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Hanidu A, Djongianto TU, Kovalenko M, Gupta E, Jansen M, Usman S, Joash K, Challacombe FL, Lees C. Determining psychological impact of delivery mode prediction using ultrasound and clinical assessment. Ultrasound Obstet Gynecol 2024. [PMID: 38308853 DOI: 10.1002/uog.27601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Affiliation(s)
- A Hanidu
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - T U Djongianto
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M Kovalenko
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - E Gupta
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M Jansen
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S Usman
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - K Joash
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - F L Challacombe
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - C Lees
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Dall'Asta A, Penas Da Costa MA, Sorrentino S, Lees C, Ghi T. Counseling in Fetal Medicine: pre- and periviable fetal growth restriction. Ultrasound Obstet Gynecol 2023. [PMID: 37902741 DOI: 10.1002/uog.27519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/07/2023] [Accepted: 10/19/2023] [Indexed: 10/31/2023]
Affiliation(s)
- A Dall'Asta
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Italy
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom
| | - M A Penas Da Costa
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Italy
| | - S Sorrentino
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Italy
| | - C Lees
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Tullio Ghi
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Italy
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Dall'asta A, Figueras F, Rizzo G, Ramirez Zegarra R, Morganelli G, Giannone M, Cancemi A, Mappa I, Lees C, Frusca T, Ghi T. Uterine artery Doppler in early labor and perinatal outcome in low-risk term pregnancy: prospective multicenter study. Ultrasound Obstet Gynecol 2023; 62:219-225. [PMID: 36905679 DOI: 10.1002/uog.26199] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/21/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The prediction of adverse perinatal outcomes in low-risk pregnancies is poor, mainly owing to the lack of reliable biomarkers. Uterine artery (UtA) Doppler is closely associated with placental function and may facilitate the peripartum detection of subclinical placental insufficiency. The objective of this study was to evaluate the association of mean UtA pulsatility index (PI) measured in early labor with obstetric intervention for suspected intrapartum fetal compromise and adverse perinatal outcome in uncomplicated singleton term pregnancies. METHODS This was a prospective multicenter observational study conducted across four tertiary maternity units. Low-risk term pregnancies with spontaneous onset of labor were included. The mean UtA-PI was recorded between uterine contractions in women admitted for early labor and converted into multiples of the median (MoM). The primary outcome of the study was the occurrence of obstetric intervention, i.e. Cesarean section or instrumental delivery, for suspected intrapartum fetal compromise. Secondary outcomes were the occurrence of adverse perinatal outcomes, including 5-min Apgar score < 7, low cord arterial pH, raised cord arterial base excess, admission to the neonatal intensive care unit (NICU) and postnatal diagnosis of small-for-gestational-age fetus. Composite adverse perinatal outcome was defined as the occurrence of at least one of the following: acidemia in the umbilical artery, defined as pH < 7.10 and/or base excess > 12 mmol/L, 5-min Apgar score < 7 or admission to the NICU. RESULTS Overall, 804 women were included, of whom 40 (5.0%) had abnormal mean UtA-PI MoM. Women who had an obstetric intervention for suspected intrapartum fetal compromise were more frequently nulliparous (72.2% vs 53.6%; P = 0.008), had a higher frequency of increased mean UtA-PI MoM (13.0% vs 4.4%; P = 0.005) and had a longer duration of labor (456 ± 221 vs 371 ± 192 min; P = 0.01). On logistic regression analysis, only increased mean UtA-PI MoM (adjusted odds ratio (aOR), 3.48 (95% CI, 1.43-8.47); P = 0.006) and parity (aOR, 0.45 (95% CI, 0.24-0.86); P = 0.015) were independently associated with obstetric intervention for suspected intrapartum fetal compromise. Increased mean UtA-PI MoM was associated with a sensitivity of 0.13 (95% CI, 0.05-0.25), specificity of 0.96 (95% CI, 0.94-0.97), positive predictive value of 0.18 (95% CI, 0.07-0.33), negative predictive value of 0.94 (95% CI, 0.92-0.95), positive likelihood ratio of 2.95 (95% CI, 1.37-6.35) and negative likelihood ratio of 0.91 (95% CI, 0.82-1.01) for obstetric intervention for suspected intrapartum fetal compromise. Pregnancies with increased mean UtA-PI MoM also showed a higher incidence of birth weight < 10th percentile (20.0% vs 6.7%; P = 0.002), NICU admission (7.5% vs 1.2%; P = 0.001) and composite adverse perinatal outcome (15.0% vs 5.1%; P = 0.008). CONCLUSION Our study, conducted in a cohort of low-risk term pregnancies enrolled in early spontaneous labor, showed an independent association between increased mean UtA-PI and obstetric intervention for suspected intrapartum fetal compromise, albeit with moderate capacity to rule in, and poor capacity to rule out, this condition. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Dall'asta
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - F Figueras
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain
| | - G Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico di Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - R Ramirez Zegarra
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - G Morganelli
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - M Giannone
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain
- Department of Woman and Child Health, Maternal-Fetal Medicine Unit, University of Padua, Padua, Italy
| | - A Cancemi
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain
| | - I Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico di Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - C Lees
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - T Frusca
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - T Ghi
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
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Dall'Asta A, Ramirez Zegarra R, Figueras F, Rizzo G, Lees C, Frusca T, Ghi T. Association between uterine artery Doppler in early spontaneous labor and adverse peripartum outcome in relation to birth weight. Ultrasound Obstet Gynecol 2023; 62:303-304. [PMID: 37326975 DOI: 10.1002/uog.26287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/19/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023]
Affiliation(s)
- A Dall'Asta
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - R Ramirez Zegarra
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - F Figueras
- Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain
| | - G Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico di Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - C Lees
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - T Frusca
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - T Ghi
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
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Stampalija T, Bhide A, Heazell AEP, Sharp A, Lees C. Computerized cardiotocography and Dawes-Redman criteria: how should we interpret criteria not met? Ultrasound Obstet Gynecol 2023; 61:661-666. [PMID: 36905681 DOI: 10.1002/uog.26198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 06/03/2023]
Affiliation(s)
- T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A E P Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - A Sharp
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - C Lees
- Institute of Developmental and Reproductive Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK
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Scalia MS, Lees C, Zamagni G, Ghi T, Bhide A, Monasta L, Ricci G, Maso G, Valensise H, Stampalija T. Use of computerized cardiotocography and Dawes-Redman criteria: results from a binational survey. Ultrasound Obstet Gynecol 2023; 61:773-775. [PMID: 37099522 DOI: 10.1002/uog.26225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 06/03/2023]
Affiliation(s)
- M S Scalia
- Department of the Mother and Neonate, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - C Lees
- Department of Metabolism, Digestion and Reproduction, Institute of Developmental and Reproductive Biology, Imperial College London, London, UK
- Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK
| | - G Zamagni
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - T Ghi
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - L Monasta
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - G Ricci
- Department of the Mother and Neonate, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - G Maso
- Department of the Mother and Neonate, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - H Valensise
- Division of Obstetrics and Gynaecology, Department of Surgery, Policlinico Casilino, University of Rome Tor Vergata, Rome, Italy
| | - T Stampalija
- Department of the Mother and Neonate, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Relph S, Vieira MC, Copas A, Alagna A, Page L, Winsloe C, Shennan A, Briley A, Johnson M, Lees C, Lawlor DA, Sandall J, Khalil A, Pasupathy D. Characteristics associated with antenatally unidentified small-for-gestational-age fetuses: prospective cohort study nested within DESiGN randomized controlled trial. Ultrasound Obstet Gynecol 2023; 61:356-366. [PMID: 36206546 DOI: 10.1002/uog.26091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To identify the clinical characteristics and patterns of ultrasound use amongst pregnancies with an antenatally unidentified small-for-gestational-age (SGA) fetus, compared with those in which SGA is identified, to understand how to design interventions that improve antenatal SGA identification. METHODS This was a prospective cohort study of singleton, non-anomalous SGA (birth weight < 10th centile) neonates born after 24 + 0 gestational weeks at 13 UK sites, recruited for the baseline period and control arm of the DESiGN trial. Pregnancy with antenatally unidentified SGA was defined if there was no scan or if the final scan showed estimated fetal weight (EFW) at the 10th centile or above. Identified SGA was defined if EFW was below the 10th centile at the last scan. Maternal and fetal sociodemographic and clinical characteristics were studied for associations with unidentified SGA using unadjusted and adjusted logistic regression models. Ultrasound parameters (gestational age at first growth scan, number and frequency of ultrasound scans) were described, stratified by presence of indication for serial ultrasound. Associations of unidentified SGA with absolute centile and percentage weight difference between the last scan and birth were also studied on unadjusted and adjusted logistic regression, according to time between the last scan and birth. RESULTS Of the 15 784 SGA babies included, SGA was not identified antenatally in 78.7% of cases. Of pregnancies with unidentified SGA, 47.1% had no recorded growth scan. Amongst 9410 pregnancies with complete data on key maternal comorbidities and antenatal complications, the risk of unidentified SGA was lower for women with any indication for serial scans (adjusted odds ratio (aOR), 0.56 (95% CI, 0.49-0.64)), for Asian compared with white women (aOR, 0.80 (95% CI, 0.69-0.93)) and for those with non-cephalic presentation at birth (aOR, 0.58 (95% CI, 0.46-0.73)). The risk of unidentified SGA was highest among women with a body mass index (BMI) of 25.0-29.9 kg/m2 (aOR, 1.15 (95% CI, 1.01-1.32)) and lowest in those with underweight BMI (aOR, 0.61 (95% CI, 0.48-0.76)) compared to women with BMI of 18.5-24.9 kg/m2 . Compared to women with identified SGA, those with unidentified SGA had fetuses of higher SGA birth-weight centile (adjusted odds for unidentified SGA increased by 1.21 (95% CI, 1.18-1.23) per one-centile increase between the 0th and 10th centiles). Duration between the last scan and birth increased with advancing gestation in pregnancies with unidentified SGA. SGA babies born within a week of the last growth scan had a mean difference between EFW and birth-weight centiles of 19.5 (SD, 13.8) centiles for the unidentified-SGA group and 0.2 (SD, 3.3) centiles for the identified-SGA group (adjusted mean difference between groups, 19.0 (95% CI, 17.8-20.1) centiles). CONCLUSIONS Unidentified SGA was more common amongst women without an indication for serial ultrasound, and in those with cephalic presentation at birth, BMI of 25.0-29.9 kg/m2 and less severe SGA. Ultrasound EFW was overestimated in women with unidentified SGA. This demonstrates the importance of improving the accuracy of SGA screening strategies in low-risk populations and continuing performance of ultrasound scans for term pregnancies. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Relph
