ABSTRACT Since mid-December 2010, there has been an increase in the number of reported cases of s... more ABSTRACT Since mid-December 2010, there has been an increase in the number of reported cases of severe H1N1A, or ‘swine flu’. Maternity units across the UK have also seen a rapid rise in the number of hospital and intensive care unit admissions due to H1N1A infection among pregnant women. Hospitalization, critical illness and mortality rates in pregnant women with H1N1A infection are significantly higher than those of non-pregnant women of the same age. For this reason, key public health messages, including respiratory and hand hygiene, should be emphasized. Midwives and doctors should also promote influenza vaccine uptake among all pregnant women who have not previously been vaccinated against H1N1A. All those who care for pregnant women should also seek vaccination themselves.
To explore if blood pressure (BP) readings over 24 h is a useful addition to uterine artery Doppl... more To explore if blood pressure (BP) readings over 24 h is a useful addition to uterine artery Doppler to screen for hypertensive disorders. In a prospective observational study, we invited nulliparous women with abnormal and normal uterine artery Doppler but normal BP at the time of their routine anomaly scan. BP was measured by the woman using automated apparatus at five specified time intervals over 24 h at 22-24 weeks. Pregnancy outcome was retrieved from delivery suite records, discharge summaries, and letters to general practitioners if necessary. Logistic regression was used to explore the contribution of uterine artery Doppler and BP measurements towards the development of pre-eclampsia. Data were available from 52 women with abnormal and 48 women with normal uterine artery Doppler. Thirteen women developed hypertension in pregnancy. Significant difference was found in the BP of women who did or did not develop hypertensive disorders. BP recordings showed the diurnal variation. Both uterine artery Doppler mean PI and BP showed significant correlation with future development of hypertension. Women can self-measure BP at home. BP readings show diurnal variation. There are significant differences in BP of women who do and do not develop hypertension later in the pregnancy. Use of home BP monitoring over 24 h of the day in mid-pregnancy is unlikely to add to the use of uterine artery Doppler and a one-off BP reading for future development of hypertension in pregnancy.
To investigate longitudinal changes in maternal serum placental growth factor (PlGF) and soluble ... more To investigate longitudinal changes in maternal serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) in pregnancies that develop preeclampsia (PE) and gestational hypertension (GH). This was a prospective longitudinal study in singleton pregnancies identified by screening at 11(+0) -13(+6) weeks' gestation as being at high-risk for PE. Blood samples were taken every four weeks until delivery. Values were compared in pregnancies that developed preterm-PE (requiring delivery before 37 weeks), term-PE, GH, and those that remained normotensive. A total of 1069 samples were analyzed in 234 women, including 172 that remained normotensive, 18 that developed GH, 22 that developed preterm-PE and 22 that developed term-PE. In the preterm-PE group, compared to the normotensive group, sFlt-1 was significantly higher from 15 weeks onwards and the difference increased with gestational age (GA) (p < 0.001). In the preterm-PE group, compared to the normotensive group, PlGF was significantly lower from 11 weeks and the difference increased significantly with GA (p < 0.001). Similarly, in the term-PE and GH groups PLGF was lower from 13 and 27 weeks, respectively, and the difference increased significantly with GA (p < 0.001). In the preterm-PE group, compared to the normotensive group, sFlt-1/PlGF ratio was significantly higher from 11 weeks and the difference increased significantly with GA (p < 0.001). A random slope model provided a significantly better fit to the data than a single-level model for sFlt (likelihood ratio(LR) = 516, degrees of freedom(df) = 3, p < 0.001), for PLGF (LR =542, df = 3,p < 0.00)1, and sFlt-1/PLGF ratio (LR=468, df = 3, p < 0.001). Repeat measurements of these biochemical markers are likely to be better predictors of PE than measurement at a single time point in pregnancy, as the differences between normotensive and hypertensive pregnancies increase with GA. In screening for preterm-PE, maternal serum PlGF is a useful marker from the first trimester, while sFlt-1 is likely to have a predictive value from the second trimester.
