Publications by authors named "Christoph Lees"
Intrapartum ultrasound for cervical dilatation: Inter- and intra-observer agreement.
Acta Obstet Gynecol Scand
December 2024
Article Synopsis
- Digital vaginal examination (DVE) is the standard method for checking labor progress, but it can be painful and subjective, with variability in results; this study aims to compare DVE to intrapartum transperineal ultrasound (TPUS).
- Conducted at a London maternity unit, the study involved nulliparous women in active labor, where TPUS measurements were taken after DVE, allowing for comparisons between the two methods. The study incorporated repeated ultrasound assessments when possible.
- Out of 206 women, complete data from 110 showed that 34% had no difference between TPUS and DVE measurements, while a mean difference of -0.9 cm was observed, indicating
Article Synopsis
- Second trimester miscarriage and preterm birth are significant issues globally, leading to the use of surgical cervical cerclage to help prevent these outcomes, with a focus on comparing the effectiveness of monofilament versus braided sutures.
- The study aims to determine if monofilament sutures reduce pregnancy loss better than braided ones in women needing cervical cerclage, as bacteria colonization on braided sutures may contribute to complications.
- Conducted across 75 UK maternity sites, this open randomized controlled trial includes women with specific risk factors for preterm birth and evaluates outcomes like miscarriage rates and perinatal mortality through a 1:1 randomization process.
Objectives: To develop a deep learning (DL)-model using convolutional neural networks (CNN) to automatically identify the fetal head position at transperineal ultrasound in the second stage of labor.
Material And Methods: Prospective, multicenter study including singleton, term, cephalic pregnancies in the second stage of labor. We assessed the fetal head position using transabdominal ultrasound and subsequently, obtained an image of the fetal head on the axial plane using transperineal ultrasound and labeled it according to the transabdominal ultrasound findings.
Monitoring and timing of delivery in preterm preeclampsia and fetal growth restriction is one of the biggest challenges in Obstetrics. Finding the optimal time of delivery of these fetuses usually involves a trade-off between the severity of the disease and prematurity. So far, most clinical guidelines recommend the use of a combination between clinical, laboratory and ultrasound markers to guide the time of delivery.
View Article and Find Full Text PDFIntroduction: To evaluate the maternal and fetal hemodynamic effects of treatment with a nitric oxide donor and oral fluid in pregnancies complicated by fetal growth restriction.
Methods: 30 normotensive participants with early fetal growth restriction were enrolled. 15 participants were treated until delivery with transdermal glyceryl trinitrate and oral fluid intake (Treated group), and 15 comprised the untreated group.
Background: There are limited data to guide the diagnosis and management of vasa previa. Currently, what is known is largely based on case reports or series and cohort studies.
Objective: This study aimed to systematically collect and classify expert opinions and achieve consensus on the diagnosis and clinical management of vasa previa using focus group discussions and a Delphi technique.
Article Synopsis
- The study explores a new methodology for 3D ultrasound imaging of fetal faces, aimed at improving the diagnosis of genetic conditions during pregnancy.
- Researchers analyzed 135 ultrasound volumes from fetuses aged 24-34 weeks, using a semi-automatic process to create 3D surface models that reflect normal growth patterns.
- The findings indicate that as gestation advances, certain facial features change, and while growth-restricted fetuses have smaller faces, their shape remains consistent; this model could aid in identifying congenital anomalies linked to facial characteristics.
Background: The evidence-based management of human labor includes the antepartum identification of patients at risk for intrapartum hypoxia. However, available evidence has shown that most of the hypoxic-related complications occur among pregnancies classified at low-risk for intrapartum hypoxia, thus suggesting that the current strategy to identify the pregnancies at risk for intrapartum fetal hypoxia has limited accuracy.
Objective: To evaluate the role of the combined assessment of the cerebroplacental ratio (CPR) and uterine arteries (UtA) Doppler in the prediction of obstetric intervention (OI) for suspected intrapartum fetal compromise (IFC) within a cohort of low-risk singleton term pregnancies in early labor.
Objectives: To compare agreement between echocardiography and regional impedance cardiography (RIC)-derived cardiac output (CO), and to construct indicative normative ranges of CO for gestational age groups.
Design, Setting And Participants: Prospective cohort observational study performed in a tertiary centre in London, UK, including neonates born between 25 and 42 weeks' gestational age.
Exposures: Neonates on the postnatal ward had 2 hours of RIC monitoring; neonates in intensive care had RIC monitoring for the first 72 hours, then weekly for 2 hours, with concomitant echocardiography measures.
Objective: Prepregnancy optimization of cardiovascular function may reduce the risk of pre-eclampsia. We aimed to assess the feasibility and effect of preconception cardiovascular monitoring, exercise, and beetroot juice on cardiovascular parameters in women planning to conceive.
Design And Method: Prospective single-site, open-label, randomized controlled trial.
The placental syndromes gestational hypertension, preeclampsia and intrauterine growth restriction are associated with an increased cardiovascular risk to the mother later in life. In this review, we argue that a woman's pre-conception cardiovascular health drives both the development of placental syndromes and long-term cardiovascular risk but acknowledge that placental syndromes can also contribute to future cardiovascular risk independent of pre-conception health. We describe how preclinical studies in models of preeclampsia inform our understanding of the links with later cardiovascular disease, and how current pre-pregnancy studies may explain relative contributions of both pre-conception factors and the occurrence of placental syndromes to long-term cardiovascular disease.
View Article and Find Full Text PDFDo differences in diagnostic criteria for late fetal growth restriction matter?
Am J Obstet Gynecol MFM
November 2023
Background: Criteria for diagnosis of fetal growth restriction differ widely according to national and international guidelines, and further heterogeneity arises from the use of different biometric and Doppler reference charts, making the diagnosis of fetal growth restriction highly variable.
Objective: This study aimed to compare fetal growth restriction definitions between Delphi consensus and Society for Maternal-Fetal Medicine definitions, using different standards/charts for fetal biometry and different reference ranges for Doppler velocimetry parameters.
Study Design: From the TRUFFLE 2 feasibility study (856 women with singleton pregnancy at 32 to 36 weeks of gestation and at risk of fetal growth restriction), we selected 564 women with available mid-pregnancy biometry.
Article Synopsis
- The traditional method of assessing labor progress has not changed much in over a century, relying on manual plotting of digital vaginal examination findings on a partogram for managing labor.
- The rise of portable ultrasound technology in obstetrics offers a potential new tool—the sonopartogram—that could provide a more accurate and objective way to track labor progress compared to traditional methods.
- Although the sonopartogram shows promise, further research is needed to determine its impact on maternal and neonatal outcomes, as factors like fetal head position and maternal characteristics still play crucial roles in labor complications.
Background: This review aims to summarize associations of the perinatal environment with arterial biophysical properties in childhood, to elucidate possible perinatal origins of adult cardiovascular disease (CVD).
Methods: A systematic search of PubMed database was performed (December 2020). Studies exploring associations of perinatal factors with arterial biophysical properties in children 12 years old or less were included.
Introduction: The objective of this study was to describe a cohort of fetuses with an ultrasound prenatal diagnosis of obliterated cavum septi pellucidi (oCSP) with the aim to explore the rate of associated malformations, the progression during pregnancy and the role of fetal magnetic resonance imaging (MRI).
Material And Methods: This was a retrospective multicenter international study of fetuses diagnosed with oCSP in the second trimester with available fetal MRI and subsequent ultrasound and/or fetal MRI follow-up in the third trimester. Where available, postnatal data were collected to obtain information on neurodevelopment.