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - M C Vieira
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - A Copas
- Centre for Pragmatic Global Health Trials, Institute for Global Health, University College London, London, UK
| | - A Alagna
- The Guy's & St Thomas' Charity, London, UK
| | - L Page
- West Middlesex University Hospital, Chelsea & Westminster Hospital NHS Foundation Trust, Isleworth, UK
| | - C Winsloe
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Centre for Pragmatic Global Health Trials, Institute for Global Health, University College London, London, UK
| | - A Shennan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - A Briley
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Caring Futures Institute, Flinders University and North Adelaide Local Health Network, Adelaide, Australia
| | - M Johnson
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - C Lees
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - D A Lawlor
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol NIHR Biomedical Research Centre, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - J Sandall
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
| | - D Pasupathy
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Dall'Asta A, Melito C, Morganelli G, Lees C, Ghi T. Determinants of placental insufficiency in fetal growth restriction. Ultrasound Obstet Gynecol 2023; 61:152-157. [PMID: 36349884 DOI: 10.1002/uog.26111] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 05/27/2023]
Affiliation(s)
- A Dall'Asta
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - C Melito
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
- Department of Obstetrics and Gynaecology, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - G Morganelli
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - C Lees
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
- Centre for Fetal Care, Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - T Ghi
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
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Familiari A, Napolitano R, Visser GHA, Lees C, Wolf H, Prefumo F. Antenatal corticosteroids and perinatal outcome in late fetal growth restriction: analysis of prospective cohort. Ultrasound Obstet Gynecol 2023; 61:191-197. [PMID: 36412975 PMCID: PMC10108243 DOI: 10.1002/uog.26127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the role of antenatal administration of corticosteroids for fetal lung maturation on the short-term perinatal outcome of pregnancy complicated by late fetal growth restriction (FGR). METHODS This cohort study was a secondary analysis of a multicenter prospective observational study, the TRUFFLE-2 feasibility study, conducted between 2017 and 2018 in 33 European perinatal centers. The study included women with a singleton pregnancy from 32 + 0 to 36 + 6 weeks of gestation with a fetus considered at risk for FGR, defined as estimated fetal weight (EFW) and/or fetal abdominal circumference < 10th percentile, or umbilicocerebral ratio (UCR) ≥ 95th percentile or a drop of more than 40 percentile points in abdominal circumference measurement from the 20-week scan. For the purposes of the current study, we identified women who received a single course of steroids to improve fetal lung maturation before delivery. Each exposed pregnancy was matched with one that did not receive antenatal corticosteroids (ACS) (control), based on gestational age at delivery and birth weight. The primary adverse outcome was a composite of abnormal condition at birth, major neonatal morbidity or perinatal death. RESULTS A total of 86 pregnancies that received ACS were matched to 86 controls. The two groups were similar with respect to gestational age (33.1 vs 33.3 weeks), EFW (1673 vs 1634 g) and UCR (0.68 vs 0.62) at inclusion, and gestational age at delivery (35.5 vs 35.9 weeks) and birth weight (1925 vs 1948 g). No significant differences were observed between the exposed and non-exposed groups in the incidence of composite adverse outcome (28% vs 24%; P = 0.73) or any of its elements. CONCLUSION The present data do not show a beneficial effect of steroids on short-term outcome of fetuses with late FGR. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A. Familiari
- Department of Woman and Child Health and Public HealthFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - R. Napolitano
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonUK
- Fetal Medicine UnitUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - G. H. A. Visser
- Department of ObstetricsUniversity Medical CenterUtrechtThe Netherlands
| | - C. Lees
- Centre for Fetal Care, Department of Obstetrics and GynaecologyQueen Charlotte's and Chelsea Hospital, Imperial College LondonLondonUK
| | - H. Wolf
- Department of Obstetrics and GynecologyAmsterdam University Medical Center (Location AMC), University of AmsterdamAmsterdamThe Netherlands
| | - F. Prefumo
- Obstetrics and Gynecology UnitIRCCS Istituto Giannina GasliniGenoaItaly
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Relph S, Vieira MC, Copas A, Coxon K, Alagna A, Briley A, Johnson M, Page L, Peebles D, Shennan A, Thilaganathan B, Marlow N, Lees C, Lawlor DA, Khalil A, Sandall J, Pasupathy D, Healey A. Improving antenatal detection of small-for-gestational-age fetus: economic evaluation of Growth Assessment Protocol. Ultrasound Obstet Gynecol 2022; 60:620-631. [PMID: 35797108 PMCID: PMC9828078 DOI: 10.1002/uog.26022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine whether the Growth Assessment Protocol (GAP), as implemented in the DESiGN trial, is cost-effective in terms of antenatal detection of small-for-gestational-age (SGA) neonate, when compared with standard care. METHODS This was an incremental cost-effectiveness analysis undertaken from the perspective of a UK National Health Service hospital provider. Thirteen maternity units from England, UK, were recruited to the DESiGN (DEtection of Small for GestatioNal age fetus) trial, a cluster randomized controlled trial. Singleton, non-anomalous pregnancies which delivered after 24 + 0 gestational weeks between November 2015 and February 2019 were analyzed. Probabilistic decision modeling using clinical trial data was undertaken. The main outcomes of the study were the expected incremental cost, the additional number of SGA neonates identified antenatally and the incremental cost-effectiveness ratio (ICER) (cost per additional SGA neonate identified) of implementing GAP. Secondary analysis focused on the ICER per infant quality-adjusted life year (QALY) gained. RESULTS The expected incremental cost (including hospital care and implementation costs) of GAP over standard care was £34 559 per 1000 births, with a 68% probability that implementation of GAP would be associated with increased costs to sustain program delivery. GAP identified an additional 1.77 SGA neonates per 1000 births (55% probability of it being more clinically effective). The ICER for GAP was £19 525 per additional SGA neonate identified, with a 44% probability that GAP would both increase cost and identify more SGA neonates compared with standard care. The probability of GAP being the dominant clinical strategy was low (11%). The expected incremental cost per infant QALY gained ranged from £68 242 to £545 940, depending on assumptions regarding the QALY value of detection of SGA. CONCLUSION The economic case for replacing standard care with GAP is weak based on the analysis reported in our study. However, this conclusion should be viewed taking into account that cost-effectiveness analyses are always limited by the assumptions made. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S. Relph
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and MedicineKing's College LondonLondonUK
| | - M. C. Vieira
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and MedicineKing's College LondonLondonUK
- Department of Obstetrics and GynaecologyUniversity of Campinas (UNICAMP), School of Medical SciencesSão PauloBrazil
| | - A. Copas
- Centre for Pragmatic Global Health TrialsInstitute for Global Health, University College LondonLondonUK
| | - K. Coxon
- Faculty of Health, Social Care and EducationKingston and St George's UniversityLondonUK
| | - A. Alagna
- The Guy's & St Thomas' CharityLondonUK
| | - A. Briley
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and MedicineKing's College LondonLondonUK
- Caring Futures InstituteCollege of Nursing and Health Sciences, Flinders UniversityAdelaideAustralia
| | - M. Johnson
- Department of Surgery and CancerImperial College LondonLondonUK
| | - L. Page
- West Middlesex University Hospital, Chelsea & Westminster Hospital NHS Foundation TrustLondonUK
| | - D. Peebles
- UCL Institute for Women's HealthUniversity College LondonLondonUK
| | - A. Shennan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and MedicineKing's College LondonLondonUK
| | - B. Thilaganathan
- Fetal Medicine UnitSt George's University Hospitals NHS Foundation TrustLondonUK
- Molecular & Clinical Sciences Research InstituteSt George's, University of LondonLondonUK
| | - N. Marlow
- UCL Institute for Women's HealthUniversity College LondonLondonUK
| | - C. Lees
- Department of Surgery and CancerImperial College LondonLondonUK
| | - D. A. Lawlor
- Population Health ScienceBristol Medical School, University of BristolBristolUK
- Bristol NIHR Biomedical Research CentreBristolUK
| | - A. Khalil
- Fetal Medicine UnitSt George's University Hospitals NHS Foundation TrustLondonUK
- Molecular & Clinical Sciences Research InstituteSt George's, University of LondonLondonUK
| | - J. Sandall
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and MedicineKing's College LondonLondonUK
| | - D. Pasupathy
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and MedicineKing's College LondonLondonUK
- Reproduction and Perinatal Centre, Faculty of Medicine and HealthUniversity of SydneySydneyAustralia
| | - A. Healey
- Department of Health Service and Population ResearchDavid Goldberg Centre, King's College LondonLondonUK
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11
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Mullins E, Perry A, Banerjee J, Townson J, Grozeva D, Milton R, Kirby N, Playle R, Bourne T, Lees C. Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study. Eur J Obstet Gynecol Reprod Biol 2022; 276:161-167. [PMID: 35914420 PMCID: PMC9295331 DOI: 10.1016/j.ejogrb.2022.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/15/2022] [Accepted: 07/14/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection. METHODS Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant. RESULTS Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021. Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants. Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering ≥ 2 weeks after infection (95 % CI 0.3-1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies. Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2. CONCLUSIONS Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering ≥ 2 weeks after infection. We suggest that clinicians' threshold for delivery should be low if there are concerns with fetal movements or fetal heart rate monitoring in the time around infection. The proportion affected by pre-eclampsia amongst participants was not higher than would be expected, although we report a higher than expected proportion affected by eclampsia. There appears to be no effect on birthweight or congenital malformations in women affected by SARS-CoV-2 infection in pregnancy and neonatal infection is uncommon. This study reflects a population with a range of infection severity for SARS-COV-2 in pregnancy, generalisable to whole obstetric populations.