Recent antenatal screening guidelines for cardiac abnormalities has increased fetal diagnosis of ... more Recent antenatal screening guidelines for cardiac abnormalities has increased fetal diagnosis of right aortic arch (RAA). We aimed to establish outcome of fetal RAA without intra-cardiac abnormalities (ICA) to guide postnatal management. Retrospective cohort study. Outcome measures were rates of chromosomal abnormalities, 22q11.2 deletion, fetal extra-cardiac abnormalities (ECA), postnatal ICA and ECA, symptoms and surgery for vascular ring. A systematic review and meta-analysis (reference: CRD42015016097) was performed; results are reported as proportions. Kaplan Meier analysis of vascular ring cases with surgery as endpoint was performed. Our cohort included 86 cases; 41 had a vascular ring. Rates of chromosomal abnormalities, 22q11.2 deletion, and fetal ECA were 14.1%, 6.4% and 17.4% respectively. Sixteen studies including our cohort (312 fetuses) were included in the systematic review. Overall chromosomal abnormalities and 22q11.2 deletion rates were 9.0% (95% CI 6.0-12.5) and 6.1% (95% CI 3.6-9.3) whilst rates for cases with no ECA were 4.6% (95% CI 2.3-7.8) and 5.1% (95% CI 2.4-8.6). ECA were seen in 14.6% (95% CI 10.6-19.0) prenatally and 4.0% (95%CI 1.5-7.6) after birth. Postnatal ICA were identified in 5.0% (95% CI 2.7-7.9). Rate of symptoms (follow up ≥24 months) was 25.2% (95% CI 16.6-35.0) while 17.1% (95% CI 9.9-25.7) had surgery. Two-year freedom from surgery was 83.0% (95% CI 74.3-90.1) CONCLUSIONS: Fetal RAA without ICA is more frequently associated with ECA than chromosomal abnormalities. Most cases however, are isolated. Vascular ring symptoms occur in about 25% of cases. Postnatal surveillance is required mainly in the first 2 years of life.
Conjoined twins are rare, representing 1 in 50,000 to 1 in 200,000 live births, and the prognosis... more Conjoined twins are rare, representing 1 in 50,000 to 1 in 200,000 live births, and the prognosis is generally poor. Accurate prenatal diagnosis by an experienced multidisciplinary team using a combination of imaging modalities allows parents to make fully informed choices. This may include termination of pregnancy, which is easier and safer at the earlier gestations at which diagnosis is now being made; continuing with the pregnancy but accepting that only palliative care is appropriate after birth; or planned intensive care and separation of the twins after birth. Delivery will invariably be by cesarean section in order to minimize the risk of peripartum harm to both mother and babies.
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, Jan 23, 2015
To evaluate the clinical accuracy of the IONA® test for aneuploidy screening. In this multi-centr... more To evaluate the clinical accuracy of the IONA® test for aneuploidy screening. In this multi-centre, blinded study samples from pregnant women at increased risk of trisomy 21 underwent cell-free DNA analysis utilizing the IONA® test. For each sample the IONA Software generated a likelihood ratio and a maternal age adjusted probability risk score for trisomies 21, 18 and 13. All results from the IONA® test were compared against accepted diagnostic karyotyping. Of the 442 samples, results from 437 were available for analysis and assessment of clinical accuracy. The IONA® test had a detection rate of 100% for trisomies 21 (43 cases, 95% CI 87.98 to 100%), 18 (10 cases, 95% CI 58.72 to 100%) and 13 (5 cases, 95% CI 35.88 to 100%) with cut-offs applied on a likelihood ratio (Cut off >1 considered high risk of trisomy) and a probability risk score incorporating adjustment for maternal age (Cut off ≥1/150 considered high risk of trisomy). The false positive rate (FPR) was 0% for trisomie...
Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 2012
Changes in cardiac output (CO) and systemic vascular resistance (SVR) have been shown to precede ... more Changes in cardiac output (CO) and systemic vascular resistance (SVR) have been shown to precede the clinical onset of pregnancy complications, such as pre-eclampsia and fetal growth restriction. CO and SVR undergo major changes during normal pregnancy. However, assessment of these vascular parameters requires intensive training and expensive techniques, so currently can be performed only in specialised centres. The aim of this study was to investigate maternal cardiovascular function measured using an ultrasonic cardiac output monitor (USCOM), a simple non-invasive continuous wave Doppler device, in a cohort of pregnant women and non-pregnant controls. This was a cross sectional study including 185 women with normal singleton pregnancies at 11-40weeks of gestation and 49 non-pregnant controls. Stroke volume (SV), CO and SVR were measured using the USCOM device. All measurements were performed with the patients in supine position. All women with a gestational age of >20weeks were in a left lateral position by placing a wedge-shaped pillow under their right side to prevent vena cava compression. In a group of 25 pregnant women, each measurement was repeated three times to evaluate the reproducibility of this technique. Cardiac index (CI), SV index (SVI) and SVR index (SVRI) relate CO, SV and SVR to the body surface area. The data were normally distributed after logarithmic transformation. Comparisons between pregnant and non-pregnant women were performed using Studentt-test, Chi-Square test or multiple regression analysis, when adjustment for potential confounders was necessary. Data analysis was performed using SPSS 16.0. In the first trimester, all of the following vascular parameters were higher in pregnant women compared to non-pregnant controls: CO [median (IQR): 4.86 (4.45-5.57) vs 5.57 (4.76-6.52)L/min, P<0.001], CI [median (IQR): 2.69 (2.44-3.07) vs 3.25 (2.80-3.86)L/min/m(2), P<0.001], SV [median (IQR): 72.51 (68.10-80.18) vs 80.75 (74.50-99.74)mL/beat, P<0.001], SVI [median (IQR): 41.93 (37.53-46.57) vs 47.01 (43.85-53.79)mL/m(2)/beat, P<0.001]. Pregnant women had significantly lower SVR [median (IQR): 1458 (1261-1649) vs 1165 (1023-1406)sec/cm(-5), P<0.001] and SVRI [median (IQR): 2646 (2307-2963) vs 2006 (1179-2277)dynes-sec/cm(-5)/m(2), P<0.001] at 11-13weeks' gestation. Using USCOM, maternal cardiac function can be assessed in a simple, non-invasive and reproducible manner. This simple technique is likely to facilitate large scale studies of maternal cardiovascular function in pregnancy.
Conjoined twins are rare, representing 1 in 50,000 to 1 in 200,000 live births, and the prognosis... more Conjoined twins are rare, representing 1 in 50,000 to 1 in 200,000 live births, and the prognosis is generally poor. Accurate prenatal diagnosis by an experienced multidisciplinary team using a combination of imaging modalities allows parents to make fully informed choices. This may include termination of pregnancy, which is easier and safer at the earlier gestations at which diagnosis is now being made; continuing with the pregnancy but accepting that only palliative care is appropriate after birth; or planned intensive care and separation of the twins after birth. Delivery will invariably be by cesarean section in order to minimize the risk of peripartum harm to both mother and babies.
Maternal cardiac adaptation to pregnancy is important in maintaining normal uteroplacental perfus... more Maternal cardiac adaptation to pregnancy is important in maintaining normal uteroplacental perfusion. These changes could potentially explain the different clinical phenotypes associated with impaired placentation and could potentially be used to guide therapy. The aim of this study was to investigate the changes in the maternal systemic circulation in normotensive pregnancies and those complicated by pre-eclampsia (PE). This was a prospective case-control study in singleton pregnancies recruited after 20 weeks' gestation, some of whom developed PE and some of whom remained normotensive. The diagnosis of PE was made according to the guidelines of the International Society for the Study of Hypertension in Pregnancy. Maternal cardiac index (CI), systemic vascular resistance index (SVRI) and inotropy, which is a measure of myocardial contractility, were assessed using a continuous-wave Doppler ultrasound technique (USCOM®). Mann-Whitney test and regression analysis were used for st...
