancy characteristics, interventions and outcomes were collected. PubMed and Scopus databases were searched for studies including pregnant women with early‐onset TTTS. The primary outcome measure was livebirths.ResultsCase series: 58 cases of early‐onset TTTS 2010‐6, with full outcome data in 44. Diagnostic criteria were variable. Median GA at intervention was 17+4 (range 15+0‐28+1); 67% of patients had laser therapy (39/58). Overall survival: 60% (53/88). At least one livebirth: 86% (38/44), Two livebirths: 34% (15/44); No survivors: 14% (6/44). GA at delivery was 32+1.5 (range 16+2‐37+4). Systematic review: 16 studies included (n = 171 pregnancies). Diagnostic criteria varied widely: 79% of studies used Quintero staging. Most offered laser (89%) at median 17+0 weeks (range 16+0‐21+6). GA at delivery was 23+0‐39+5 weeks. Overall survival: 69% (129/186). At least one livebirth: 74% (127/171). Two livebirths: 59% (55/93). No survivors: 26% (44/171).ConclusionsIn comparison with the commonly accepted overall survival for TTTS treated after 18 weeks of 60–90%, outcomes in early‐onset TTTS were at the lower bound of this range. Gestational age at intervention is similar to that of later onset TTTS, indicating a lack of therapeutic options when a diagnosis is made before 18 weeks.

Journal article

Shaw CJ, Rivens I, Civale J, Botting KJ, Allison BJ, Brain KL, Niu Y, Ter Haar G, Giussani DA, Lees CCet al., 2019, Maternal and fetal cardiometabolic recovery following ultrasound-guided high-intensity focused ultrasound placental vascular occlusion, Journal of the Royal Society Interface, Vol: 16, ISSN: 1742-5662

High-intensity focused ultrasound (HIFU) is a non-invasive method of selective placental vascular occlusion, providing a potential therapy for conditions such as twin-twin transfusion syndrome. In order to translate this technique into human studies, evidence of prolonged fetal recovery and maintenance of a healthy fetal physiology following exposure to HIFU is essential. At 116 ± 2 days gestation, 12 pregnant ewes were assigned to control ( n = 6) or HIFU vascular occlusion ( n = 6) groups and anaesthetized. Placental blood vessels were identified using colour Doppler ultrasound; HIFU-mediated vascular occlusion was performed through intact maternal skin (1.66 MHz, 5 s duration, in situ ISPTA 1.8-3.9 kW cm-2). Unidentifiable colour Doppler signals in targeted vessels following HIFU exposure denoted successful occlusion. Ewes and fetuses were then surgically instrumented with vascular catheters and transonic flow probes and recovered from anaesthesia. A custom-made wireless data acquisition system, which records continuous maternal and fetal cardiovascular data, and daily blood sampling were used to assess wellbeing for 20 days, followed by post-mortem examination. Based on a comparison of pre- and post-treatment colour Doppler imaging, 100% (36/36) of placental vessels were occluded following HIFU, and occlusion persisted for 20 days. All fetuses survived. No differences in maternal or fetal blood pressure, heart rate, heart rate variability, metabolic status or oxygenation were observed between treatment groups. There was evidence of normal fetal maturation and no evidence of chronic fetal stress. There were no maternal injuries and no placental vascular haemorrhage. There was both a uterine and fetal burn, which did not result in any obstetric or fetal complications. This study demonstrates normal long-term recovery of fetal sheep from exposure to HIFU-mediated placental vascular occlusion and underlines the potential of HIFU as a potential non-invasive th

Journal article

Dall'Asta A, Paramasivam G, Shaw C, Lees Cet al., 2019, EP.135 Surface vascular placental mapping with virtual endoscopy (sonofetoscopy): qualitative comparison of singleton and monochorionic twin pregnancies, British Maternal & Fetal Medicine Society (BMFMS) 21st Annual Conference 2019, Publisher: Wiley, Pages: 64-64, ISSN: 1470-0328

Conference paper

Shaw C, Rivens I, Civale J, Botting KJ, Niu Y, ter Haar G, Lees C, Giussani DAet al., 2019, O-077 Novel and non-invasive high intensity focused ultrasound treatment of twin-twin transfusion syndrome, SRI 2019: Annual Meeting of the Society for Reproductive Investigation, Publisher: Elsevier, ISSN: 1071-5576

Conference paper

Tay J, Masini G, McEniery CM, Giussani DA, Shaw CJ, Wilkinson IB, Bennett PR, Lees CCet al., 2019, Uterine and fetal placental Doppler indices are associated with maternal cardiovascular function, American Journal of Obstetrics and Gynecology, Vol: 220, Pages: 96.e1-96.e8, ISSN: 0002-9378