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Affiliation(s)
- E Mullins
- Imperial College London and The George Institute for Global Health, Imperial College Healthcare NHS Trust, London W12 0HS, UK.
| | - A Perry
- Lead Research Midwife and Manager, Women's Health Research Centre, Imperial College London, W12 0HS, UK
| | - J Banerjee
- Imperial College Healthcare NHS Trust, Institute of Reproductive and Developmental Biology, Imperial College London, W12 0HS, UK
| | - J Townson
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - D Grozeva
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - R Milton
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - N Kirby
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - R Playle
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - T Bourne
- Imperial College London, Consultant Gyanecologist, Queen Charlotte's and Chelsea Hospital, London W12 0HS, UK
| | - C Lees
- Centre for Fetal Care, Imperial College Healthcare NHS Trust, Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0HS, UK
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12
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Khalil A, Samara A, O'Brien P, Morris E, Draycott T, Lees C, Ladhani S. Monkeypox and pregnancy: what do obstetricians need to know? Ultrasound Obstet Gynecol 2022; 60:22-27. [PMID: 35652380 DOI: 10.1002/uog.24968] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A Samara
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - P O'Brien
- The Royal College of Obstetricians and Gynaecologists, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - E Morris
- The Royal College of Obstetricians and Gynaecologists, London, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| | - T Draycott
- The Royal College of Obstetricians and Gynaecologists, London, UK
- North Bristol NHS Trust Department of Women's Health, Westbury on Trym, UK
| | - C Lees
- Imperial College London, London, UK
| | - S Ladhani
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, London, UK
- Immunisation and Countermeasures Division, Public Health, England
- British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, London, UK
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13
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Salvesen K, Ter Haar G, Miloro P, Sinkovskaya E, Lees C, Bourne T, Maršál K, Dall'asta A. ISUOG Safety Committee updated recommendation on use of respirators by practitioners undertaking obstetric and gynecological ultrasound in context of SARS-CoV-2 Omicron variant of concern. Ultrasound Obstet Gynecol 2022; 59:411. [PMID: 35132712 PMCID: PMC9111197 DOI: 10.1002/uog.24870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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14
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Rowe S, Lees C, Lee J, Eaves S, Paleri S, Jin D, Rayner C, Hayat U, Adams H. Is Pacing Always Permanent Following TAVI? A Single-Centre Experience. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Lees C, Stampalija T, Hecher K. Re: Outcome-based comparison of SMFM and ISUOG definitions of fetal growth restriction. Ultrasound Obstet Gynecol 2021; 58:493-494. [PMID: 34468059 DOI: 10.1002/uog.23747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/06/2021] [Indexed: 06/13/2023]
Affiliation(s)
- C Lees
- Imperial College School of Medicine, Imperial College London, London, UK
- Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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16
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Bhide A, Acharya G, Baschat A, Bilardo CM, Brezinka C, Cafici D, Ebbing C, Hernandez-Andrade E, Kalache K, Kingdom J, Kiserud T, Kumar S, Lee W, Lees C, Leung KY, Malinger G, Mari G, Prefumo F, Sepulveda W, Trudinger B. ISUOG Practice Guidelines (updated): use of Doppler velocimetry in obstetrics. Ultrasound Obstet Gynecol 2021; 58:331-339. [PMID: 34278615 DOI: 10.1002/uog.23698] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 06/13/2023]
Affiliation(s)
- A Bhide
- Fetal Medicine Unit, St George's University Hospital and St George's University of London, London, UK
| | - G Acharya
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet & Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Women's Health and Perinatology Research Group, Faculty of Medicine, University of Tromsø and University Hospital of Northern Norway, Tromsø, Norway
| | - A Baschat
- Johns Hopkins Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - C M Bilardo
- Department of Obstetrics and Gynecology Amsterdam UMC, Amsterdam and Academic Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C Brezinka
- Univ Klinik fuer Gynaekologie und Geburtshilfe, Innsbruck, Austria
| | - D Cafici
- Sociedad Argentina de Ultrasonografía en Medicina y Biología, Argentina
| | - C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - E Hernandez-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - K Kalache
- Gynaecology, Charité, CBF, Berlin, Germany
| | - J Kingdom
- Maternal-Fetal Medicine Division, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - T Kiserud
- Department of Clinical Science, University of Bergen and Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - S Kumar
- Mater Research Institute/University of Queensland, Brisbane, Australia
| | - W Lee
- Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - C Lees
- Centre for Fetal Care, Queen Charlotte's & Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Development & Regeneration KU Leuven, Leuven, Belgium
| | - K Y Leung
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong
| | - G Malinger
- Division of Ob-Gyn Ultrasound, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Mari
- Women's Health Institute, Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - F Prefumo
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - W Sepulveda
- FETALMED - Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - B Trudinger
- Department of Obstetrics and Gynaecology, University of Sydney, Sydney, Australia
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17
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Salvesen K, Abramowicz J, Ter Haar G, Miloro P, Sinkovskaya E, Dall'Asta A, Maršál K, Lees C. ISUOG statement on the non-diagnostic use of ultrasound in pregnancy. Ultrasound Obstet Gynecol 2021; 58:147. [PMID: 34198364 DOI: 10.1002/uog.23611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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18
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Salvesen K, Abramowicz J, Ter Haar G, Miloro P, Sinkovskaya E, Dall'Asta A, Maršál K, Lees C. ISUOG statement on the safe use of Doppler for fetal ultrasound examination in the first 13 + 6 weeks of pregnancy (updated). Ultrasound Obstet Gynecol 2021; 57:1020. [PMID: 34077607 DOI: 10.1002/uog.23610] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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19
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Lees C, Stampalija T, Hecher K. Diagnosis and management of fetal growth restriction: the ISUOG guideline and comparison with the SMFM guideline. Ultrasound Obstet Gynecol 2021; 57:884-887. [PMID: 34077604 DOI: 10.1002/uog.23664] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Affiliation(s)
- C Lees
- Institute for Reproductive and Developmental Biology, Imperial College London, London, UK
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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20
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Jin D, Lees C, MacIntyre P, Dwyer N, Hayat U, Adams H. The Tasmanian TAVI Service: Initial Experience and Outcomes. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Kasaven LS, Saso S, Barcroft J, Yazbek J, Joash K, Stalder C, Nagi JB, Smith JR, Lees C, Bourne T, Jones BP. Authors' reply Re: Implications for the future of Obstetrics and Gynaecology following the COVID-19 pandemic: a commentary. BJOG 2020; 128:616-617. [PMID: 33151618 DOI: 10.1111/1471-0528.16564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 01/14/2023]
Affiliation(s)
- L S Kasaven
- Department of Cancer and Surgery, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK.,Department of Cancer and Surgery, Imperial College London, London, UK
| | - S Saso
- Department of Cancer and Surgery, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK.,Department of Cancer and Surgery, Imperial College London, London, UK
| | - J Barcroft
- Department of Cancer and Surgery, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK.,Department of Cancer and Surgery, Imperial College London, London, UK
| | - J Yazbek
- Department of Cancer and Surgery, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK.,Department of Cancer and Surgery, Imperial College London, London, UK
| | - K Joash
- Department of Cancer and Surgery, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK
| | - C Stalder
- Department of Cancer and Surgery, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK
| | - J B Nagi
- Department of Cancer and Surgery, Imperial College London, London, UK
| | - J R Smith
- Department of Cancer and Surgery, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK.,Department of Cancer and Surgery, Imperial College London, London, UK
| | - C Lees
- Department of Cancer and Surgery, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK.,Department of Cancer and Surgery, Imperial College London, London, UK
| | - T Bourne
- Department of Cancer and Surgery, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK.,Department of Cancer and Surgery, Imperial College London, London, UK
| | - B P Jones
- Department of Cancer and Surgery, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK.,Department of Cancer and Surgery, Imperial College London, London, UK
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22
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Kasaven LS, Saso S, Barcroft J, Yazbek J, Joash K, Stalder C, Ben Nagi J, Smith JR, Lees C, Bourne T, Jones BP. Implications for the future of Obstetrics and Gynaecology following the COVID-19 pandemic: a commentary. BJOG 2020; 127:1318-1323. [PMID: 32716588 DOI: 10.1111/1471-0528.16431] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2020] [Indexed: 12/31/2022]
Affiliation(s)
- L S Kasaven
- Department of Cancer and Surgery, Imperial College NHS Trust, Queen Charlotte's and Chelsea Hospital, London, UK.,Department of Cancer and Surgery, Imperial College London, London, UK
| | - S Saso
- Department of Cancer and Surgery, Imperial College NHS Trust, Queen Charlotte's and Chelsea Hospital, London, UK.,Department of Cancer and Surgery, Imperial College London, London, UK
| | - J Barcroft
- Department of Cancer and Surgery, Imperial College NHS Trust, Queen Charlotte's and Chelsea Hospital, London, UK.,Department of Cancer and Surgery, Imperial College London, London, UK
| | - J Yazbek
- Department of Cancer and Surgery, Imperial College NHS Trust, Queen Charlotte's and Chelsea Hospital, London, UK.,Department of Cancer and Surgery, Imperial College London, London, UK
| | - K Joash
- Department of Cancer and Surgery, Imperial College NHS Trust, Queen Charlotte's and Chelsea Hospital, London, UK
| | - C Stalder
- Department of Cancer and Surgery, Imperial College NHS Trust, Queen Charlotte's and Chelsea Hospital, London, UK
| | - J Ben Nagi
- Department of Cancer and Surgery, Imperial College London, London, UK
| | - J R Smith
- Department of Cancer and Surgery, Imperial College NHS Trust, Queen Charlotte's and Chelsea Hospital, London, UK.,Department of Cancer and Surgery, Imperial College London, London, UK
| | - C Lees
- Department of Cancer and Surgery, Imperial College NHS Trust, Queen Charlotte's and Chelsea Hospital, London, UK.,Department of Cancer and Surgery, Imperial College London, London, UK
| | - T Bourne
- Department of Cancer and Surgery, Imperial College NHS Trust, Queen Charlotte's and Chelsea Hospital, London, UK.,Department of Cancer and Surgery, Imperial College London, London, UK
| | - B P Jones
- Department of Cancer and Surgery, Imperial College NHS Trust, Queen Charlotte's and Chelsea Hospital, London, UK.,Department of Cancer and Surgery, Imperial College London, London, UK
