1.
Placental syndromes: getting to the heart of the matter
Ultrasound in obstetrics & gynecology,
January 2017, 2017-Jan, 2017-01-00, 20170101, Letnik:
49, Številka:
1
Journal Article
A video podcast of the TED Talk of this article can be accessed from the following link: http://bit.ly/2i1SqDk
2.
3.
4.
Consensus definition of fetal growth restriction: a Delphi procedure
Gordijn, S. J.; Beune, I. M.; Thilaganathan, B. ...
Ultrasound in obstetrics & gynecology,
September 2016, 2016-Sep, 20160901, Letnik:
48, Številka:
3
Journal Article
ABSTRACT
Objective
To determine, by expert consensus, a definition for early and late fetal growth restriction (FGR) through a Delphi procedure.
Method
A Delphi survey was conducted among an ...
international panel of experts on FGR. Panel members were provided with 18 literature‐based parameters for defining FGR and were asked to rate the importance of these parameters for the diagnosis of both early and late FGR on a 5‐point Likert scale. Parameters were described as solitary parameters (parameters that are sufficient to diagnose FGR, even if all other parameters are normal) and contributory parameters (parameters that require other abnormal parameter(s) to be present for the diagnosis of FGR). Consensus was sought to determine the cut‐off values for accepted parameters.
Results
A total of 106 experts were approached, of whom 56 agreed to participate and entered the first round, and 45 (80%) completed all four rounds. For early FGR (< 32 weeks), three solitary parameters (abdominal circumference (AC) < 3rd centile, estimated fetal weight (EFW) < 3rd centile and absent end‐diastolic flow in the umbilical artery (UA)) and four contributory parameters (AC or EFW < 10th centile combined with a pulsatility index (PI) > 95th centile in either the UA or uterine artery) were agreed upon. For late FGR (≥ 32 weeks), two solitary parameters (AC or EFW < 3rd centile) and four contributory parameters (EFW or AC < 10th centile, AC or EFW crossing centiles by > two quartiles on growth charts and cerebroplacental ratio < 5th centile or UA‐PI > 95th centile) were defined.
Conclusion
Consensus‐based definitions for early and late FGR, as well as cut‐off values for parameters involved, were agreed upon by a panel of experts. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
več
5.
Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta‐analysis
Pagani, G.; Thilaganathan, B.; Prefumo, F.
Ultrasound in obstetrics & gynecology,
September 2014, Letnik:
44, Številka:
3
Journal Article
ABSTRACT
Objectives
The finding of fetal ventriculomegaly is variably associated with other fetal abnormalities and, even when isolated, is thought to be linked to abnormal neurodevelopmental ...
outcome. The aim of this study was to undertake a systematic review and meta‐analysis of the current literature to assess the prevalence of neurodevelopmental delay in cases of isolated mild fetal ventriculomegaly, as well as the false‐negative rate of prenatal imaging for the diagnosis of associated abnormalities in patients referred for isolated mild ventriculomegaly.
Methods
Studies that assessed neurodevelopmental outcome in isolated ventriculomegaly were identified from a search of scientific databases. Studies that did not check for karyotype or that excluded cases of bilateral ventriculomegaly were not included in the analysis. Ventriculomegaly was defined as mild when the width of the ventricular atrium was between 10 and 15 mm. Cases in which an associated abnormality (abnormal karyotype, structural abnormality or fetal infection) was observed either before or after birth were not considered as part of the isolated group. Neurodevelopmental delay was defined as an abnormal quotient score, according to the test used.
Results
The search yielded 961 possible citations; of these, 904 were excluded by review of the title or as they did not meet the selection criteria. Full manuscripts were retrieved for 57 studies, and 20 were included in the review with a total of 699 cases of isolated mild ventriculomegaly. The overall prevalence of neurodevelopmental delay was 7.9% (95% CI, 4.7–11.1%). Of the 20 studies included in the systematic review, nine reported data on postnatal imaging, showing a prevalence of previously undiagnosed findings of 7.4% (95% CI, 3.1–11.8%).
Conclusions
The false‐negative rate of prenatal imaging is 7.4% in apparently isolated fetal ventriculomegaly of ≤ 15 mm. The incidence of neurodevelopmental delay in truly isolated ventriculomegaly of ≤ 15 mm is 7.9%. As the latter rate is similar to that noted in the general population, large prospective cohort studies assessing the prevalence of childhood disability, rather than subtle neurodevelopmental delay, are required. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd
This article has been selected for Journal Club. Click here to view slides and discussion points.
več
6.
