Publications by authors named "Gardener G"

Previous studies have focused on demographic factors that might predict non-completion of pulmonary rehabilitation (PR). We aimed to identify key modifiable factors that promote completion of PR. A mixed methods survey was offered to participants completing a discharge assessment following PR.

View Article and Find Full Text PDF
Article Synopsis
  • Non-invasive prenatal tests (NIPT) using massively parallel sequencing (MPS) aim to predict fetal blood group antigens for women who are alloimmunised, specifically targeting multiple nucleotide variants.
  • The study involved sequencing maternal blood samples from 33 cases and analyzing genetic data to match outcomes against established methods, with a focus on detecting low-frequency variants.
  • Results showed a 97.2% agreement with validated methods, highlighting the effectiveness of MPS for screening various blood groups and the potential to enhance care for alloimmunised women, while caution is advised for specific Rh factor cases.
View Article and Find Full Text PDF
Article Synopsis
  • A phase 2 clinical trial evaluated the safety and effectiveness of a maternal RSV vaccine (RSVPreF3) in 213 healthy pregnant women, focusing on its impact during late pregnancy and its effects on newborns.
  • The vaccine was well tolerated with no significant adverse events linked to it, demonstrating significant increases in mothers' RSV-specific neutralizing antibodies compared to a placebo.
  • Results showed successful transfer of protective antibodies to newborns, with antibody levels in infants highest at birth, supporting the vaccine's promise for maternal immunization against RSV.
View Article and Find Full Text PDF

Background: Delayed reporting of decreased fetal movements (DFM) could represent a missed opportunity to prevent stillbirth. Mobile phone applications (apps) have the potential to improve maternal awareness and reporting of DFM and contribute to stillbirth prevention.

Aims: To evaluate the effectiveness of the My Baby's Movements (MBM) app on late-gestation stillbirth rates.

View Article and Find Full Text PDF

Introduction: The authors aim to review the early outcomes of fetostopic laser ablation (FLA) to improve outcomes for twin-to-twin transfusion syndrome (TTTS) in an emerging national centre in Malaysia.

Materials And Methods: This is a retrospective cohort study of 17 monochorionic diamniotic (MCDA) twin pregnancies with severe TTTS treated by FLA over 15 months in a single centre by a single operator after performing simulations.

Result: The overall survival rate at day 28 after birth for at least one twin was 76% while the dual-twin survival was 64%.

View Article and Find Full Text PDF

Background: Despite a paucity of evidence, it is widely accepted that a perceived reduction in fetal movements is associated with an increased risk of stillbirth and poor obstetrical outcome. Consequently, many international guidelines recommend urgent ultrasound assessment of fetal well-being in women presenting with decreased fetal movements.

Objective: This study aimed to compare rates of abnormal ultrasound findings reflective of fetal compromise between women presenting with decreased fetal movements and gestation-matched controls in the third trimester.

View Article and Find Full Text PDF

Background: Two randomized controlled trials compared the neonatal and infant outcomes after fetoscopic endoluminal tracheal occlusion with expectant prenatal management in fetuses with severe and moderate isolated congenital diaphragmatic hernia, respectively. Fetoscopic endoluminal tracheal occlusion was carried out at 27 to 29 weeks' gestation (referred to as "early") for severe and at 30 to 31 weeks ("late") for moderate hypoplasia. The reported absolute increase in the survival to discharge was 13% (95% confidence interval, -1 to 28; P=.

View Article and Find Full Text PDF

Background: Fetal supraventricular tachycardia is a relatively uncommon cardiac rhythm abnormality which is often associated with adverse perinatal outcomes if untreated. Although there are several treatment modalities and protocols in use globally, there is no consensus as to the most effective antiarrhythmic to manage this condition.

Aim: This study aimed to evaluate perinatal outcomes following prenatal maternal therapy for fetal supraventricular tachycardia.

View Article and Find Full Text PDF

Maternal alloimmunisation against red blood cell antigens can cause haemolytic disease of the fetus and newborn (HDFN). Although most frequently caused by anti-D, since the implementation of rhesus D (RhD) immunoglobulin prophylaxis, other alloantibodies have become more prevalent in HDFN. Recent advances in non-invasive prenatal testing (NIPT) have allowed early prediction of HDFN risk in alloimmunised pregnancies and allow clinicians to focus health resources on those pregnancies that require intervention.

View Article and Find Full Text PDF

Objective: The My Baby's Movements (MBM) trial aimed to evaluate the impact on stillbirth rates of a multifaceted awareness package (the MBM intervention).

Design: Stepped-wedge cluster-randomised controlled trial.

Setting: Twenty-seven maternity hospitals in Australia and New Zealand.

