27 results found
Masini G, Foo LF, Tay J, et al., 2022, Reply: Preeclampsia has 2 phenotypes that require different treatment strategies, AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, Vol: 227, Pages: 114-115, ISSN: 0002-9378
Masini G, Foo LF, Tay J, et al., 2022, Preeclampsia has two phenotypes which require different treatment strategies, American Journal of Obstetrics and Gynecology, Vol: 226, Pages: S1006-S1018, ISSN: 0002-9378
The opinion on the mechanisms underlying the pathogenesis of preeclampsia still divides scientists and clinicians. This common complication of pregnancy has long been viewed as a disorder linked primarily to placental dysfunction, which is caused by abnormal trophoblast invasion, however, evidence from the previous two decades has triggered and supported a major shift in viewing preeclampsia as a condition that is caused by inherent maternal cardiovascular dysfunction, perhaps entirely independent of the placenta. In fact, abnormalities in the arterial and cardiac functions are evident from the early subclinical stages of preeclampsia and even before conception. Moving away from simply observing the peripheral blood pressure changes, studies on the central hemodynamics reveal two different mechanisms of cardiovascular dysfunction thought to be reflective of the early-onset and late-onset phenotypes of preeclampsia. More recent evidence identified that the underlying cardiovascular dysfunction in these phenotypes can be categorized according to the presence of coexisting fetal growth restriction instead of according to the gestational period at onset, the former being far more common at early gestational ages. The purpose of this review is to summarize the hemodynamic research observations for the two phenotypes of preeclampsia. We delineate the physiological hemodynamic changes that occur in normal pregnancy and those that are observed with the pathologic processes associated with preeclampsia. From this, we propose how the two phenotypes of preeclampsia could be managed to mitigate or redress the hemodynamic dysfunction, and we consider the implications for future research based on the current evidence. Maternal hemodynamic modifications throughout pregnancy can be recorded with simple-to-use, noninvasive devices in obstetrical settings, which require only basic training. This review includes a brief overview of the methodologies and techniques used to study hemody
Masini G, Tay J, McEniery CM, et al., 2020, Maternal cardiovascular dysfunction is associated with hypoxic cerebral and umbilical doppler changes, Journal of Clinical Medicine, Vol: 9, Pages: 1-10, ISSN: 2077-0383
We investigate the relationship between maternal cardiovascular (CV) function and fetal Doppler changes in healthy pregnancies and those with pre-eclampsia (PE), small for gestational age (SGA) or fetal growth restriction (FGR). This was a three-centre prospective study, where CV assessment was performed using inert gas rebreathing, continuous Doppler or impedance cardiography. Maternal cardiac output (CO) and peripheral vascular resistance (PVR) were analysed in relation to the uterine artery, umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PI, expressed as z-scores by gestational week) using polynomial regression analyses, and in relation to the presence of absent/reversed end diastolic (ARED) flow in the UA. We included 81 healthy controls, 47 women with PE, 65 with SGA/FGR and 40 with PE + SGA/FGR. Maternal CO was inversely related to fetal UA PI and positively related to MCA PI; the opposite was observed for PVR, which was also positively associated with increased uterine artery impedance. CO was lower (z-score 97, p = 0.02) and PVR higher (z-score 2.88, p = 0.02) with UA ARED flow. We report that maternal CV dysfunction is associated with fetal vascular changes, namely raised impedance in the fetal-placental circulation and low impedance in the fetal cerebral vessels. These findings are most evident with critical UA Doppler changes and represent a potential mechanism for therapeutic intervention.