BackgroundThe mechanism underlying fetal-placental Doppler index changes in preeclampsia and/or fetal growth restriction are unknown, although both are associated with maternal cardiovascular dysfunction.ObjectiveWe sought to investigate whether there was a relationship between maternal cardiac output and vascular resistance and fetoplacental Doppler findings in healthy and complicated pregnancy.Study DesignWomen with healthy pregnancies (n=62), preeclamptic pregnancies (n=13), preeclamptic pregnancies with fetal growth restriction (n=15), or fetal growth restricted pregnancies (n=17) from 24–40 weeks gestation were included. All of them underwent measurement of cardiac output with the use of an inert gas rebreathing technique and derivation of peripheral vascular resistance. Uterine and fetal Doppler indices were recorded; the latter were z scored to account for gestation. Associations were determined by polynomial regression analyses.ResultsMean uterine artery pulsatility index was higher in fetal growth restriction (1.37; P=.026) and preeclampsia+fetal growth restriction (1.63; P=.001) but not preeclampsia (0.92; P=1) compared with control subjects (0.8). There was a negative relationship between uterine pulsatility index and cardiac output (r2=0.101; P=.025) and umbilical pulsatility index z score and cardiac output (r2=0.078; P=.0015), and there were positive associations between uterine pulsatility index and peripheral vascular resistance (r2=0.150; P=.003) and umbilical pulsatility index z score and peripheral vascular resistance (r2= 0.145; P=.001). There was no significant relationship between cardiac output and peripheral vascular resistance with cerebral Doppler indices.ConclusionUterine artery Doppler change is abnormally elevated in fetal growth restriction with and without preeclampsia, but not in preeclampsia, which may explain the limited sensitivity of uterine artery Doppler changes for all these complications when considered in aggregate. Fur

Journal article

Shaw CJ, Allison BJ, Itani N, Botting KJ, Niu Y, Lees CC, Giussani DAet al., 2018, Altered autonomic control of heart rate variability in the chronically hypoxic fetus, The Journal of Physiological, Vol: 596, Pages: 6105-6119, ISSN: 1469-7793

Although fetal heart rate variability (FHRV) has long been recognised as a powerful predictor of fetal wellbeing, the mechanisms by which it is reduced in the chronically hypoxic fetus have yet to be established. In particular, the physiological mechanism underlying the reduction of short term variation (STV) in fetal compromise remains unclear. In this study, we present a longitudinal study of the development of autonomic control of FHRV, assessed by indirect indices, time domain (SDNN, RMSSD) and power spectral analysis (LF, HF, LF/HF), in normoxic and chronically hypoxic, chronically catheterised, singleton fetal sheep over the last third of gestation. We used isobaric chambers able to maintain pregnant sheep for prolonged periods in hypoxic conditions (stable fetal femoral arterial PO2 10-12 mmHg), and a customised wireless data acquisition system to record beat-to-beat variation in the fetal heart rate. We determined in vivo longitudinal changes in overall FHRV and the sympathetic and parasympathetic contribution to FHRV in hypoxic (n = 6) and normoxic (n = 6) ovine fetuses with advancing gestational age. Normoxic fetuses show gestational age-related increases in overall indices of FHRV, and in the sympathetic nervous system contribution to FHRV (P < 0.001). Conversely, gestational-age related increases in overall FHRV were impaired by exposure to chronic hypoxia, and there was evidence of suppression of the sympathetic nervous system control of FHRV after 72 h of exposure to hypoxia (P < 0.001). This demonstrates that exposure to late gestation isolated chronical fetal hypoxia has the potential to alter the development of the autonomic nervous system control of FHRV in sheep. This presents a potential mechanism by which a reduction in indices of FHRV in human fetuses affected by uteroplacental dysfunction can predict fetuses at increased risk. This article is protected by copyright. All rights reserved.

Journal article

Shaw CJ, Rivens I, Civale J, Botting KJ, Ter Haar G, Giussani DA, Lees CCet al., 2018, Trans-abdominal in vivo placental vessel occlusion using High Intensity Focused Ultrasound., Scientific Reports, Vol: 8, Pages: 13631-13631, ISSN: 2045-2322

Pre-clinically, High Intensity Focused Ultrasound (HIFU) has been shown to safely and effectively occlude placental blood vessels in the acute setting, when applied through the uterus. However, further development of the technique to overcome the technical challenges of targeting and occluding blood vessels through intact skin remains essential to translation into human studies. So too does the assessment of fetal wellbeing following this procedure, and demonstration of the persistence of vascular occlusion. At 115 ± 10 d gestational age (term~147 days) 12 pregnant sheep were exposed to HIFU (n = 6), or to a sham (n = 6) therapy through intact abdominal skin (1.66 MHz, 5 s duration, in situ ISPTA 1.3-4.4 kW.cm-2). Treatment success was defined as undetectable colour Doppler signal in the target placental vessel following HIFU exposures. Pregnancies were monitored for 21 days using diagnostic ultrasound from one day before HIFU exposure until term, when post-mortem examination was performed. Placental vessels were examined histologically for evidence of persistent vascular occlusion. HIFU occluded 31/34 (91%) of placental vessels targeted, with persistent vascular occlusion evident on histological examination 20 days after treatment. The mean diameter of occluded vessels was 1.4 mm (range 0.3-3.3 mm). All pregnancies survived until post mortem without evidence of significant maternal or fetal iatrogenic harm, preterm labour, maternal or fetal haemorrhage or infection. Three of six ewes exposed to HIFU experienced abdominal skin burns, which healed without intervention within 21 days. Mean fetal weight, fetal growth velocity and other measures of fetal biometry were not affected by exposure to HIFU. Fetal Doppler studies indicated a transient increase in the umbilical artery pulsatility index (PI) and a decrease in middle cerebral artery PI as a result of general anaesthesia, which was