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Abramowicz JS, Basseal JM, Brezinka C, Dall'Asta A, Deng J, Harrison G, Lee JCS, Lim A, Maršal K, Miloro P, Poon LC, Salvesen KÅ, Sande R, ter Haar G, Westerway SC, Xie MX, Lees C. ISUOG Safety Committee Position Statement on use of personal protective equipment and hazard mitigation in relation to SARS-CoV-2 for practitioners undertaking obstetric and gynecological ultrasound. Ultrasound Obstet Gynecol 2020; 55:886-891. [PMID: 32255535 PMCID: PMC7262197 DOI: 10.1002/uog.22035] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- J. S. Abramowicz
- Department of Obstetrics and GynecologyUniversity of ChicagoChicagoILUSA
| | - J. M. Basseal
- Discipline of Infectious Diseases & Immunology, Faculty of Medicine and HealthThe University of Sydney; and Australasian Society for Ultrasound in Medicine (ASUM)NSWAustralia
| | - C. Brezinka
- Department of Obstetrics and GynecologyMedical University of InnsbruckInnsbruckAustria
| | - A. Dall'Asta
- Department of Medicine and Surgery, Obstetrics and Gynecology UnitUniversity of ParmaParmaItaly
| | - J. Deng
- Barts Heart Centre, London; and University College LondonLondonUK
| | - G. Harrison
- Society and College of Radiographers (SCoR)UK
| | - J. C. S. Lee
- Department of Urogynaecology, Division of Obstetrics and GynaecologyKK Women's and Children's HospitalSingapore
| | - A. Lim
- Imaging Department, Imperial College Healthcare NHS Trust; and Hon SecretaryBMUSUK
| | - K. Maršal
- Department of Obstetrics and GynecologyLund University, University HospitalLundSweden
| | - P. Miloro
- Ultrasound and Underwater Acoustics, National Physical LaboratoryTeddingtonUK
| | - L. C. Poon
- Department of Obstetrics and GynaecologyThe Chinese University of Hong KongHong Kong SAR
| | - K. Å. Salvesen
- Department of Obstetrics and GynecologySt Olavs hospitalTrondheimNorway
| | - R. Sande
- Department of Obstetrics and GynecologyStavanger University HospitalStavangerNorway
| | - G. ter Haar
- Therapy Ultrasound, Division of Radiotherapy & Imaging, Joint Department of PhysicsRoyal Marsden Hospital, Institute of Cancer ResearchSurreyUK
| | - S. C. Westerway
- School of Dentistry & Health Sciences, Charles Sturt University; and Australasian Society for Ultrasound in Medicine (ASUM)SydneyNSWAustralia
| | - M. X. Xie
- Department of Ultrasound, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - C. Lees
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
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Poon LC, Abramowicz JS, Dall'Asta A, Sande R, Ter Haar G, Maršal K, Brezinka C, Miloro P, Basseal J, Westerway SC, Abu-Rustum RS, Lees C. ISUOG Safety Committee Position Statement on safe performance of obstetric and gynecological scans and equipment cleaning in context of COVID-19. Ultrasound Obstet Gynecol 2020; 55:709-712. [PMID: 32207189 DOI: 10.1002/uog.22027] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- L C Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR
| | - J S Abramowicz
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - A Dall'Asta
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - R Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - G Ter Haar
- Therapy Ultrasound, Division of Radiotherapy & Imaging, Joint Department of Physics, Royal Marsden Hospital, Institute of Cancer Research, Surrey, UK
| | - K Maršal
- Department of Obstetrics and Gynecology (Emeritus), Lund University, University Hospital, Lund, Sweden
| | - C Brezinka
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - P Miloro
- Ultrasound and Underwater Acoustics, National Physical Laboratory, Teddington, UK
| | - J Basseal
- Discipline of Infectious Diseases & Immunology, Faculty of Medicine and Health, The University of Sydney; and Australasian Society for Ultrasound in Medicine (ASUM), NSW, Australia
| | - S C Westerway
- School of Dentistry & Health Sciences, Charles Sturt University; and Australasian Society for Ultrasound in Medicine (ASUM), Sydney, NSW, Australia
| | - R S Abu-Rustum
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - C Lees
- Imperial College School of Medicine, Imperial College London, London, UK
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Stampalija T, Arabin B, Wolf H, Bilardo C, Lees C. An abnormal cerebroplacental ratio (CPR) is predictive of early childhood delayed neurodevelopment in the setting of fetal growth restriction. Am J Obstet Gynecol 2020; 222:391-392. [PMID: 31870732 DOI: 10.1016/j.ajog.2019.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
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Ganzevoort W, Thornton JG, Marlow N, Thilaganathan B, Arabin B, Prefumo F, Lees C, Wolf H. Comparative analysis of 2-year outcomes in GRIT and TRUFFLE trials. Ultrasound Obstet Gynecol 2020; 55:68-74. [PMID: 31125465 PMCID: PMC6973288 DOI: 10.1002/uog.20354] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/06/2019] [Accepted: 05/10/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To explore the effect on perinatal outcome of different fetal monitoring strategies for early-onset fetal growth restriction (FGR). METHODS This was a cohort analysis of individual participant data from two European multicenter trials of fetal monitoring methods for FGR: the Growth Restriction Intervention Study (GRIT) and the Trial of Umbilical and Fetal Flow in Europe (TRUFFLE). All women from GRIT (n = 238) and TRUFFLE (n = 503) who were randomized between 26 and 32 weeks' gestation were included. The women were grouped according to intervention and monitoring method: immediate delivery (GRIT) or delayed delivery with monitoring by conventional cardiotocography (CTG) (GRIT), computerized CTG (cCTG) only (GRIT and TRUFFLE) or cCTG and ductus venosus (DV) Doppler (TRUFFLE). The primary outcome was survival without neurodevelopmental impairment at 2 years of age. RESULTS Gestational age at delivery and birth weight were similar in both studies. Fetal death rate was similar between the GRIT and TRUFFLE groups, but neonatal and late death were more frequent in GRIT (18% vs 6%; P < 0.01). The rate of survival without impairment at 2 years was lowest in pregnancies that underwent immediate delivery (70% (95% CI, 61-78%)) or delayed delivery with monitoring by CTG (69% (95% CI, 57-82%)), increased in those monitored using cCTG only in both GRIT (80% (95% CI, 68-91%)) and TRUFFLE (77% (95% CI, 70-84%)), and was highest in pregnancies monitored using cCTG and DV Doppler (84% (95% CI, 80-89%)) (P < 0.01 for trend). CONCLUSIONS This analysis supports the hypothesis that the optimal method for fetal monitoring in pregnancies complicated by early-onset FGR is a combination of cCTG and DV Doppler assessment. TRIAL REGISTRATION GRIT ISRCTN41358726 and TRUFFLE ISRCTN56204499. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- W. Ganzevoort
- Department of ObstetricsAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - J. G. Thornton
- Division of Child Health, Obstetrics and Gynaecology, School of MedicineUniversity of Nottingham, Nottingham City HospitalNottinghamUK
| | - N. Marlow
- Department of Academic NeonatologyUCL Institute for Women's HealthLondonUK
| | - B. Thilaganathan
- Fetal Medicine UnitSt George's University Hospitals NHS Foundation Trust, University of LondonLondonUK
- Vascular Biology and Research Centre, Molecular & Clinical Sciences Research InstituteSt George's University of LondonLondonUK
| | - B. Arabin
- Center for Mother and Child of the Philipps UniversityMarburgGermany
| | - F. Prefumo
- Maternal–Fetal Medicine UnitUniversity of BresciaBresciaItaly
| | - C. Lees
- Department of Obstetrics & GynaecologyRosie HospitalCambridgeUK
- Department of Obstetrics and GynecologyKU LeuvenBelgium
| | - H. Wolf
- Department of ObstetricsAmsterdam University Medical CenterAmsterdamThe Netherlands
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Bijl RC, Valensise H, Novelli GP, Vasapollo B, Wilkinson I, Thilaganathan B, Stöhr EJ, Lees C, van der Marel CD, Cornette JMJ. Methods and considerations concerning cardiac output measurement in pregnant women: recommendations of the International Working Group on Maternal Hemodynamics. Ultrasound Obstet Gynecol 2019; 54:35-50. [PMID: 30737852 DOI: 10.1002/uog.20231] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/18/2019] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
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. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R C Bijl
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - H Valensise
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
- Division of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy
| | - G P Novelli
- Department of Cardiology, San Sebastiano Martire Hospital, Frascati, Italy
| | - B Vasapollo
- Division of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy
| | - I Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - B Thilaganathan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - E J Stöhr
- Cardiff School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, UK
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, USA
| | - C Lees
- Department of Obstetrics, Imperial College, London, UK
| | - C D van der Marel
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J M J Cornette
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
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Opie CA, Gibson-Thorpe B, Lees C, Haines HM. 'Believe in me and I will believe in myself', a rural Australian health service learns how to mangan dunguludja ngatan (build strong employment) for Aboriginal and Torres Strait Islander people: a qualitative study. Hum Resour Health 2019; 17:44. [PMID: 31217016 PMCID: PMC6585108 DOI: 10.1186/s12960-019-0384-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 06/05/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Australian Aboriginal people have higher rates of unemployment and poorer health than non-Aboriginal Australians. Historical segregation policies that spanned 60 years negatively impacted workforce inclusion. A Victorian regional health service recently developed an Aboriginal Employment Plan (AEP) targeted to reach 2% employment of Aboriginal people by 2020. This study aimed to identify strategies that will build strong Aboriginal employment. METHODOLOGY A qualitative research protocol was designed. Purposive recruitment of people with a vested interest in the growth of Aboriginal employment at the health service participated in focus groups and individual interviews. RESULTS Twenty-four people including local Elders, past and present Aboriginal employees, key community stakeholders and health service executives participated. Learnings from the past, the present and strategies for the future emerged from two important stories: (1) the story of a strong group of local Aboriginal people who successfully approached the matron of the hospital in the early 1960s for employment. (2) The story of the 'verandah babies'. DISCUSSION The history of the health service in question demonstrated the power of the possible with a self-determined group of Aboriginal people, who, in the face of cultural inequity, achieved employment at the health service. The opportunity for healing and a new start was illustrated by the story of women who gave birth on the verandahs due to their exclusion from the main hospital. Today, the 'verandahs' have been replaced with a modern hospital decorated with Aboriginal art, expressing cultural safety and inclusion, presenting fertile ground for strengthening and sustaining Aboriginal employment. CONCLUSION Eleven strategies have emerged from three themes; safety, equity and pathway, offering mainstream health services insight into how to mangan dunguludja ngatan (build strong employment). Cultural safety can be achieved through acknowledging the past and reconciling that through engaging, partnering and collaborating with the Aboriginal community. Visual representations of culture and participation in celebratory activities engender awareness and understanding. The development of local, flexible career development pathways for Aboriginal people facilitates a 'sense of belonging' to the health service and a dual 'sense of pride' within the community: whereby the Aboriginal person feels proud to represent their community and the community is proud to be represented. Cultural equity is facilitated through mutual learning and reciprocal understanding of difference.