Perinatal changes in fetal cardiac geometry and function in diabetic pregnancy at term
Patey, O.; Carvalho, J. S.; Thilaganathan, B.
Ultrasound in obstetrics & gynecology,
November 2019, Letnik:
54, Številka:
5
Journal Article
ABSTRACT
Objective
To evaluate the effect of diabetes in pregnancy on fetal and neonatal cardiac geometry and function around the time of delivery.
Methods
This was a prospective study of 75 pregnant ...
women delivering at term, comprising 54 normal pregnancies and 21 with a diagnosis of pregestational or gestational diabetes mellitus. Fetal and neonatal conventional and spectral tissue Doppler and two‐dimensional speckle‐tracking echocardiography were performed a few days before and within hours after delivery. Fetal and neonatal cardiac geometry, global myocardial deformation and performance, diastolic and systolic function and left ventricular (LV) torsion were compared between normal pregnancies and those with diabetes, and perinatal changes within the diabetes group were assessed.
Results
Compared with normal pregnancies, diabetic pregnancies demonstrated significant differences in fetal ventricular geometry, myocardial deformation and cardiac function (right ventricular (RV) sphericity index, 0.56 vs 0.65; LV torsion, 2.1 °/cm vs 5.6 °/cm; LV isovolumetric relaxation time, 101 ms vs 115 ms; and RV isovolumetric contraction time, 107 ms vs 119 ms; P < 0.001 for all). Compared with normal pregnancies, diabetic pregnancies demonstrated significant differences in neonatal cardiac parameters (mean RV sphericity index, 0.43 vs 0.55; mean LV torsion, 1.30 °/cm vs 2.78 °/cm; median LV myocardial performance index (MPI′), 0.39 vs 0.51; median RV‐MPI′, 0.34 vs 0.40; P < 0.01 for all). Paired comparison between fetal and neonatal cardiac indices in diabetic pregnancies demonstrated that delivery resulted in a significant improvement in some, but not all, cardiac indices (mean RV sphericity index, 0.65 vs 0.55; mean LV torsion, 5.60 °/cm vs 2.78 °/cm; median RV‐MPI′, 0.51 vs 0.40; P < 0.01 for all).
Conclusions
Compared with normal term fetuses and neonates, those of diabetic women exhibit cardiac indices indicative of myocardial impairment, reflecting a response to a relatively hyperglycemic intrauterine environment with alteration in fetal loading conditions (LV preload deprivation and increased RV afterload) and adaptation to subsequent acute changes in hemodynamic load at delivery. Elucidating mechanisms that contribute to the alterations in perinatal cardiac function in diabetic pregnancy could help in refining management and developing better therapeutic strategies to reduce the risk of adverse pregnancy outcomes. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
več
7.
Consensus definition and essential reporting parameters of selective fetal growth restriction in twin pregnancy: a Delphi procedure
Khalil, A.; Beune, I.; Hecher, K. ...
Ultrasound in obstetrics & gynecology,
January 2019, 2019-Jan, 2019-01-00, 20190101, Letnik:
53, Številka:
1
Journal Article
ABSTRACT
Objectives
Twin pregnancy complicated by selective fetal growth restriction (sFGR) is associated with increased perinatal mortality and morbidity. Inconsistencies in the diagnostic criteria ...
for sFGR employed in existing studies hinder the ability to compare or combine their findings. It is therefore challenging to establish robust evidence‐based management or monitoring pathways for these pregnancies. The main aim of this study was to determine, by expert consensus using a Delphi procedure, the key diagnostic features of and the essential reporting parameters in sFGR.
Methods
A Delphi process was conducted among an international panel of experts in sFGR in twin pregnancy. Panel members were provided with a list of literature‐based parameters for diagnosing sFGR and were asked to rate their importance on a five‐point Likert scale. Parameters were described as solitary (sufficient to diagnose sFGR, even if all other parameters are normal) or contributory (those that require other abnormal parameter(s) to be present for the diagnosis of sFGR). Consensus was sought to determine the cut‐off values for accepted parameters, as well as parameters used in the monitoring, management and assessment of outcome of twin pregnancy complicated by sFGR. The questions were presented in two separate categories according to chorionicity.