Santhirakumaran S, Tay J, Lees C, 2019, The relationship between maternal characteristics and carotid intima-media thickness using an automated ultrasound technique, Hypertension in Pregnancy, Vol: 38, Pages: 252-259, ISSN: 1064-1955
Objective: To investigate CIMT and its relationship with maternal demographic characteristics in healthy pregnancy. Methods: CIMT was measured using an au. Results: CIMT showed no relationship with gestational age (rho=−0.124, p=0.335), parity (Z=−0.055, p=0.960) and MAP (rho=0.110, p=0.393). A relationship was found between CIMT and maternal age (rho=0.277, p=0.028), booking BMI (rho=0.278, p=0.027), and BMI at time of study (rho=0.287, p=0.023). CIMT ranged from 0.30-0.80mm, the 97.5th percentile was 0.63 mm. Conclusion: In healthy pregnancy, we reported CIMT was related to BMI and maternal age but not parity or gestational age.
Tay J, Lees C, 2019, RE: Tay et al, Uterine and fetal placental Doppler indices are associated with maternal cardiovascular function, American Journal of Obstetrics and Gynecology, Vol: 221, Pages: 291-292, ISSN: 0002-9378
Bijl RC, Valensise H, Novelli GP, et al., 2019, Methods and considerations concerning cardiac output measurement in pregnant women: recommendations of the International Working Group on Maternal Hemodynamics, Ultrasound in Obstetrics and Gynecology, Vol: 54, Pages: 35-50, ISSN: 0960-7692
Cardiac output (CO), along with blood pressure and vascular resistance, is one of the most important parameters of maternal hemodynamic function. Substantial changes in CO occur in normal pregnancy and in most obstetric complications. With the development of several non‐invasive techniques for the measurement of CO, there is a growing interest in the determination of this parameter in pregnancy. These techniques were initially developed for use in critical‐care settings and were subsequently adopted in obstetrics, often without appropriate validation for use in pregnancy. In this article, methods and devices for the measurement of CO are described and compared, and recommendations are formulated for their use in pregnancy, with the aim of standardizing the assessment of CO and peripheral vascular resistance in clinical practice and research studies on maternal hemodynamics.
Paramasivam G, Kumar S, Sanna E, et al., 2019, Selective reduction in complex triplet pregnancy by radiofrequency ablation: single-centre experience, RCOG world congress 2019, Publisher: WILEY, Pages: 52-53, ISSN: 1470-0328
Masini G, Foo LF, Cornette J, et al., 2019, Cardiac output changes from prior to pregnancy to post partum using two non-invasive techniques, Heart, Vol: 105, Pages: 715-720, ISSN: 1355-6037
OBJECTIVES: We aimed to describe cardiac output (CO) trend from prepregnancy to post partum using an inert gas rebreathing (IGR) device and compare these measurements with those obtained by a pulse waveform analysis (PWA) technique, both cross-sectionally and longitudinally. METHODS: Non-smoking healthy women, aged 18-44 years, with body mass index <35 were included in this prospective observational study. CO measurements were collected at different time points (prepregnancy, at four different gestational epochs and post partum) using IGR and PWA. A linear mixed model analysis tested whether the longitudinal change in CO differed between the techniques. Bland-Altman analysis and intraclass correlation coefficient (ICC) were used for cross-sectional and a four-quadrant plot for longitudinal comparisons. RESULTS: Of the 413 participants, 69 had a complete longitudinal assessment throughout pregnancy. In this latter cohort, the maximum CO rise was seen at 15.2 weeks with IGR (+17.5% from prepregnancy) and at 10.4 weeks with PWA (+7.7% from prepregnancy). Trends differed significantly (p=0.0093). Cross-sectional analysis was performed in the whole population of 413 women: the mean CO was 6.14 L/min and 6.38 L/min for PWA and IGR, respectively, the percentage of error was 46% and the ICC was 0.348, with similar results at all separate time points. Longitudinal concordance was 64%. CONCLUSIONS: Despite differences between devices, the maximum CO rise in healthy pregnancies is more modest and earlier than previously reported. The two methods of CO measurement do not agree closely and cannot be used interchangeably. Technique-specific reference ranges are needed before they can be applied in research and clinical settings.
