Transperineal ultrasound in labour
INTRAPARTUM ULTRASOUND: SONO-VE STUDY

Currently, all women admitted to delivery units throughout the world undergo internal digital vaginal examination (digital VE) when they are thought to be in labour. The digital VE though an age-honoured practice is an uncomfortable experience for the labouring woman is subjective and agreement between observers is frequently poor. Multiple examinations have been linked to infection to the mother or fetus reducing the time to delivery in preterm labour. It has recently become possible to make assessments more objectively using transperineal ultrasound. We are carrying out the Sono-VE Study: Assessing the acceptability and feasibility of transperineal ultrasound and based on the sonopartogram, developing a predictive model for labour outcome. This is a prospective observational study of 700 women using transperineal ultrasound between 24-42 weeks gestation and a prospective longitudinal observational study in all term (37-42 weeks) labouring women.

Our European Collaborators include KU Leuven in Belgium (data analytical and statistical support) and the Norwegian University of Science and Technology at Trondheim. Funding sources include a BMA Helen Lawson fellowship for Dr Sana Usman who is the research fellow dedicated to the project.

The sonopartogram-an ultrasound based representation of labour progress:

Hassan WA, Eggebo T, Ferguson M, Gillett A, Studd J, Pasupathy D, Lees CC. The sonopartogram: a novel method for recording progress of labor by ultrasound. Ultrasound in Obstetrics & Gynecology. 2014;43(2):189194.

Maternal cardiovascular adaptation to pregnancy
The CONCEIVE study is a unique longitudinal study investigating whether and how cardiovascular and metabolic changes from pre-conception and through pregnancy are associated with adverse pregnancy outcomes, specifically, the development of preeclampsia and/or small for gestational age babies. Currently, the pathogenesis of pre-eclampsia remains elusive. The most common hypothesis is that impaired trophoblastic invasion leads to release of placental factors into maternal circulation, from which subsequently arise endothelial dysfunction. However, up to 40% of normal pregnancies show poor trophoblastic invasion. Our aim is to investigate whether differences in cardiovascular adaptation very early in pregnancy predispose to pre-eclampsia or small for gestational age babies. We are recruiting 600 women prior to pregnancy and following them all the way through and into the postnatal period with simple non-invasive cardiovascular assessment and blood and urine tests.

Funding for for Dr Lin Foo, research fellow and Alice Gautreau, research midwife has been provided by the Biomedical Research Centre (BRC) at Imperial College Healthcare NHS Trust, Imperial College Healthcare NHS Trust Charities and Imperial College London and the project is a collaboration with the Department of Clinical Pharmacology, Cambridge University.

Cardiovascular function in pre-eclampsia and fetal growth restriction
PRECEPT STUDY

The PRECEPT study's aim is to assess maternal cardiovascular changes in established uteroplacental insufficiency. The study recruits women after 24 weeks gestation whose pregnancies are affected by pre-eclampsia and/or fetal growth restriction and women with normal pregnancies and compares their cardiovascular status, namely cardiac output, augmentation index, pulse wave velocity, peripheral vascular resistance and central blood pressure from diagnosis until post-delivery, to characterize changes in relation to time of diagnosis and therapy whilst assessing fetal circulatory changes using Doppler. The metabonomic and cardiovascular biomarker profiles will be investigated in relation to maternal cardiovascular function.

Funding for this study is provided by Imperial NHS Trust and Imperial College London for Dr Jasmine Tay and the project is a collaboration with the Department of Clinical Pharmacology, Cambridge University.

Non invasive fetal therapy: HIFU
DEVELOPING A NON-INVASIVE TREATMENT FOR TWIN-TWIN TRANSFUSION SYNDROME AND FETAL VASCULAR TUMOURS USING HIGH INTENSITY FOCUSED ULTRASOUND

Twin-Twin Transfusion Syndrome (TTTS) affects 10-15% of twins which share a placenta and is a result of abnormal connections between the blood vessels in the shared placenta. It may have serious consequences including premature delivery, permanent handicap or death for babies affected. More severe cases are currently treated by keyhole surgery, where a hole is made in the womb and a laser is used to burn away the abnormal blood vessels. Making even a small hole in the womb carries a risk of bleeding, infection and miscarriage or preterm delivery. Our research aims to develop an alternative treatment for TTTS which could still burn away blood vessels, but without the need for invasive surgery. The new treatment, called High intensity Focused Ultrasound (HIFU) can target sound waves very accurately so they destroy tissue and has been used in humans to treat cancer growths without the need for surgery. However research has not been done in pregnancy to show the effects of blocking blood vessels in the placenta with HIFU. We are currently in laboratory stages of developing and testing the safety and effectiveness of this new system to use on placental blood vessels, and if these tests are successful we hope to develop a clinical trial to use HIFU in human pregnancy.
The work is being performed between Imperial College, the Department of Physiology, Development and Neuroscience, University of Cambridge, and Royal Marsden Hospital by Dr Caroline Shaw. Funders include Action Medical Research, The Isaac Newton Trust and Genesis at Imperial College.

The TRUFFLE 2 Study
The TRUFFLE 2 study follows on from the successful multicentre European TRUFFLE collaboration (2002-2015) which investigated the optimal monitoring and timing of delivery in severely growth restricted babies at 26-32 weeks.

The TRUFFLE 2 study will investigate whether in small babies or those whose growth is slowing, slightly earlier delivery based on fetal cerebral artery Doppler improves perinatal outcome compared to waiting until conventional measures would lead to delivery. This is a 36 centre European, UK and Scandinavian collaboration planned to start in Q2 2019. For more details visit www.truffle-study.org

3D facial and brain morphology in prenatal diagnosis
This study is funded by the Imperial BRC and Imperial Healthcare NHS Trust, in collaboration with Great Ormond Street, University College London and the Institute for Child Health in London. The project aims to develop automatic analysis algorithms to detect subtle differences in fetal brain and facial morphology that could be associated with genetic conditions, in order to facilitate counselling and planning of delivery and in the neonatal period.