Corin, an atrial natriuretic peptide-converting enzyme, has been found to promote trophoblast inv... more Corin, an atrial natriuretic peptide-converting enzyme, has been found to promote trophoblast invasion and spiral artery remodeling. Reduced maternal plasma atrial natriuretic peptide (ANP) levels and elevated corin levels have been reported in pregnancies complicated by PE. The aim of this study was to investigate longitudinal changes in maternal plasma levels of corin and midregional proatrial natriuretic peptide (MR-PANP) in pregnancies that develop preeclampsia (PE) and gestational hypertension (GH). Nested case control study drawn from a larger prospective longitudinal study in singleton pregnancies identified by screening at 11+0-13+6weeks' gestation as being at high risk for PE. Blood samples were taken every four weeks until delivery. Values were compared in pregnancies that developed preterm-PE (requiring delivery before 37weeks), term-PE, GH, and those that remained normotensive. The distribution of maternal plasma corin and PANP were made Gaussian after log10 transfor...
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2015
Corin, an atrial natriuretic peptide-converting enzyme, has been found to promote trophoblast inv... more Corin, an atrial natriuretic peptide-converting enzyme, has been found to promote trophoblast invasion and spiral artery remodeling. Yet, elevated maternal plasma atrial natriuretic peptide (ANP) and corin levels have been reported in pregnancies complicated by pre-eclampsia (PE). The aim of this study was to investigate longitudinal changes in maternal plasma levels of corin and mid-regional proatrial natriuretic peptide (MR-PANP) in pregnancies that develop PE and gestational hypertension (GH). This was a nested case-control study drawn from a larger prospective longitudinal study in singleton pregnancies identified as being at high risk for PE by screening at 11 + 0 to 13 + 6 weeks' gestation. Blood samples were taken every 4 weeks until delivery. Values were compared in pregnancies that developed preterm PE (requiring delivery before 37 weeks' gestation), term PE, GH and those that remained normotensive. A total of 471 samples were analyzed from 122 women, including 85 t...
ABSTRACT Since mid-December 2010, there has been an increase in the number of reported cases of s... more ABSTRACT Since mid-December 2010, there has been an increase in the number of reported cases of severe H1N1A, or ‘swine flu’. Maternity units across the UK have also seen a rapid rise in the number of hospital and intensive care unit admissions due to H1N1A infection among pregnant women. Hospitalization, critical illness and mortality rates in pregnant women with H1N1A infection are significantly higher than those of non-pregnant women of the same age. For this reason, key public health messages, including respiratory and hand hygiene, should be emphasized. Midwives and doctors should also promote influenza vaccine uptake among all pregnant women who have not previously been vaccinated against H1N1A. All those who care for pregnant women should also seek vaccination themselves.
To explore if blood pressure (BP) readings over 24 h is a useful addition to uterine artery Doppl... more To explore if blood pressure (BP) readings over 24 h is a useful addition to uterine artery Doppler to screen for hypertensive disorders. In a prospective observational study, we invited nulliparous women with abnormal and normal uterine artery Doppler but normal BP at the time of their routine anomaly scan. BP was measured by the woman using automated apparatus at five specified time intervals over 24 h at 22-24 weeks. Pregnancy outcome was retrieved from delivery suite records, discharge summaries, and letters to general practitioners if necessary. Logistic regression was used to explore the contribution of uterine artery Doppler and BP measurements towards the development of pre-eclampsia. Data were available from 52 women with abnormal and 48 women with normal uterine artery Doppler. Thirteen women developed hypertension in pregnancy. Significant difference was found in the BP of women who did or did not develop hypertensive disorders. BP recordings showed the diurnal variation. Both uterine artery Doppler mean PI and BP showed significant correlation with future development of hypertension. Women can self-measure BP at home. BP readings show diurnal variation. There are significant differences in BP of women who do and do not develop hypertension later in the pregnancy. Use of home BP monitoring over 24 h of the day in mid-pregnancy is unlikely to add to the use of uterine artery Doppler and a one-off BP reading for future development of hypertension in pregnancy.