Tay J, Masini G, McEniery CM, et 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
Lees C, Tay J, Wilkinson I, 2018, Reply to: Early and late preeclampsia are characterized by high cardiac output, but in the presence of fetal growth restriction, cardiac output is low: insights from a prospective study, American Journal of Obstetrics and Gynecology, Vol: 219, Pages: 627-628, ISSN: 0002-9378
Gyselaers W, Spaanderman M, International Working Group on Maternal Hemodynamics, 2018, Assessment of venous hemodynamics and volume homeostasis during pregnancy: recommendations of the International Working Group on Maternal Hemodynamics, Ultrasound in Obstetrics and Gynecology, Vol: 52, Pages: 174-185, ISSN: 0960-7692
Venous hemodynamics and volume homeostasis are important aspects of cardiovascular physiology. However, today their relevance is still very much underappreciated. Their most important role is maintenance and control of venous return and, as such, cardiac output. A high-flow/low-resistance circulation, remaining constant under physiological circumstances, is mandatory for an uncomplicated course of pregnancy. In this article, characteristics of normal and abnormal venous and volume regulating functions are discussed with respect to normal and pathologic outcomes of pregnancy, and current (non-invasive) methods to assess these functions are summarized. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Tay J, Costanzi A, Basello K, et al., 2018, Maternal Serum B Cell activating factor in hypertensive and normotensive pregnancies, Pregnancy Hypertension, Vol: 13, Pages: 58-61, ISSN: 2210-7789
ObjectivesThe objective of this study was the analysis of B-Cell Activating Factor (BAFF) levels in pregnancies affected by PE, and in pregnancies affected by fetal growth restriction without Hypertensive disorders and its possible correlation with pulse wave velocity and cardiac output.Study designProspective study of 69 women at 24–40 weeks gestation. Haemodynamic function was assessed in those with Pre-eclampsia (PE, n = 19), fetal growth restriction (FGR, n = 10) and healthy pregnancies (n = 40). Maternal venous BAFF levels at recruitment were measured using ELISA. We analysed the relationship between BAFF and cardiac output (CO), and BAFF and PWV (pulse wave velocity); the gold standard for assessing arterial stiffness. PWV was measured with an oscillometric device and CO using inert gas rebreathing technique. PWV and CO were converted to gestation adjusted indices (z scores).Main outcome measuresThe association between BAFF levels in PE and FGR, and the relationship of BAFF with PWV and CO.ResultsBAFF was higher in PE (p = 0.03) but not in FGR (p = 0.83) when compared to healthy pregnancies. There was a positive correlation between BAFF levels and z score PWV (r = 0.25, p = 0.04), but not CO (r = −0.01, p = 0.91). BAFF levels did not change with gestational age. (r = 0.012, p = 0.925).ConclusionsThese findings provide evidence of a possible contribution of BAFF to both maternal inflammation and arterial dysfunction associated with PE. Though no relationship was found with another disorder of placentation: normotensive FGR, this condition is not thought to be associated with maternal inflammation.