Journal article

Mylrea-Lowndes B, Harikumar N, Shaw C, Lees Cet al., 2017, OP26.02 A systematic review of diagnosis, management and outcomes for twin-twin transfusion syndrome (TTTS) diagnosed before 18 weeks' gestation, ISUOG World Congress 2017, Publisher: Wiley, Pages: 132-132, ISSN: 0960-7692

Conference paper

Mylrea-Lowndes B, Legg S, Shaw C, Lees Cet al., 2017, OP26.01 A case series of the characteristics, course and outcomes for twin-twin transfusion syndrome (TTTS) diagnosed before 18 weeks' gestation, ISUOG World Congress 2017, Publisher: Wiley, Pages: 132-132, ISSN: 0960-7692

Conference paper

Shaw CJ, Rivens I, Civale J, Botting KJ, Giussani DA, ter Haar G, Lees CCet al., 2017, Technical and safety considerations for High Intensity Focused Ultrasound (HIFU) non-invasive placental vascular occlusion, Publisher: WILEY, Pages: 5-5, ISSN: 1470-0328

Conference paper

Shaw CJ, Rivens I, Civale J, Botting KJ, Giussani DA, ter Haar G, Lees CCet al., 2017, High Intensity Focused Ultrasound (HIFU): A method of non-invasive placental vascular occlusion, Publisher: WILEY, Pages: 5-5, ISSN: 1470-0328

Conference paper

Shaw C, Rivens I, Civale J, Botting K, Giussani D, ter Haar G, Lees Cet 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

Conference paper

Shaw C, Rivens I, Civale J, Botting K, Giussani D, ter Haar G, Lees Cet 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

Conference paper

Shaw CJ, Civale J, Botting KJ, Niu Y, Ter Haar G, Rivens I, Giussani DA, Lees CCet 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.

Journal article

Lai J, Nowlan N, Vaidyanathan R, Shaw C, Lees Cet 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.

Journal article

Lobmaier SM, Mensing van Charante N, Ferrazzi E, Giussani DA, Shaw CJ, Müller A, Ortiz JU, Ostermayer E, Haller B, Prefumo F, Frusca T, Hecher K, Arabin B, Thilaganathan B, Papageorghiou AT, Bhide A, Martinelli P, Duvekot JJ, van Eyck J, Visser GH, Schmidt G, Ganzevoort W, Lees CC, Schneider KT, TRUFFLE investigators see Acknowledgmentset 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

Journal article

Shaw CJ, Rivens I, Civale J, Botting KJ, Giussani DA, ter Haar G, Lees CCet 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

Journal article

Shaw CJ, Civale J, Botting KJ, Niu Y, Giussani DA, Rivens I, ter Haar G, Lees CCet 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

Journal article

Shaw CJ, Lees CC, Giussani DA, 2016, Variations on fetal heart rate variability, Journal of Physiology - London, Vol: 594, Pages: 1279-1280, ISSN: 0022-3751

Journal article

Shaw CJ, Civale J, Giussani DA, Rivens I, ter Haar G, Lees CCet al., 2015, Ultrasound-guided High Intensity Focused Ultrasound (HIFU) ablation of placental vasculature, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 122, Pages: 54-54, ISSN: 1470-0328

Journal article

Shaw CJ, Botting KJ, Niu Y, ter Haar G, Lees CC, Giussani DAet al., 2015, Surgical uterine manipulation results in fetal brain sparing reflex, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 122, Pages: 56-56, ISSN: 1470-0328

Journal article

Shaw CJ, Allison BJ, Lees CC, Giussain DAet al., 2015, Fetal heart rate variability in the chronically hypoxic fetus, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 122, Pages: 55-55, ISSN: 1470-0328

Journal article

Shaw CJ, Botting KJ, Niu Y, Brew A, Rivens I, ter Haar G, Lees CC, Giussani DAet al., 2015, Surgical Uterine Manipulation Results in a Fetal Brain Sparing Reflex, REPRODUCTIVE SCIENCES, Vol: 22, Pages: 180A-180A, ISSN: 1933-7191

Journal article

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