To investigate longitudinal changes in maternal serum placental growth factor (PlGF) and soluble ... more To investigate longitudinal changes in maternal serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) in pregnancies that develop preeclampsia (PE) and gestational hypertension (GH). This was a prospective longitudinal study in singleton pregnancies identified by screening at 11(+0) -13(+6) weeks' gestation as being at high-risk for PE. Blood samples were taken every four weeks until delivery. Values were compared in pregnancies that developed preterm-PE (requiring delivery before 37 weeks), term-PE, GH, and those that remained normotensive. A total of 1069 samples were analyzed in 234 women, including 172 that remained normotensive, 18 that developed GH, 22 that developed preterm-PE and 22 that developed term-PE. In the preterm-PE group, compared to the normotensive group, sFlt-1 was significantly higher from 15 weeks onwards and the difference increased with gestational age (GA) (p < 0.001). In the preterm-PE group, compared to the normotensive group, PlGF was significantly lower from 11 weeks and the difference increased significantly with GA (p < 0.001). Similarly, in the term-PE and GH groups PLGF was lower from 13 and 27 weeks, respectively, and the difference increased significantly with GA (p < 0.001). In the preterm-PE group, compared to the normotensive group, sFlt-1/PlGF ratio was significantly higher from 11 weeks and the difference increased significantly with GA (p < 0.001). A random slope model provided a significantly better fit to the data than a single-level model for sFlt (likelihood ratio(LR) = 516, degrees of freedom(df) = 3, p < 0.001), for PLGF (LR =542, df = 3,p < 0.00)1, and sFlt-1/PLGF ratio (LR=468, df = 3, p < 0.001). Repeat measurements of these biochemical markers are likely to be better predictors of PE than measurement at a single time point in pregnancy, as the differences between normotensive and hypertensive pregnancies increase with GA. In screening for preterm-PE, maternal serum PlGF is a useful marker from the first trimester, while sFlt-1 is likely to have a predictive value from the second trimester.
Recent antenatal screening guidelines for cardiac abnormalities has increased fetal diagnosis of ... more Recent antenatal screening guidelines for cardiac abnormalities has increased fetal diagnosis of right aortic arch (RAA). We aimed to establish outcome of fetal RAA without intra-cardiac abnormalities (ICA) to guide postnatal management. Retrospective cohort study. Outcome measures were rates of chromosomal abnormalities, 22q11.2 deletion, fetal extra-cardiac abnormalities (ECA), postnatal ICA and ECA, symptoms and surgery for vascular ring. A systematic review and meta-analysis (reference: CRD42015016097) was performed; results are reported as proportions. Kaplan Meier analysis of vascular ring cases with surgery as endpoint was performed. Our cohort included 86 cases; 41 had a vascular ring. Rates of chromosomal abnormalities, 22q11.2 deletion, and fetal ECA were 14.1%, 6.4% and 17.4% respectively. Sixteen studies including our cohort (312 fetuses) were included in the systematic review. Overall chromosomal abnormalities and 22q11.2 deletion rates were 9.0% (95% CI 6.0-12.5) and 6.1% (95% CI 3.6-9.3) whilst rates for cases with no ECA were 4.6% (95% CI 2.3-7.8) and 5.1% (95% CI 2.4-8.6). ECA were seen in 14.6% (95% CI 10.6-19.0) prenatally and 4.0% (95%CI 1.5-7.6) after birth. Postnatal ICA were identified in 5.0% (95% CI 2.7-7.9). Rate of symptoms (follow up ≥24 months) was 25.2% (95% CI 16.6-35.0) while 17.1% (95% CI 9.9-25.7) had surgery. Two-year freedom from surgery was 83.0% (95% CI 74.3-90.1) CONCLUSIONS: Fetal RAA without ICA is more frequently associated with ECA than chromosomal abnormalities. Most cases however, are isolated. Vascular ring symptoms occur in about 25% of cases. Postnatal surveillance is required mainly in the first 2 years of life.