Results
A total of 72 experts were approached, of whom 60 agreed to participate and entered the first round; 48 (80%) completed all four rounds. For the definition of sFGR irrespective of chorionicity, one solitary parameter (estimated fetal weight (EFW) of one twin < 3rd centile) was agreed. For monochorionic twin pregnancy, at least two out of four contributory parameters (EFW of one twin < 10th centile, abdominal circumference of one twin < 10th centile, EFW discordance of ≥ 25%, and umbilical artery pulsatility index of the smaller twin > 95th centile) were agreed. For sFGR in dichorionic twin pregnancy, at least two out of three contributory parameters (EFW of one twin < 10th centile, EFW discordance of ≥ 25%, and umbilical artery pulsatility index of the smaller twin > 95th centile) were agreed.
Conclusions
Consensus‐based diagnostic features of sFGR in both monochorionic and dichorionic twin pregnancies, as well as cut‐off values for the parameters involved, were agreed upon by a panel of experts. Future studies are needed to validate these diagnostic features before they can be used in clinical trials of interventions. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
več
8.
Implementation of routine first trimester combined screening for pre‐eclampsia: a clinical effectiveness study
Guy, GP; Leslie, K; Diaz Gomez, D ...
BJOG : an international journal of obstetrics and gynaecology,
January 2021, Letnik:
128, Številka:
2
Journal Article
Objective
Evaluate clinical effectiveness of the first trimester combined (FMF) pre‐eclampsia screening programme when implemented in a public healthcare setting.
Design
Retrospective cohort study.
...
Setting
London tertiary hospital from January 2017 to March 2019.
Methods
7720 women screened for pre‐eclampsia according to National Institute for Health and Care Excellence (NICE) risk‐based guidance and 4841 by the Fetal Medical Foundation (FMF) algorithm which combined maternal risk factors, blood pressure, PAPP‐A and uterine artery Doppler indices in the first trimester. High risk was defined by standard NICE criteria in the pre‐intervention cohort (prescribed 75 mg aspirin) or a risk of ≥1:50 for preterm pre‐eclampsia from the FMF algorithm in the post‐intervention cohort (prescribed 150 mg aspirin).
Main outcome measures
Screening effectiveness, rates of pre‐eclampsia.
Results
The FMF screening programme resulted in a significant reduction in the screen‐positive rate (16.1 versus 8.2%, odds ratio OR 0.50, 95% confidence interval CI 0.41–0.53) with a concurrent increase in targeted aspirin use in women classified as high risk for pre‐eclampsia (28.9 versus 99.0%, OR 241.6, 95% CI 89.6–652.0). Screening indices were uniformly improved for the FMF algorithm with receiver operating characteristic (ROC) analysis demonstrating excellent discrimination for preterm pre‐eclampsia (area under the curve AUC = 0.846, 95% CI 0.778–0.915, P value <.001). Interrupted time series analysis showed that the FMF screening programme resulted in a significant 21‐month relative effect reduction of 80% (P = .025) and 89% (P = .017), for preterm and early pre‐eclampsia, respectively.
Conclusions
First trimester combined screening for pre‐eclampsia is both feasible and effective in a public healthcare setting. Such an approach results in a two‐fold de‐escalation of risk, doubling of pre‐eclampsia detection, near total physician compliance of aspirin use and a significant reduction in the prevalence of preterm pre‐eclampsia.
Tweetable
Implementation of 1st trimester combined pre‐eclampsia screening effectively reduces prevalence of the disorder.
Tweetable
Implementation of 1st trimester combined pre‐eclampsia screening effectively reduces prevalence of the disorder.
This article includes Author Insights, a video is available at https://vimeo.com/rcog/authorinsights16361
več
9.
Perinatal changes in cardiac geometry and function in growth‐restricted fetuses at term
Patey, O.; Carvalho, J. S.; Thilaganathan, B.
Ultrasound in obstetrics & gynecology,
20/May , Letnik:
53, Številka:
5
Journal Article
ABSTRACT
Objective
To evaluate the effect of fetal growth restriction (FGR) at term on fetal and neonatal cardiac geometry and function.
Methods
This was a prospective study of 87 pregnant women ...
delivering at term, comprising 54 normally grown and 33 FGR pregnancies. Fetal and neonatal conventional and spectral tissue Doppler and two‐dimensional speckle tracking echocardiography were performed a few days before and within hours after birth. Fetal cardiac geometry, global myocardial deformation and performance and systolic and diastolic function were compared between normal and FGR pregnancies before and after birth.