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Affiliation(s)
- C. A. Opie
- Echuca Regional Health, Echuca, Australia
- University of Melbourne, Shepparton, Australia
| | | | - C. Lees
- Echuca Regional Health, Echuca, Australia
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Cali G, Forlani F, Lees C, Timor-Tritsch I, Palacios-Jaraquemada J, Dall'Asta A, Bhide A, Flacco ME, Manzoli L, Labate F, Perino A, Scambia G, D'Antonio F. Prenatal ultrasound staging system for placenta accreta spectrum disorders. Ultrasound Obstet Gynecol 2019; 53:752-760. [PMID: 30834661 DOI: 10.1002/uog.20246] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/12/2019] [Accepted: 02/07/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To develop a prenatal ultrasound staging system for placenta accreta spectrum (PAS) disorders in women with placenta previa and to evaluate its association with surgical outcome, placental invasion and the clinical staging system for PAS disorders proposed by the International Federation of Gynecology and Obstetrics (FIGO). METHODS This was a secondary retrospective analysis of prospectively collected data from women with placenta previa. We classified women according to the following staging system for PAS disorders, based upon the presence of ultrasound signs of PAS in women with placenta previa: PAS0, placenta previa with no ultrasound signs of invasion or with placental lacunae but no evidence of abnormal uterus-bladder interface; PAS1, presence of at least two of placental lacunae, loss of the clear zone or bladder wall interruption; PAS2, PAS1 plus uterovescical hypervascularity; PAS3, PAS1 or PAS2 plus evidence of increased vascularity in the inferior part of the lower uterine segment potentially extending into the parametrial region. We explored whether this ultrasound staging system correlates with surgical outcome (estimated blood loss (EBL, mL), units of packed red blood cells (PRBC), fresh frozen plasma (FFP) and platelets (PLT) transfused, operation time (min), surgical complications defined as the occurrence of any damage to the bladder, ureters or bowel, length of hospital stay (days) and admission to intensive care unit (ICU)) and depth of placental invasion. The correlation between the present ultrasound staging system and the clinical grading system proposed by FIGO was assessed. Prenatal and surgical management were not based on the proposed prenatal ultrasound staging system. Linear and multiple regression models were used. RESULTS Two-hundred and fifty-nine women were included in the analysis. Mean EBL was 516 ± 151 mL in women with PAS0, 609 ± 146 mL in those with PAS1, 950 ± 190 mL in those with PAS2 and 1323 ± 533 mL in those with PAS3, and increased significantly with increasing severity of PAS ultrasound stage. Mean units of PRBC transfused were 0.05 ± 0.21 in PAS0, 0.10 ± 0.45 in PAS1, 1.19 ± 1.11 in PAS2 and 4.48 ± 2.06 in PAS3, and increased significantly with PAS stage. Similarly, there was a progressive increase in the mean units of FFP transfused from PAS1 to PAS3 (0.0 ± 0.0 in PAS1, 0.25 ± 1.0 in PAS2 and 3.63 ± 2.67 in PAS3). Women presenting with PAS3 on ultrasound had significantly more units of PLT transfused (2.37 ± 2.40) compared with those with PAS0 (0.03 ± 0.18), PAS1 (0.0 ± 0.0) or PAS2 (0.0 ± 0.0). Mean operation time was longer in women with PAS3 (184 ± 32 min) compared with those with PAS1 (153 ± 38 min) or PAS2 (161 ± 28 min). Similarly, women with PAS3 had longer hospital stay (7.4 ± 2.1 days) compared with those with PAS0 (3.4 ± 0.6 days), PAS1 (6.4 ± 1.3 days) or PAS2 (5.9 ± 0.8 days). On linear regression analysis, after adjusting for all potential confounders, higher PAS stage was associated independently with a significant increase in EBL (314 (95% CI, 230-399) mL per one-stage increase; P < 0.001), units of PRBC transfused (1.74 (95% CI, 1.33-2.15) per one-stage increase; P < 0.001), units of FFP transfused (1.19 (95% CI, 0.61-1.77) per one-stage increase; P < 0.001), units of PLT transfused (1.03 (95% CI, 0.59-1.47) per one-stage increase; P < 0.001), operation time (38.8 (95% CI, 31.6-46.1) min per one-stage increase; P < 0.001) and length of hospital stay (0.83 (95% CI, 0.46-1.27) days per one-stage increase; P < 0.001). On logistic regression analysis, increased severity of PAS was associated independently with surgical complications (odds ratio, 3.14 (95% CI, 1.36-7.25); P = 0.007), while only PAS3 was associated with admission to the ICU (P < 0.001). All women with PAS0 on ultrasound were classified as having Grade-1 PAS disorder according to the FIGO grading system. Conversely, of the women presenting with PAS1 on ultrasound, 64.1% (95% CI, 48.4-77.3%) were classified as having Grade-3, while 35.9% (95% CI, 22.7-51.6%) were classified as having Grade-4 PAS disorder, according to the FIGO grading system. All women with PAS2 were categorized as having Grade-5 and all those with PAS3 as having Grade-6 PAS disorder according to the FIGO system. CONCLUSION Ultrasound staging of PAS disorders is feasible and correlates with surgical outcome, depth of invasion and the FIGO clinical grading system. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G Cali
- Department of Obstetrics and Gynaecology, Arnas Civico Hospital, Palermo, Italy
- Department of Obstetrics and Gynaecology, Azienda Ospedaliera Villa Sofia Cervello, Palermo, Italy
| | - F Forlani
- Department of Obstetrics and Gynaecology, Arnas Civico Hospital, Palermo, Italy
| | - C Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - I Timor-Tritsch
- Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, New York University School of Medicine, New York, NY, USA
| | - J Palacios-Jaraquemada
- Centre for Medical Education and Clinical Research (CEMIC), University Hospital, Buenos Aires, Argentina
| | - A Dall'Asta
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - A Bhide
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - M E Flacco
- Local Health Unit of Pescara, Pescara, Italy
| | - L Manzoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - F Labate
- Department of Obstetrics and Gynaecology, Azienda Ospedaliera Villa Sofia Cervello, Palermo, Italy
| | - A Perino
- Department of Obstetrics and Gynaecology, Azienda Ospedaliera Villa Sofia Cervello, Palermo, Italy
| | - G Scambia
- Department of Obstetrics and Gynecology, Catholic University of The Sacred Heart, Rome, Italy
| | - F D'Antonio
- Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway
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Lees C, Weerasinghe S, Lamond N, Younis T, Ramjeesingh R. Palliative care consultation and aggressive care at end of life in unresectable pancreatic cancer. ACTA ACUST UNITED AC 2019; 26:28-36. [PMID: 30853795 DOI: 10.3747/co.26.4389] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Palliative care (pc) consultation has been associated with less aggressive care at end of life in a number of malignancies, but the effect of the consultation timing has not yet been fully characterized. For patients with unresectable pancreatic cancer (upcc), aggressive and resource-intensive treatment at the end of life can be costly, but not necessarily of better quality. In the present study, we investigated the association, if any, between the timing of specialist pc consultation and indicators of aggressive care at end of life in patients with upcc. Methods This retrospective cohort study examined the potential effect of the timing of specialist pc consultation on key indicators of aggressive care at end of life in all patients diagnosed with upcc in Nova Scotia between 1 January 2010 and 31 December 2015. Statistical analysis included univariable and multivariable logistic regression. Results In the 365 patients identified for inclusion in the study, specialist pc consultation was found to be associated with decreased odds of experiencing an indicator of aggressive care at end of life; however, the timing of the consultation was not significant. Residency in an urban area was associated with decreased odds of experiencing an indicator of aggressive care at end of life. We observed no association between experiencing an indicator of aggressive care at end of life and consultation with medical oncology or radiation oncology. Conclusions Regardless of timing, specialist pc consultation was associated with decreased odds of experiencing an indicator of aggressive care at end of life. That finding provides further evidence to support the integral role of pc in managing patients with a life-limiting malignancy.