View Article and Find Full Text PDF

Background: Fetoscopic endoluminal tracheal occlusion (FETO) has been associated with increased postnatal survival among infants with severe pulmonary hypoplasia due to isolated congenital diaphragmatic hernia on the left side, but data are lacking to inform its effects in infants with moderate disease.

Methods: In this open-label trial conducted at many centers with experience in FETO and other types of prenatal surgery, we randomly assigned, in a 1:1 ratio, women carrying singleton fetuses with a moderate isolated congenital diaphragmatic hernia on the left side to FETO at 30 to 32 weeks of gestation or expectant care. Both treatments were followed by standardized postnatal care.

View Article and Find Full Text PDF

Background: Stillbirth is a major public health problem that is slow to improve in Australia. Understanding the causes of stillbirth through appropriate investigation is the cornerstone of prevention and important for parents to understand why their baby died.

Aim: The aim of this study is to assess compliance with the Perinatal Society of Australia and New Zealand (PSANZ) Perinatal Mortality Clinical Practice Guidelines (2009) for stillbirths.

View Article and Find Full Text PDF

Background: In 2015, the stillbirth rate after 28 weeks (late gestation) in Australia was 35% higher than countries with the lowest rates globally. Reductions in late gestation stillbirth rates have steadily improved in Australia. However, to amplify and sustain reductions, more needs to be done to reduce practice variation and address sub-optimal care.

View Article and Find Full Text PDF

Anti-D immunoglobulin prophylaxis reduces the risk of RhD negative women becoming alloimmunised to the RhD antigen and is a major preventative strategy in reducing the burden of haemolytic disease of the fetus and newborn (HDFN). HDFN also arises from other maternal red cell antibodies, with the most clinically significant, after anti-D, being anti-K, anti-c and anti-E. Among the 39 human blood group systems advanced genomic technologies are still revealing novel or rare antigens involved in maternal alloimmunisation.

View Article and Find Full Text PDF

Background: Twin anemia polycythemia sequence is a chronic form of unbalanced fetofetal transfusion through minuscule placental anastomoses in monochorionic twins, leading to anemia in the donor and polycythemia in the recipient. Owing to the low incidence of twin anemia polycythemia sequence, data on diagnosis, management, and outcome are limited.

Objective: This study aimed to investigate the diagnosis, management, and outcome in a large international cohort of spontaneous twin anemia polycythemia sequence.

View Article and Find Full Text PDF

The aim of this study was to investigate the management and outcome in the post-laser twin anemia polycythemia sequence (TAPS). Data of the international TAPS Registry, collected between 2014 and 2019, were used for this study. The primary outcomes were perinatal mortality and severe neonatal morbidity.

View Article and Find Full Text PDF

Objective: To investigate the antenatal management and outcome in a large international cohort of monochorionic twin pregnancies with spontaneous or post-laser twin anemia-polycythemia sequence (TAPS).

Methods: This study analyzed data of monochorionic twin pregnancies diagnosed antenatally with spontaneous or post-laser TAPS in 17 fetal therapy centers, recorded in the TAPS Registry between 2014 and 2019. Antenatal diagnosis of TAPS was based on fetal middle cerebral artery peak systolic velocity > 1.

View Article and Find Full Text PDF

Background: Stillbirth is a devastating pregnancy outcome that has a profound and lasting impact on women and families. Globally, there are over 2.6 million stillbirths annually and progress in reducing these deaths has been slow.

View Article and Find Full Text PDF

Objective: To evaluate whether there is a differential benefit of planned Cesarean delivery (CD) over planned vaginal delivery (VD) in women with a twin pregnancy and the first twin in cephalic presentation, depending on prespecified baseline maternal and pregnancy characteristics, and/or gestational age (GA) at delivery.

Methods: This was a secondary analysis of the Twin Birth Study, which included 2804 women with a twin pregnancy and the first twin (Twin A) in cephalic presentation between 32 + 0 and 38 + 6 weeks' gestation at 106 centers in 25 countries. Women were assigned randomly to either planned CD or planned VD.

View Article and Find Full Text PDF

Background: 'Bundles of care' are being implemented to improve key practice gaps in perinatal care. As part of our development of a stillbirth prevention bundle, we consulted with Australian maternity care providers.

Objective: To gain the insights of Australian maternity care providers to inform the development and implementation of a bundle of care for stillbirth prevention.

View Article and Find Full Text PDF

Objective: To assess the effect of maternal sildenafil therapy on fetal growth in pregnancies with early-onset fetal growth restriction.

Design: A randomised placebo-controlled trial.

Setting: Thirteen maternal-fetal medicine units across New Zealand and Australia.

View Article and Find Full Text PDF