Results
Compared with normally grown fetuses, FGR fetuses exhibited more globular ventricular geometry and poorer myocardial deformation and cardiac function (left ventricular (LV) sphericity index (SI), 0.54 vs 0.49; right ventricular (RV) SI, 0.60 vs 0.54; LV torsion, 1.2 °/cm vs 3.0 °/cm; LV isovolumetric contraction time normalized by cardiac cycle length, 121 ms vs 104 ms; interventricular septum early diastolic myocardial peak velocity/atrial contraction myocardial diastolic peak velocity ratio, 0.60 vs 0.71; P < 0.01 for all). The poorest perinatal outcomes occurred in FGR fetuses with the most impaired cardiac functional indices. When compared with normally grown neonates, FGR neonates showed persistent alteration in cardiac parameters (LV‐SI, 0.53 vs 0.50; RV‐SI, 0.54 vs 0.44; LV torsion, 1.1 °/cm vs 1.4 °/cm; LV myocardial performance index (MPI′), 0.52 vs 0.42; P < 0.01 for all). Paired comparison of fetal vs neonatal cardiac indices in FGR demonstrated that birth was associated with a significant improvement in some, but not all, cardiac indices (RV‐SI, 0.60 vs 0.54; RV‐MPI′, 0.49 vs 0.39; P < 0.001 for all).
Conclusions
Compared with normal pregnancies, FGR fetuses and neonates at term exhibit altered cardiac indices indicative of myocardial impairment that reflect adaptation to placental hypoxemia and alterations in hemodynamic load around the time of birth. Elucidating potential mechanisms that contribute to the alterations in perinatal cardiac adaptation in FGR could improve management and aid the development of better therapeutic strategies to reduce the risk of adverse pregnancy outcome. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
več
10.
Home blood‐pressure monitoring in a hypertensive pregnant population
Perry, H.; Sheehan, E.; Thilaganathan, B. ...
Ultrasound in obstetrics & gynecology,
April 2018, Letnik:
51, Številka:
4
Journal Article
ABSTRACT
Objective
The majority of patients with chronic or gestational hypertension do not develop pre‐eclampsia. Home blood‐pressure monitoring (HBPM) has the potential to offer a more accurate and ...
acceptable means of monitoring hypertensive patients during pregnancy compared with traditional pathways of frequent outpatient monitoring. The aim of this study was to determine whether HBPM reduces visits to antenatal services and is safe in pregnancy.
Methods
This was a case–control study of 166 hypertensive pregnant women, which took place at St George's Hospital, University of London. Inclusion criteria were: chronic hypertension, gestational hypertension or high risk of developing pre‐eclampsia, no significant proteinuria (≤ 1+ proteinuria on dipstick testing) and normal biochemical and hematological markers. Exclusion criteria were maternal age < 16 years, systolic blood pressure > 155 mmHg or diastolic blood pressure > 100 mmHg, significant proteinuria (≥ 2+ proteinuria on dipstick testing or protein/creatinine ratio > 30 mg/mmol), evidence of small‐for‐gestational age (estimated fetal weight < 10th centile), signs of severe pre‐eclampsia, significant mental health concerns or insufficient understanding of the English language. Pregnant women in the HBPM group were taught how to measure and record their blood pressure using a validated machine at home and attended every 1–2 weeks for assessment depending on clinical need. The control group was managed as per the local protocol prior to the implementation of HBPM. The two groups were compared with respect to number of visits to antenatal services and outcome.
Results
There were 108 women in the HBPM group and 58 in the control group. There was no difference in maternal age, parity, body mass index, ethnicity or smoking status between the groups, but there were more women with chronic hypertension in the HBPM group compared with the control group (49.1% vs 25.9%, P = 0.004). The HBPM group had significantly fewer outpatient attendances per patient (6.5 vs 8.0, P = 0.003) and this difference persisted when taking into account differences in duration of monitoring (0.8 vs 1.6 attendances per week, P < 0.001). There was no difference in the incidence of adverse maternal, fetal or neonatal outcome between the two groups.
Conclusion
HBPM in hypertensive pregnancies has the potential to reduce the number of hospital visits required by patients without compromising maternal and pregnancy outcomes. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Resumen
Control de la presión arterial en el hogar en una población de embarazadas con hipertensión
Objetivo
La mayoría de las pacientes con hipertensión crónica o gestacional no desarrollan preeclampsia. El control de la presión arterial en el hogar (HBPM, por sus siglas en inglés) puede ofrecer un medio más preciso y aceptable para controlar a las pacientes con hipertensión durante el embarazo, en comparación con las formas tradicionales de control ambulatorio frecuente. El objetivo de este estudio fue determinar si el HBPM reduce las visitas a los servicios prenatales y es una práctica segura durante el embarazo.