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Affiliation(s)
- C Lees
- Division of Palliative Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - S Weerasinghe
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS
| | - N Lamond
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - T Younis
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - R Ramjeesingh
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
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Ghi T, Eggebø T, Lees C, Kalache K, Rozenberg P, Youssef A, Salomon LJ, Tutschek B. ISUOG Practice Guidelines: intrapartum ultrasound. Ultrasound Obstet Gynecol 2018; 52:128-139. [PMID: 29974596 DOI: 10.1002/uog.19072] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/08/2018] [Accepted: 03/16/2018] [Indexed: 06/08/2023]
Abstract
The purpose of these Guidelines is to review the published techniques of ultrasound in labor and their practical applications, to summarize the level of evidence regarding the use of ultrasound in labor and to provide guidance to practitioners on when ultrasound in labor is clinically indicated and how the sonographic findings may affect labor management. We do not imply or suggest that ultrasound in labor is a necessary standard of care.
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Affiliation(s)
- T Ghi
- Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - T Eggebø
- National Center for Fetal Medicine, Trondheim University Hospital (St Olavs Hospital), Trondheim, Norway
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - C Lees
- Centre for Fetal Care, Queen Charlottes and Chelsea Hospital, London, UK
| | - K Kalache
- Sidra Medical and Research Center, Doha, Qatar
| | - P Rozenberg
- Centre Hospitalier Poissy Saint Germain, Obstetrics & Gynaecology, Paris, France
| | - A Youssef
- Obstetrics and Gynecology, S. Orsola Malpighi Hospital, Bologna, Italy
| | - L J Salomon
- Hôpital Universitaire Necker-Enfants Malades, AP-HP, Université Paris Descartes, Maternité, Paris, France
- Société Française pour l'Amélioration des Pratiques Echographiques, SFAPE
| | - B Tutschek
- Prenatal Zurich, Heinrich-Heine-University, Medical Faculty, Zürich, Switzerland
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Lees C. Reply. Ultrasound Obstet Gynecol 2018; 51:703. [PMID: 29727067 DOI: 10.1002/uog.19062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- C Lees
- Division of Cancer & Surgery, Imperial College London, Institute for Reproductive & Developmental Biology, London, UK
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Foo FL, McEniery CM, Lees C, Khalil A. Assessment of arterial function in pregnancy: recommendations of the International Working Group on Maternal Hemodynamics. Ultrasound Obstet Gynecol 2017; 50:324-331. [PMID: 28667668 DOI: 10.1002/uog.17565] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/29/2017] [Accepted: 06/08/2017] [Indexed: 06/07/2023]
Abstract
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. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F L Foo
- Division of Cancer & Surgery, Imperial College London, Institute for Reproductive & Developmental Biology, London, UK
| | - C M McEniery
- Division of Experimental Medicine & Immunotherapeutics, University of Cambridge, ACCI, Addenbrookes Hospital, Cambridge, UK
| | - C Lees
- Division of Cancer & Surgery, Imperial College London, Institute for Reproductive & Developmental Biology, London, UK
| | - A Khalil
- St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
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Bilardo CM, Hecher K, Visser GHA, Papageorghiou AT, Marlow N, Thilaganathan B, Van Wassenaer-Leemhuis A, Todros T, Marsal K, Frusca T, Arabin B, Brezinka C, Derks JB, Diemert A, Duvekot JJ, Ferrazzi E, Ganzevoort W, Martinelli P, Ostermayer E, Schlembach D, Valensise H, Thornton J, Wolf H, Lees C. Severe fetal growth restriction at 26-32 weeks: key messages from the TRUFFLE study. Ultrasound Obstet Gynecol 2017; 50:285-290. [PMID: 28938063 DOI: 10.1002/uog.18815] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Indexed: 06/07/2023]
Affiliation(s)
- C M Bilardo
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G H A Visser
- University Medical Center, Division of Woman and Baby, Utrecht, The Netherlands
| | - A T Papageorghiou
- St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - N Marlow
- Department of Academic Neonatology, UCL Institute for Women's Health, London, UK
| | - B Thilaganathan
- St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - A Van Wassenaer-Leemhuis
- Department of Neonatology, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
| | - T Todros
- Department of Obstetrics & Gynecology, University of Turin, Turin, Italy
| | - K Marsal
- Department of Obstetrics and Gynecology, Lund University, University Hospital, Lund, Sweden
| | - T Frusca
- Maternal-Fetal Medicine Unit, University of Parma, Parma, Italy
| | - B Arabin
- Department of Perinatology, Isala Clinics, Zwolle, The Netherlands
- Center for Mother and Child of the Philipps University, Marburg, Germany
| | - C Brezinka
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - J B Derks
- Perinatal Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J J Duvekot
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - E Ferrazzi
- Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - P Martinelli
- Department of Gynecology and Obstetrics, University Federico II of Naples, Naples, Italy
| | - E Ostermayer
- Section of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - D Schlembach
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - H Valensise
- Department of Biomedicine, Tor Vergata University, Policlinico Casilino, Rome, Italy
| | - J Thornton
- Department of Obstetrics and Gynaecology, City Hospital, Nottingham, UK
| | - H Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - C Lees
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Van Wassenaer-Leemhuis AG, Marlow N, Lees C, Wolf H. The association of neonatal morbidity with long-term neurological outcome in infants who were growth restricted and preterm at birth: secondary analyses from TRUFFLE (Trial of Randomized Umbilical and Fetal Flow in Europe). BJOG 2017; 124:1072-1078. [DOI: 10.1111/1471-0528.14511] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - N Marlow
- Department of Academic Neonatology; Institute for Women's Health; University College London; London UK
| | - C Lees
- Department of Obstetrics; Imperial College; London UK
| | - H Wolf
- Department of Obstetrics; Academic Medical Center; Amsterdam the Netherlands
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Talbot T, Dangoor A, Shah R, Naik J, Lees C, Lester J, Cipelli R, Hodgson M, Patel A, Summerhayes M, Newsom-Davis T. 87: Resource use associated with the management of docetaxel-related haematological toxicities, including neutropenic sepsis (NS), in patients with advanced non-small cell lung cancer (NSCLC) in the UK NHS: REVEAL-NS. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30137-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tay J, Foo L, McEniery C, Wilkinson I, Lees C. D5. Is maternal arterial function impaired in pregnancies with fetal growth restriction? J Matern Fetal Neonatal Med 2016. [DOI: 10.1080/14767058.2016.1234780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tay J, Foo L, McEniery C, Wilkinson I, Lees C. F3. Cardiac output and total peripheral resistance in pregnancies with fetal growth restriction. J Matern Fetal Neonatal Med 2016. [DOI: 10.1080/14767058.2016.1234788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rivas MA, Graham D, Sulem P, Stevens C, Desch AN, Goyette P, Gudbjartsson D, Jonsdottir I, Thorsteinsdottir U, Degenhardt F, Mucha S, Kurki MI, Li D, D'Amato M, Annese V, Vermeire S, Weersma RK, Halfvarson J, Paavola-Sakki P, Lappalainen M, Lek M, Cummings B, Tukiainen T, Haritunians T, Halme L, Koskinen LLE, Ananthakrishnan AN, Luo Y, Heap GA, Visschedijk MC, MacArthur DG, Neale BM, Ahmad T, Anderson CA, Brant SR, Duerr RH, Silverberg MS, Cho JH, Palotie A, Saavalainen P, Kontula K, Färkkilä M, McGovern DPB, Franke A, Stefansson K, Rioux JD, Xavier RJ, Daly MJ, Barrett J, de Lane K, Edwards C, Hart A, Hawkey C, Jostins L, Kennedy N, Lamb C, Lee J, Lees C, Mansfield J, Mathew C, Mowatt C, Newman B, Nimmo E, Parkes M, Pollard M, Prescott N, Randall J, Rice D, Satsangi J, Simmons A, Tremelling M, Uhlig H, Wilson D, Abraham C, Achkar JP, Bitton A, Boucher G, Croitoru K, Fleshner P, Glas J, Kugathasan S, Limbergen JV, Milgrom R, Proctor D, Regueiro M, Schumm PL, Sharma Y, Stempak JM, Targan SR, Wang MH. A protein-truncating R179X variant in RNF186 confers protection against ulcerative colitis. Nat Commun 2016; 7:12342. [PMID: 27503255 PMCID: PMC4980482 DOI: 10.1038/ncomms12342] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 06/24/2016] [Indexed: 01/05/2023] Open
Abstract
Protein-truncating variants protective against human disease provide in vivo validation of therapeutic targets. Here we used targeted sequencing to conduct a search for protein-truncating variants conferring protection against inflammatory bowel disease exploiting knowledge of common variants associated with the same disease. Through replication genotyping and imputation we found that a predicted protein-truncating variant (rs36095412, p.R179X, genotyped in 11,148 ulcerative colitis patients and 295,446 controls, MAF=up to 0.78%) in RNF186, a single-exon ring finger E3 ligase with strong colonic expression, protects against ulcerative colitis (overall P=6.89 × 10(-7), odds ratio=0.30). We further demonstrate that the truncated protein exhibits reduced expression and altered subcellular localization, suggesting the protective mechanism may reside in the loss of an interaction or function via mislocalization and/or loss of an essential transmembrane domain.