Tay J, Foo L, Masini G, et al., 2018, Cardiac output in pre eclampsia is associated with the presence of fetal growth restriction, not gestation at onset: a prospective cohort study, American Journal of Obstetrics and Gynecology, Vol: 218, Pages: 517.e1-517.e12, ISSN: 0002-9378
BACKGROUND AND OBJECTIVES: Pre-eclampsia (PE) and fetal growth restriction (FGR) are considered to be placentally-mediated disorders. The clinical manifestations are widely held to relate to gestation age at onset with early- and late-onset PE considered to be phenotypically distinct. Recent studies have reported conflicting findings in relation to cardiovascular function, and in particular cardiac output, in PE and FGR. STUDY DESIGN: We investigated maternal cardiovascular function in relation to clinical subtype in 45 pathological pregnancies (14 'PE only', 16 'FGR only', 15 'PE and FGR') and compared these with 107 healthy person observations. Cardiac output (CO) was the primary outcome measure, and was assessed using an inert gas rebreathing method (Innocor®), from which peripheral vascular resistance was derived (PVR); arterial function was assessed by Vicorder ®, a cuff-based oscillometric device. Cardiovascular parameters were normalised for gestational age in relation to healthy pregnancies using Z scores, thus allowing for comparison across the gestational range 24-40 weeks. RESULTS: Compared with healthy control pregnancies, women with PE had higher CO Z scores (1.87 ± 1.35; p=0.0001) and lower PVR Z scores (-0.76± 0.89; p=0.025); those with FGR had higher PVR Z scores (0.57± 1.18; p=0.04) and those with both PE and FGR had lower CO Z scores (-0.80 ± 1.3; p= 0.007) and higher PVR Z scores (2.16 ± 1.96; p=0.0001). These changes were not related to gestational age of onset. All those affected by PE and/or FGR had abnormally raised augmentation index (AIx) and pulse wave velocity (PWV). Furthermore, in PE, low CO was associated with low birthweight and high CO with high birthweight. (r=0.42, p=0.03). CONCLUSIONS: PE is associated with high CO, but if PE presents with FGR, the opposite is true; both conditions are, nevertheless, defined by hypertension. FGR without PE is associated with high PVR. Though 'early' and 'l
Meah VL, Backx K, Davenport MH, et al., 2018, Functional hemodynamic testing in pregnancy: recommendations of the International Working Group on Maternal Hemodynamics, Ultrasound in Obstetrics and Gynecology, Vol: 51, Pages: 331-340, ISSN: 0960-7692
In the general population, functional hemodynamic testing, such as that during submaximal aerobic exercise and isometric handgrip, and the cold pressor test, has long been utilized to unmask abnormalities in cardiovascular function. During pregnancy, functional hemodynamic testing places additional demands on an already stressed maternal cardiovascular system. Dysfunctional responses to such tests in early pregnancy may predict the development of hypertensive disorders that develop later in gestation. For each of the above functional hemodynamic tests, these recommendations provide a description of the test, test protocol and equipment required, and an overview of the current understanding of clinical application during pregnancy.
Foo LF, Tay J, Wilkinson I, 2018, Treatment Options for Hypertension in Pregnancy, Maternal Hemodynamics, Pages: 141-160, ISBN: 9781107157378
Hypertensive disorders of pregnancy affect approximately 5-10% of all maternities and are major contributors of maternal and neonatal morbidity and mortality worldwide. This group of disorders encompasses chronic hypertension, as well as conditions that arise de novo in pregnancy: gestational hypertension and preeclampsia. The latter group is thought to be part of the same continuum but with arbitrary division. Research into the etiology of hypertension in pregnancy has largely been focused on preeclampsia, with a majority of studies exploring either pregnancy-associated factors such as placental derived or immunologic responses to pregnancy tissue, or maternal constitutional factors such as cardiovascular health and endothelial dysfunction. The evidence base for the pathophysiology and progression of hypertensive disorders in pregnancy, particularly preeclampsia, is reviewed. Clinical algorithms and pharmacological agents for the management of hypertension in pregnancy are summarized, with a brief focus on postpartum considerations. Novel therapeutic options for the management of preeclampsia are also explored.
Lees C, Gyselaers W, 2018, Maternal Hemodynamics, Pages: 1-256, ISBN: 9781107157378
Discover new concepts in cardiovascular and hemodynamic functionality during pregnancy, with international experts in feto-maternal medicine. During the early stages of pregnancy, the maternal heart and circulation are subject to major gestational adaptive changes that allow for a normal course and outcome for both mother and baby. Any disruption to these processes can precipitate the onset of severe maternal and fetal complications such as preeclampsia, or intrauterine growth restriction. This invaluable reference work provides a comprehensive discussion of each aspect of the circulation. With a focus on the physiologic and pathophysiologic aspects of maternal cardiovascular function, this guide supports non-invasive assessment, management and prevention techniques for cardiovascular disease, for all stages of fetal and neonatal life. This text supports researchers and specialists in maternal-fetal medicine, whilst providing a key grounding in the topic, for trainees wishing to be at the cutting edge of theories and research.