Métodos
Se describe un estudio de control de casos de 166 mujeres embarazadas con hipertensión, que se llevó a cabo en el hospital St. George de la Universidad de Londres. Los criterios de inclusión fueron: hipertensión crónica, hipertensión gestacional o alto riesgo de desarrollo de preeclampsia, proteinuria no significativa (proteinuria ≤1gr + en las pruebas con tiras reactivas) y marcadores bioquímicos y hematológicos normales. Los criterios de exclusión fueron: edad materna <16 años, tensión arterial sistólica >155 mmHg o tensión arterial diastólica >100 mmHg, proteinuria significativa (proteinuria ≥2gr + en pruebas con tiras reactivas o cociente proteína/creatinina >30 mg/mmol), evidencia de desarrollo pequeño para la edad gestacional (peso fetal estimado <10o percentil), signos de preeclampsia grave, problemas significativos de salud mental o comprensión insuficiente del idioma inglés. A las mujeres embarazadas del grupo de HBPM se les enseñó cómo medir y registrar en el hogar su presión arterial con una máquina homologada y visitas de revisión cada 1 a 2 semanas, según sus necesidades clínicas. El grupo de control se controló de acuerdo con el protocolo local antes de la implementación del HBPM. Los dos grupos se compararon con respecto al número de visitas a los servicios prenatales y el resultado.
Resultados
El grupo de HBPM estuvo formado por 108 mujeres y el de control por 58. No hubo diferencias entre los grupos en cuanto a la edad materna, paridad, índice de masa corporal, origen étnico o tabaquismo, pero si hubo más mujeres con hipertensión crónica en el grupo de HBPM en comparación con el grupo de control (49,1% vs. 25,9%, P = 0,004). El grupo de HBPM tuvo significativamente menos visitas ambulatorias por paciente (6,5 vs. 8,0, P = 0,003) y esta diferencia se mantuvo cuando se tomaron en cuenta las diferencias en la duración del control (0,8 vs. 1,6 visitas por semana, P <0,001). No hubo diferencias entre los dos grupos en la incidencia de resultados adversos maternos, fetales o neonatales.
Conclusión
El HBPM en embarazos con hipertensión tiene potencial para reducir el número de visitas necesarias al hospital, sin comprometer los resultados maternos y del embarazo.
摘要
妊娠期高血压人群进行家庭血压监测
目的
大多数慢性或妊娠期高血压患者并不发生先兆子痫。家庭血压监测(home blood‐pressure monitoring,HBPM)与传统的频繁门诊监测方法相比,为妊娠期高血压患者监测提供了一种更加准确、易行的方法。本研究的目的是检测HBPM能否减少产前就诊次数,以及在妊娠期间是否安全。
方法
研究为病例对照研究,纳入于伦敦大学圣乔治医院就诊的166例妊娠期高血压患者。纳入标准:慢性高血压,妊娠期高血压或发生先兆子痫的风险较高,无明显蛋白尿(试纸法尿蛋白≤1+)且生化和血液学标志物正常。排除标准:孕妇年龄<16岁,收缩压>155 mmHg或舒张压>100 mmHg,明显蛋白尿(试纸法尿蛋白≥2+或蛋白/肌酐比值>30 mg/mmol),有证据显示为小于胎龄儿(估计胎儿体重<第10百分位数),重度先兆子痫体征,明显心理健康问题或不能英语交流。教会HBPM组孕妇如何应用经过测试的仪器在家检测和记录血压,并根据临床需要每隔1~2周接受一次评估。对照组在进行HBPM前根据当地方案进行监测。比较2组的产前就诊次数和结局。
结果
HBPM组纳入108例孕妇,对照组纳入58例孕妇。孕妇年龄、产次、体重指数、种族或吸烟情况无差异,但HBPM组慢性高血压患者数量多于对照组(49.1%和25.9%,P =0.004)。HBPM组每位患者的门诊就诊次数明显较少(6.5和8.0,P =0.003),将监测时间不同考虑在内时,这种差异持续存在(每周就诊次数0.8和1.6,P <0.001)。2组比较,不良母体、胎儿或新生儿结局的发生率无差异。
结论
妊娠期高血压患者进行HBPM可能减少患者的就诊次数,且不影响母体和妊娠结局。
This article's has been translated into Spanish and Chinese. Follow the links from the to view the translations.
več
PDF