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Affiliation(s)
- Manuel A. Rivas
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Daniel Graham
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
| | | | - Christine Stevens
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
| | - A. Nicole Desch
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
| | - Philippe Goyette
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada H1T1C8
| | - Daniel Gudbjartsson
- deCODE Genetics, Amgen Inc., 101 Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, 101 Reykjavik, Iceland
| | - Ingileif Jonsdottir
- deCODE Genetics, Amgen Inc., 101 Reykjavik, Iceland
- Department of Immunology, Landspitali, the National University Hospital of Iceland, 101 Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, 101 Reykjavik, Iceland
| | - Unnur Thorsteinsdottir
- deCODE Genetics, Amgen Inc., 101 Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, 101 Reykjavik, Iceland
| | - Frauke Degenhardt
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, 24118 Kiel, Germany
| | - Sören Mucha
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, 24118 Kiel, Germany
| | - Mitja I. Kurki
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Dalin Li
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
- Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California 90048 USA
| | - Mauro D'Amato
- Department of Biosciences and Nutrition, Karolinska Institutet, 14183 Stockholm, Sweden
- BioCruces Health Research Institute and IKERBASQUE, Basque Foundation for Science, 48903 Bilbao, Spain
| | - Vito Annese
- Unit of Gastroenterology, Istituto di Ricovero e Cura a Carattere Scientifico-Casa Sollievo della Sofferenza (IRCCS-CSS) Hospital, 71013 San Giovanni Rotondo, Italy
- Strutture Organizzative Dipartimentali (SOD) Gastroenterologia 2, Azienda Ospedaliero Universitaria (AOU) Careggi, 50134 Florence, Italy
| | - Severine Vermeire
- Department of Clinical and Experimental Medicine, Translational Research in GastroIntestinal Disorders (TARGID), Katholieke Universiteit (KU) Leuven, Leuven 3000, Belgium
- Division of Gastroenterology, University Hospital Gasthuisberg, BE-3000 Leuven, Belgium
| | - Rinse K. Weersma
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, SE 701 82 Örebro, Sweden
| | - Paulina Paavola-Sakki
- Department of Medicine, University of Helsinki, 00100 Helsinki, Finland
- Helsinki University Hospital, 00100 Helsinki, Finland
- Clinic of Gastroenterology, Helsinki University Hospital, 00100 Helsinki, Finland
| | - Maarit Lappalainen
- Department of Medicine, University of Helsinki, 00100 Helsinki, Finland
- Helsinki University Hospital, 00100 Helsinki, Finland
- Research Programs Unit, Immunobiology, and Department of Medical and Clinical Genetics, University of Helsinki, 00014 Helsinki, Finland
| | - Monkol Lek
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Beryl Cummings
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Taru Tukiainen
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Talin Haritunians
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
- Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California 90048 USA
| | - Leena Halme
- Department of Transplantation and Liver Surgery, University of Helsinki, 00100 Helsinki, Finland
| | - Lotta L. E. Koskinen
- Research Programs Unit, Immunobiology, and Department of Medical and Clinical Genetics, University of Helsinki, 00014 Helsinki, Finland
- Department of Medical Genetics, Biomedicum Helsinki, University of Helsinki, 00100 Helsinki, Finland
| | - Ashwin N. Ananthakrishnan
- Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
- Division of Medical Sciences, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Yang Luo
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SA, UK
| | - Graham A. Heap
- IBD Pharmacogenetics, Royal Devon and Exeter NHS Trust, Exeter EX2 5DW, UK
| | - Marijn C. Visschedijk
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Daniel G. MacArthur
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Benjamin M. Neale
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Tariq Ahmad
- Peninsula College of Medicine and Dentistry, Exeter PL6 8BU, UK
| | - Carl A. Anderson
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton CB10 1SA, UK
| | - Steven R. Brant
- Meyerhoff Inflammatory Bowel Disease Center, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, 21205, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, 21205, USA
| | - Richard H. Duerr
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 15261, USA
| | - Mark S. Silverberg
- Department of Medicine, Inflammatory Bowel Disease Centre, Mount Sinai Hospital, Toronto, Ontario, Canada M5G 1X5
| | - Judy H Cho
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut 06510, USA
| | - Aarno Palotie
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
- Institute for Molecular Medicine Finland, University of Helsinki, 00100 Helsinki, Finland
- Massachusetts General Hospital, Center for Human Genetic Research, Psychiatric and Neurodevelopmental Genetics Unit, Boston, Massachusetts 02114, USA
| | - Päivi Saavalainen
- Research Programs Unit, Immunobiology, University of Helsinki, 00100 Helsinki, Finland
| | - Kimmo Kontula
- Department of Medicine, University of Helsinki, 00100 Helsinki, Finland
- Helsinki University Hospital, 00100 Helsinki, Finland
| | - Martti Färkkilä
- Department of Medicine, University of Helsinki, 00100 Helsinki, Finland
- Helsinki University Hospital, 00100 Helsinki, Finland
- Clinic of Gastroenterology, Helsinki University Hospital, 00100 Helsinki, Finland
| | - Dermot P. B. McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
- Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, California 90048 USA
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, 24118 Kiel, Germany
| | - Kari Stefansson
- deCODE Genetics, Amgen Inc., 101 Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, 101 Reykjavik, Iceland
| | - John D. Rioux
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada H1T1C8
- Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada H3T 1J4
| | - Ramnik J. Xavier
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Mark J. Daly
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
| | - J. Barrett
- IBD Pharmacogenetics, Royal Devon and Exeter NHS Trust, Exeter EX2 5DW, UK
| | - K. de Lane
- IBD Pharmacogenetics, Royal Devon and Exeter NHS Trust, Exeter EX2 5DW, UK
| | - C. Edwards
- Department of Gastroenterology, Torbay Hospital, Devon, UK
| | - A. Hart
- Department of Medicine, St. Mark's Hospital, Middlesex, UK
| | - C. Hawkey
- Nottingham Digestive Disease Centre, Queens Medical Centre, Nottingham, UK
| | - L. Jostins
- Wellcome Trust Centre for Human Genetics, University of Oxford, Headington, UK
- Christ Church, University of Oxford, Oxford, UK
| | - N. Kennedy
- Gastrointestinal Unit, Wester General Hospital, University of Edinburgh, Edinburgh, UK
| | - C. Lamb
- Newcastle University, Newcastle upon Tyne, UK
| | - J. Lee
- Inflammatory Bowel Disease Research Group, Addenbrooke's Hospital, Cambridge, UK
| | - C. Lees
- Gastrointestinal Unit, Wester General Hospital, University of Edinburgh, Edinburgh, UK
| | | | - C. Mathew
- Department of Medical and Molecular Genetics, Guy's Hospital, London, UK
- Department of Medical and Molecular Genetics, King's College London School of Medicine, Guy's Hospital, London, UK
| | - C. Mowatt
- Department of Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - B. Newman
- Genetic Medicine, Manchester Academic Health Science Centre, Manchester, UK
- The Manchester Centre for Genomic Medicine, University of Manchester, Manchester, UK
| | - E. Nimmo
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - M. Parkes
- Inflammatory Bowel Disease Research Group, Addenbrooke's Hospital, Cambridge, UK
| | - M. Pollard
- IBD Pharmacogenetics, Royal Devon and Exeter NHS Trust, Exeter EX2 5DW, UK
| | - N. Prescott
- Department of Medical and Molecular Genetics, Guy's Hospital, London, UK
- Department of Medical and Molecular Genetics, King's College London School of Medicine, Guy's Hospital, London, UK
| | - J. Randall
- IBD Pharmacogenetics, Royal Devon and Exeter NHS Trust, Exeter EX2 5DW, UK
| | - D. Rice
- IBD Pharmacogenetics, Royal Devon and Exeter NHS Trust, Exeter EX2 5DW, UK
| | - J. Satsangi
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - A. Simmons
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK
- Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - M. Tremelling
- Gastroenterology & General Medicine, Norfolk and Norwich University Hospital, Norwich, UK
| | - H. Uhlig
- Translational Gastroenterology Unit and the Department of Pediatrics, University of Oxford, Oxford, UK
| | - D. Wilson
- Pediatric Gastroenterology and Nutrition, Royal Hospital for Sick Children, Edinburgh, UK
- Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - C. Abraham
- Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - J. P. Achkar
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - A. Bitton
- Division of Gastroenterology, Royal Victoria Hospital, Montréal, Québec, Canada
| | - G. Boucher
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada H1T1C8
| | - K. Croitoru
- Inflammatory Bowel Disease Group, Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - P. Fleshner
- Department of Transplantation and Liver Surgery, University of Helsinki, 00100 Helsinki, Finland
| | - J. Glas
- Division of Gastroenterology, Royal Victoria Hospital, Montréal, Québec, Canada
| | - S. Kugathasan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - J. V. Limbergen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada
| | - R. Milgrom
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut 06510, USA
| | - D. Proctor
- Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - M. Regueiro
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 15261, USA
| | - P. L. Schumm
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Y. Sharma
- Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J. M. Stempak
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut 06510, USA
| | - S. R. Targan
- Department of Transplantation and Liver Surgery, University of Helsinki, 00100 Helsinki, Finland
| | - M. H. Wang
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA
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Osborn M, Webber B, McElroy A, Defeo A, Patel D, Lees C, McElmurry R, Riddle M, Blazar B, Tolar J. 371 CRISPR/Cas9-based genetic correction for recessive dystrophic epidermolysis bullosa (RDEB). J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Meher S, Hernandez-Andrade E, Basheer SN, Lees C. Impact of cerebral redistribution on neurodevelopmental outcome in small-for-gestational-age or growth-restricted babies: a systematic review. Ultrasound Obstet Gynecol 2015; 46:398-404. [PMID: 25683973 DOI: 10.1002/uog.14818] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 01/31/2015] [Accepted: 02/03/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To review systematically the evidence on impact of cerebral redistribution, as assessed by fetal middle cerebral artery (MCA) Doppler, on neurological outcomes in small-for-gestational-age (SGA) or growth-restricted fetuses. METHODS For this systematic review, MEDLINE was searched for all controlled studies reporting neurological outcomes in SGA or growth-restricted babies with cerebral redistribution based on MCA Doppler indices, from inception to September 2013. We used relative risk or odds ratios, with 95% CI, to identify the association of cerebral redistribution with neurological outcomes. RESULTS The search yielded 1180 possible citations, of which nine studies were included in the review, with a total of 1198 fetuses. Definitions of SGA and cerebral redistribution were variable, as was study quality. Data could not be synthesized in meta-analyses because of heterogeneity in outcome reporting. Cerebral redistribution was not associated with increased risk of intraventricular hemorrhage in neonates (five studies; n = 806). When present in preterm fetuses, cerebral redistribution was associated with normal Neonatal Behavioral Assessment Scale (NBAS) scores at 40 weeks (one study; n = 62) but abnormal psychomotor development at 1 year of age on the Bayley scale (one study; n = 172). When present in term SGA fetuses, cerebral redistribution was associated with increased risk of motor and state organizational problems on NBAS (two studies; n = 158), and lower mean percentile scores in communication and problem solving at 2 years of age on the Ages and Stages Questionnaire (one study; n = 125). CONCLUSIONS SGA fetuses with cerebral redistribution may be at higher risk of neurodevelopmental problems. More data are needed from adequately controlled studies with long-term follow-up before conclusions can be drawn. If these findings are true, there is a need to re-evaluate timing of delivery in the management of SGA fetuses, particularly when cerebral redistribution is found at term gestation.