Foo FL, McEniery CM, Lees C, et al., 2017, Assessment of arterial function in pregnancy: recommendations of the International Working Group on Maternal Haemodynamics., Ultrasound in Obstetrics and Gynecology, Vol: 50, Pages: 324-331, ISSN: 0960-7692
There is strong evidence supporting the role of maternal arterial dysfunction in pregnancy-specific disorders such as pre-eclampsia and intrauterine growth restriction. As more work is focused towards this field, it is important that methods and interpretation of arterial function assessment are applied appropriately. Here, we summarize techniques and devices commonly used in maternal health studies, with consideration of their technical application in pregnant cohorts.
Usman S, Foo L, Tay J, et al., 2017, Authors' reply [Use of magnesium sulfate in preterm deliveries for neuroprotection of the neonate], Obstetrician and Gynaecologist, Vol: 19, Pages: 255-256, ISSN: 1744-4667
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.
Foo L, Tay J, Lees CC, et al., 2015, Hypertension in Pregnancy: Natural History and Treatment Options, CURRENT HYPERTENSION REPORTS, Vol: 17, ISSN: 1522-6417
- Author Web Link
- Citations: 26
Tay J, 2015, A ‘classic’ case of heavy menstrual bleeding?, Challenging Concepts in Obstetrics and Gynaecology Cases with Expert Commentary, Publisher: Oxford University Press, USA, ISBN: 9780199654994
This is a case-based guide to difficult scenarios faced in the fields of obstetrics and gynaecology.
O'Brien AL, Chandiramani M, Lees CC, et al., 2014, MIDWIFE LED DELIVERY NICE guidance on place of birth falls short of neutrality, BMJ-BRITISH MEDICAL JOURNAL, Vol: 349, ISSN: 1756-1833
- Author Web Link
- Citations: 2
Tay J, Mohan S, Higham J, 2011, Current approaches to managing heavy menstrual bleeding, Prescriber, Vol: 22, Pages: 27-35, ISSN: 0959-6682
Tay J, Parker H, Dhange P, et al., 2010, Isolated torsion of the fallopian tube in a patient with polycystic ovarian syndrome (PCOS), EUROPEAN JOURNAL OF OBSTETRICS & GYNECOLOGY AND REPRODUCTIVE BIOLOGY, Vol: 150, Pages: 218-219, ISSN: 0301-2115
- Author Web Link
- Citations: 1
Furness P, Glazebrook C, Tay J, et al., 2009, Medically unexplained physical symptoms in children: exploring hospital staff perceptions., Clin Child Psychol Psychiatry, Vol: 14, Pages: 575-587
Many children present at GP surgeries with debilitating symptoms with no obvious physical cause and are then referred to acute settings for investigation. Research with GPs suggests caring for this group of patients presents a significant challenge, however, the impact upon the range of hospital staff with whom they have contact has been little studied. This study aimed to explore perceptions and experiences of caring for children with medically unexplained physical symptoms (MUPS) and their families among the paediatric staff at one large UK hospital Trust. Data demonstrated staff awareness that children affected by MUPS have complex needs and the perception that those needs resulted in extra demands and anxieties, especially regarding time management, care protocols and communication. There was a clear desire by general paediatric staff for more information and training from psychiatric services to help them care for this group. Results also revealed staff perceptions of the quality of current MUPS care and suggestions as to how this could be improved.
Glazebrook C, Furness P, Tay J, et al., 2009, Development of a Scale to Assess the Attitudes of Paediatric Staff to Caring for Children with Medically Unexplained Symptoms: Implications for the Role of CAMHS in Paediatric Care, CHILD AND ADOLESCENT MENTAL HEALTH, Vol: 14, Pages: 104-108, ISSN: 1475-357X
- Author Web Link
- Citations: 5
Tay J, Siddiq T, Atiomo W, 2009, Future recruitment into obstetrics and gynaecology: Factors affecting early career choice, JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 29, Pages: 369-372, ISSN: 0144-3615
- Author Web Link
- Citations: 6
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