Conjoined twins are rare, representing 1 in 50,000 to 1 in 200,000 live births, and the prognosis... more Conjoined twins are rare, representing 1 in 50,000 to 1 in 200,000 live births, and the prognosis is generally poor. Accurate prenatal diagnosis by an experienced multidisciplinary team using a combination of imaging modalities allows parents to make fully informed choices. This may include termination of pregnancy, which is easier and safer at the earlier gestations at which diagnosis is now being made; continuing with the pregnancy but accepting that only palliative care is appropriate after birth; or planned intensive care and separation of the twins after birth. Delivery will invariably be by cesarean section in order to minimize the risk of peripartum harm to both mother and babies.
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, Jan 23, 2015
To evaluate the clinical accuracy of the IONA® test for aneuploidy screening. In this multi-centr... more To evaluate the clinical accuracy of the IONA® test for aneuploidy screening. In this multi-centre, blinded study samples from pregnant women at increased risk of trisomy 21 underwent cell-free DNA analysis utilizing the IONA® test. For each sample the IONA Software generated a likelihood ratio and a maternal age adjusted probability risk score for trisomies 21, 18 and 13. All results from the IONA® test were compared against accepted diagnostic karyotyping. Of the 442 samples, results from 437 were available for analysis and assessment of clinical accuracy. The IONA® test had a detection rate of 100% for trisomies 21 (43 cases, 95% CI 87.98 to 100%), 18 (10 cases, 95% CI 58.72 to 100%) and 13 (5 cases, 95% CI 35.88 to 100%) with cut-offs applied on a likelihood ratio (Cut off >1 considered high risk of trisomy) and a probability risk score incorporating adjustment for maternal age (Cut off ≥1/150 considered high risk of trisomy). The false positive rate (FPR) was 0% for trisomie...
Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 2012
Changes in cardiac output (CO) and systemic vascular resistance (SVR) have been shown to precede ... more Changes in cardiac output (CO) and systemic vascular resistance (SVR) have been shown to precede the clinical onset of pregnancy complications, such as pre-eclampsia and fetal growth restriction. CO and SVR undergo major changes during normal pregnancy. However, assessment of these vascular parameters requires intensive training and expensive techniques, so currently can be performed only in specialised centres. The aim of this study was to investigate maternal cardiovascular function measured using an ultrasonic cardiac output monitor (USCOM), a simple non-invasive continuous wave Doppler device, in a cohort of pregnant women and non-pregnant controls. This was a cross sectional study including 185 women with normal singleton pregnancies at 11-40weeks of gestation and 49 non-pregnant controls. Stroke volume (SV), CO and SVR were measured using the USCOM device. All measurements were performed with the patients in supine position. All women with a gestational age of >20weeks were in a left lateral position by placing a wedge-shaped pillow under their right side to prevent vena cava compression. In a group of 25 pregnant women, each measurement was repeated three times to evaluate the reproducibility of this technique. Cardiac index (CI), SV index (SVI) and SVR index (SVRI) relate CO, SV and SVR to the body surface area. The data were normally distributed after logarithmic transformation. Comparisons between pregnant and non-pregnant women were performed using Studentt-test, Chi-Square test or multiple regression analysis, when adjustment for potential confounders was necessary. Data analysis was performed using SPSS 16.0. In the first trimester, all of the following vascular parameters were higher in pregnant women compared to non-pregnant controls: CO [median (IQR): 4.86 (4.45-5.57) vs 5.57 (4.76-6.52)L/min, P<0.001], CI [median (IQR): 2.69 (2.44-3.07) vs 3.25 (2.80-3.86)L/min/m(2), P<0.001], SV [median (IQR): 72.51 (68.10-80.18) vs 80.75 (74.50-99.74)mL/beat, P<0.001], SVI [median (IQR): 41.93 (37.53-46.57) vs 47.01 (43.85-53.79)mL/m(2)/beat, P<0.001]. Pregnant women had significantly lower SVR [median (IQR): 1458 (1261-1649) vs 1165 (1023-1406)sec/cm(-5), P<0.001] and SVRI [median (IQR): 2646 (2307-2963) vs 2006 (1179-2277)dynes-sec/cm(-5)/m(2), P<0.001] at 11-13weeks' gestation. Using USCOM, maternal cardiac function can be assessed in a simple, non-invasive and reproducible manner. This simple technique is likely to facilitate large scale studies of maternal cardiovascular function in pregnancy.