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Affiliation(s)
- S Meher
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - E Hernandez-Andrade
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, MI, USA
| | - S N Basheer
- Department of Paediatric Neurology and Neonatal Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - C Lees
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Karina M, Lees C, Tadman M, Wang L, Talbot D. 1210 A retrospective study of 400 patients with neuroendocrine tumours treated in Oxford University hospitals since 2011. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30514-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Morlando M, Ferrara L, D'Antonio F, Lawin-O'Brien A, Sankaran S, Pasupathy D, Khalil A, Papageorghiou A, Kyle P, Lees C, Thilaganathan B, Bhide A. Dichorionic triplet pregnancies: risk of miscarriage and severe preterm delivery with fetal reduction versus expectant management. Outcomes of a cohort study and systematic review. BJOG 2015; 122:1053-60. [DOI: 10.1111/1471-0528.13348] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2015] [Indexed: 10/23/2022]
Affiliation(s)
- M Morlando
- Fetal Medicine Unit; Academic Department of Obstetrics and Gynaecology; St George's University of London; London UK
| | - L Ferrara
- Queen Charlotte's and Chelsea Hospital; London UK
| | - F D'Antonio
- Fetal Medicine Unit; Academic Department of Obstetrics and Gynaecology; St George's University of London; London UK
| | | | - S Sankaran
- Fetal Medicine Unit; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - D Pasupathy
- Fetal Medicine Unit; Guy's and St Thomas’ NHS Foundation Trust; London UK
- Division of Women's Health; King's College; London UK
| | - A Khalil
- Fetal Medicine Unit; Academic Department of Obstetrics and Gynaecology; St George's University of London; London UK
| | - A Papageorghiou
- Fetal Medicine Unit; Academic Department of Obstetrics and Gynaecology; St George's University of London; London UK
| | - P Kyle
- Fetal Medicine Unit; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - C Lees
- Queen Charlotte's and Chelsea Hospital; London UK
| | - B Thilaganathan
- Fetal Medicine Unit; Academic Department of Obstetrics and Gynaecology; St George's University of London; London UK
| | - A Bhide
- Fetal Medicine Unit; Academic Department of Obstetrics and Gynaecology; St George's University of London; London UK
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Mayland CR, Lees C, West A, Cox T, Mason SR, Ellershaw JE. SUPPORTING PATIENTS AND THEIR FAMILIES WHO WISH TO DIE AT HOME - BEREAVED RELATIVES' VIEWS ABOUT THE CARE AND SUPPORT RECEIVED. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000653.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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45
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Lees C. Reply: To PMID 24078432. Ultrasound Obstet Gynecol 2014; 43:237-238. [PMID: 24497422 DOI: 10.1002/uog.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- C Lees
- Fetal Medicine Department, Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
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Israfil-Bayli F, Toozs-Hobson P, Lees C, Slack M, Daniels J, Vince A, Ismail KMK. Cervical cerclage and type of suture material: a survey of UK consultants’ practice. J Matern Fetal Neonatal Med 2014; 27:1584-8. [DOI: 10.3109/14767058.2013.870551] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wilkinson DJC, de Crespigny L, Lees C, Savulescu J, Thiele P, Tran T, Watkins A. Perinatal management of trisomy 18: a survey of obstetricians in Australia, New Zealand and the UK. Prenat Diagn 2014; 34:42-9. [PMID: 24122837 PMCID: PMC3963474 DOI: 10.1002/pd.4249] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/20/2013] [Accepted: 09/29/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to explore the attitudes of obstetricians in Australia, New Zealand and the UK towards prenatally diagnosed trisomy 18 (T18). METHOD Obstetricians were contacted by email and invited to participate in an anonymous electronic survey. RESULTS Survey responses were obtained from 1018/3717 (27%) practicing obstetricians/gynaecologists. Most (60%) had managed a case of T18 in the last 2 years. Eighty-five per cent believed that T18 was a 'lethal malformation', although 38% expected at least half of liveborn infants to survive for more than 1 week. Twenty-one per cent indicated that a vegetative existence was the best developmental outcome for surviving children. In a case of antenatally diagnosed T18, 95% of obstetricians would provide a mother with the option of termination. If requested, 99% would provide maternal-focused obstetric care (aimed at maternal wellbeing rather than fetal survival), whereas 80% would provide fetal-oriented obstetric care (to maximise fetal survival). Twenty-eight per cent would never discuss the option of caesarean; 21% would always discuss this option. Management options, attitudes and knowledge of T18 were associated with location, practice type, gender and religion of obstetricians. CONCLUSION There is variability in obstetricians' attitudes towards T18, with significant implications for management of affected pregnancies.
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Affiliation(s)
- D J C Wilkinson
- Robinson Institute, University of AdelaideAdelaide, Australia
- Oxford Uehiro Centre for Practical Ethics, University of OxfordOxford, UK
| | - L de Crespigny
- Oxford Uehiro Centre for Practical Ethics, University of OxfordOxford, UK
| | - C Lees
- Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS TrustDu Cane Rd, London, W12 0HS
| | - J Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of OxfordOxford, UK
| | - P Thiele
- Monash UniversityFrankston, Australia
| | - T Tran
- Robinson Institute, University of AdelaideAdelaide, Australia
| | - A Watkins
- Mercy Hospital for WomenMelbourne, Australia
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Lees C, Tuthill M, Croxford W, Sharkey R, Newsom-Davis T. 42 Lung cancer diagnosis in the acute setting. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70043-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Alberry M, Hassan WA, Goodburn S, Brockelsby J, Wladimiroff J, Nash R, Lees C. The impact of national guidance for anomaly screening and invasive testing: unintended consequences. Arch Dis Child Fetal Neonatal Ed 2014; 99:F83-6. [PMID: 23833074 DOI: 10.1136/archdischild-2013-303914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Recent guidance from the UK National Screening Committee (NSC) and the Fetal Anomaly Screening Programme (FASP) has led to important changes in prenatal ultrasound diagnosis and invasive testing. These relate to prenatal ultrasound investigation of what were previously known as 'soft markers' for Down's syndrome at the time of the detailed anomaly scan and as to whether full karyotype or FISH (fluorescent in situ hybridisation)/QFPCR (quantitative fluorescence PCR) testing for trisomies should be carried out when an invasive test is performed. Neither recommendation is directly related to the other but both in combination could have profound implications for the detection of chromosomal abnormalities other than trisomy 21 (Down's syndrome). In the light of two cases recently managed in one regional fetal medicine unit, we retrospectively reviewed cases where, with correct application of the NSC and FASP recommendations, non-lethal and clinically important chromosomal abnormalities would most likely not have been detected.
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Affiliation(s)
- M Alberry
- Department of Fetal Medicine, Rosie Hospital, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, , Cambridge, UK
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Lees C, Marlow N, Arabin B, Bilardo CM, Brezinka C, Derks JB, Duvekot J, Frusca T, Diemert A, Ferrazzi E, Ganzevoort W, Hecher K, Martinelli P, Ostermayer E, Papageorghiou AT, Schlembach D, Schneider KTM, Thilaganathan B, Todros T, van Wassenaer-Leemhuis A, Valcamonico A, Visser GHA, Wolf H. Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE). Ultrasound Obstet Gynecol 2013; 42:400-408. [PMID: 24078432 DOI: 10.1002/uog.13190] [Citation(s) in RCA: 307] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Few data exist for counseling and perinatal management of women after an antenatal diagnosis of early-onset fetal growth restriction. Yet, the consequences of preterm delivery and its attendant morbidity for both mother and baby are far reaching. The objective of this study was to describe perinatal morbidity and mortality following early-onset fetal growth restriction based on time of antenatal diagnosis and delivery. METHODS We report cohort outcomes for a prospective multicenter randomized management study of fetal growth restriction (Trial of Randomized Umbilical and Fetal Flow in Europe (TRUFFLE)) performed in 20 European perinatal centers between 2005 and 2010. Women with a singleton fetus at 26-32 weeks of gestation, with abdominal circumference < 10(th) percentile and umbilical artery Doppler pulsatility index > 95(th) percentile, were recruited. The main outcome measure was a composite of fetal or neonatal death or severe morbidity: survival to discharge with severe brain injury, bronchopulmonary dysplasia, proven neonatal sepsis or necrotizing enterocolitis. RESULTS Five-hundred and three of 542 eligible women formed the study group. Mean ± SD gestational age at diagnosis was 29 ± 1.6 weeks and mean ± SD estimated fetal weight was 881 ± 217 g; 12 (2.4%) babies died in utero. Gestational age at delivery was 30.7 ± 2.3 weeks, and birth weight was 1013 ± 321 g. Overall, 81% of deliveries were indicated by fetal condition and 97% were by Cesarean section. Of 491 liveborn babies, outcomes were available for 490 amongst whom there were 27 (5.5%) deaths and 118 (24%) babies suffered severe morbidity. These babies were smaller at birth (867 ± 251 g) and born earlier (29.6 ± 2.0 weeks). Death and severe morbidity were significantly related to gestational age, both at study entry and delivery and also with the presence of maternal hypertensive morbidity. The median time to delivery was 13 days for women without hypertension, 8 days for those with gestational hypertension, 4 days for pre-eclampsia and 3 days for HELLP syndrome. CONCLUSIONS Fetal outcome in this study was better than expected from contemporary reports: perinatal death was uncommon (8%) and 70% survived without severe neonatal morbidity. The intervals to delivery, death and severe morbidity were related to the presence and severity of maternal hypertensive conditions.
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Affiliation(s)
- C Lees
- Department of Obstetrics & Gynaecology, Rosie Hospital, Cambridge, UK; Department of Obstetrics and Gynecology, KU Leuven, Belgium
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