Conjoined twins are rare, representing 1 in 50,000 to 1 in 200,000 live births, and the prognosis... more Conjoined twins are rare, representing 1 in 50,000 to 1 in 200,000 live births, and the prognosis is generally poor. Accurate prenatal diagnosis by an experienced multidisciplinary team using a combination of imaging modalities allows parents to make fully informed choices. This may include termination of pregnancy, which is easier and safer at the earlier gestations at which diagnosis is now being made; continuing with the pregnancy but accepting that only palliative care is appropriate after birth; or planned intensive care and separation of the twins after birth. Delivery will invariably be by cesarean section in order to minimize the risk of peripartum harm to both mother and babies.
Maternal cardiac adaptation to pregnancy is important in maintaining normal uteroplacental perfus... more Maternal cardiac adaptation to pregnancy is important in maintaining normal uteroplacental perfusion. These changes could potentially explain the different clinical phenotypes associated with impaired placentation and could potentially be used to guide therapy. The aim of this study was to investigate the changes in the maternal systemic circulation in normotensive pregnancies and those complicated by pre-eclampsia (PE). This was a prospective case-control study in singleton pregnancies recruited after 20 weeks' gestation, some of whom developed PE and some of whom remained normotensive. The diagnosis of PE was made according to the guidelines of the International Society for the Study of Hypertension in Pregnancy. Maternal cardiac index (CI), systemic vascular resistance index (SVRI) and inotropy, which is a measure of myocardial contractility, were assessed using a continuous-wave Doppler ultrasound technique (USCOM®). Mann-Whitney test and regression analysis were used for st...
Corin, an atrial natriuretic peptide-converting enzyme, has been found to promote trophoblast inv... more Corin, an atrial natriuretic peptide-converting enzyme, has been found to promote trophoblast invasion and spiral artery remodeling. Reduced maternal plasma atrial natriuretic peptide (ANP) levels and elevated corin levels have been reported in pregnancies complicated by PE. The aim of this study was to investigate longitudinal changes in maternal plasma levels of corin and midregional proatrial natriuretic peptide (MR-PANP) in pregnancies that develop preeclampsia (PE) and gestational hypertension (GH). Nested case control study drawn from a larger prospective longitudinal study in singleton pregnancies identified by screening at 11+0-13+6weeks' gestation as being at high risk for PE. Blood samples were taken every four weeks until delivery. Values were compared in pregnancies that developed preterm-PE (requiring delivery before 37weeks), term-PE, GH, and those that remained normotensive. The distribution of maternal plasma corin and PANP were made Gaussian after log10 transfor...
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2015
Corin, an atrial natriuretic peptide-converting enzyme, has been found to promote trophoblast inv... more Corin, an atrial natriuretic peptide-converting enzyme, has been found to promote trophoblast invasion and spiral artery remodeling. Yet, elevated maternal plasma atrial natriuretic peptide (ANP) and corin levels have been reported in pregnancies complicated by pre-eclampsia (PE). The aim of this study was to investigate longitudinal changes in maternal plasma levels of corin and mid-regional proatrial natriuretic peptide (MR-PANP) in pregnancies that develop PE and gestational hypertension (GH). This was a nested case-control study drawn from a larger prospective longitudinal study in singleton pregnancies identified as being at high risk for PE by screening at 11 + 0 to 13 + 6 weeks' gestation. Blood samples were taken every 4 weeks until delivery. Values were compared in pregnancies that developed preterm PE (requiring delivery before 37 weeks' gestation), term PE, GH and those that remained normotensive. A total of 471 samples were analyzed from 122 women, including 85 t...
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