Working to enhance maternal and fetal survival rates
This WRH Research Group is operating within our department's Maternal & Fetal Health and Data Science Theme and is run by Prof. Sally Collins.
Research project: Placental imaging
Why this project is important?
The placenta is a unique organ within the human body, it is both indispensable during pregnancy but then immediately disposable after a baby is delivered.
The placenta acts as a baby's lifeline throughout pregnancy, fighting infections and enabling the flow of nutrients, thermo-regulation, hormones, waste elimination, and gas exchange via the mother's blood supply.
Our research focuses on this remarkable organ to address two areas:
- Utilising ultrasound imaging of the placenta early in pregnancy in order to predict adverse pregnancy outcomes including fetal growth restriction (FGR), the consequences of which can be devastating.
- Raising awareness of Placenta Accreta Spectrum (PAS), also known as abnormally invasive placenta (AIP) amongst clinicians and patients. Prof. Sally Collins' Placental Accreta Webpage
Video: Can AI help identify the biggest causes of stillbirth?
Prof. Sally Collins and an OxPLus participant explain how OxNNet uses AI to assess the risk of stillbirth, offering crucial benefits to prospective mothers and parents.
WHAT WE ARE DOING
When a baby is developing during pregnancy, it has the potential to grow to an appropriate size and failing to reach that expected size is called Fetal Growth Restriction (FGR). We know that failure of the placenta to develop properly is the most common cause of FGR and that FGR is the single biggest risk for stillbirth.
Our research team, has over many years been developing a computer algorithm which can provide real-time measurements of placental size and blood flow from a simple 3D-ultrasound scan taken early in pregnancy (weeks 11-14). By using these measurements, we can predict a placenta that is not functioning as well as it should and therefore putting the growing baby at risk of harm. Having this information early in pregnancy will allow doctors to carefully monitor these mothers for the remainder of their pregnancy, taking extra growth scans, and delivering early any babies felt to be at risk.
To be certain that this new test works in real-life we have conducted two research studies with approximately 7500 pregnant women in two UK centres.
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Stillbirth currently devastates 8 families a day in the UK. Our research focusses on developing a much-needed early screening test for fetal growth restriction (FGR) to enable clinicians to identify women at-risk of stillbirth due to an abnormally small placenta.
WHAT WE HOPE TO ACHIEVE
The current methods used to predict the risk of FGR early in pregnancy are based on maternal history and clinical judgement alone. These assessments are subjective, not quantifiable and in many cases fail to correctly identify women at risk. As a result, many women deemed ‘low-risk’ are unaware their baby is failing to thrive until they present with a stillbirth while women deemed ‘high-risk’ experience a pregnancy dominated by extra tests and anxiety only to go on to deliver well-grown, healthy babies.
Our aim to develop a reliable, cost-effective first-trimester screening method for FGR is therefore desperately needed. Such a screening test would not only improve pregnancy outcomes, reducing the number of families dealing with the heartbreak that results from the loss of a baby but also decrease unnecessary stress for the women undergoing increased surveillance for no clinical benefit.
How we help
Until now, it has been impractical to calculate placental volume and blood flow from a 3-D ultrasound scan, as the tools were either unavailable or too time-consuming and operator dependent. We have developed a method that has fully computerised this process, giving reliable measurements of both the size of the placenta and its overall perfusion.
Combining this technology with other novel imaging tools (such as automated artefact removal) has enabled the team to generate a user-friendly software device, the OxNNet Toolkit. This piece of software can be installed on a PC and then used to analyse uploaded ultrasound scans and output numerical values for the estimated placental volume and vascularity. Our aim is to use this software as a basis for the development of a population-based screening test for fetal growth restriction
our research studies
Our research has reached the stage where we need to test that the software we have developed performs as expected. To do this we have conducted two observational research studies to evaluate whether using the software to analyse 3D ultrasound scans alone and in conjunction with other pregnancy-related measures can predict FGR.
-The first study, funded by the National Institute for Health Research (NIHR) recruited approximately 4000 pregnant women in the early stages of pregnancy and undergoing first trimester ultrasound scanning at a research centre independent of the NHS.
-The second study, funded by the Sir Jules Thorn Charitable Trust recruited approximately 3500 women, again undergoing the routine ultrasound scanning but this time in a busy, NHS ultrasound department. It is hoped that the combination of results from these two studies can demonstrate that the use of the software tool is an effective predictor of FGR when used to analyse 3-D ultrasound scans taken in early pregnancy and that its use within the NHS could be both cost-effective and simple to incorporate into the existing protocols for the routine monitoring of pregnant women.
UPDATE: How our research is going?
November 2024
We are currently analysing the results obtained from the initial 4000 women study and hope to have some results available shortly.
The second 3500 women study has just recently finished recruitment and we must now wait until all our participants have delivered their babies before we can start to analyse the data collected.
Useful links
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AI Award NIHR
The Artificial Intelligence in Health and Care Award (AI Award) supported AI solutions across the whole development pathway, from initial feasibility to clinical implementation.
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Copyright: Shutterstock
Maternal and Fetal Health theme
Our Maternal & Fetal Health research covers the following research groups: Lactation, Intelligent Imaging in Fetal Health, the Clinical Research Group, Oxford Labour Monitoring, Placental Imaging and Pre-eclampsia.
Data Science Theme
Data science, a cross-cutting theme, extends across all four research pillars/themes
Key publications
1. Ultrasound Discrimination Between Placenta Accreta Spectrum and Urinary Bladder Varices. Theophilus K-B. et al, (2024), Obstetric Anesthesia Digest, 44, 136 - 137.
2. External validation of and improvement upon a model for the prediction of placenta accreta spectrum severity using prospectively collected multicenter ultrasound data. Kolak M. et al, (2024), Acta Obstet Gynecol Scand.
3. Foley’s catheter tourniquet: A lifesaving, innovative, inexpensive, and useful tool in reducing blood loss in prenatally undiagnosed placenta accreta spectrum surgery. Opei Adarkwa K. et al, (2024), European Journal of Obstetrics & Gynecology and Reproductive Biology.
4. The Soleymani and Collins Obstetric morbidity score (SaCOMS): A quantitative tool for measuring maternal morbidity from complex obstetric surgery such as placenta accreta spectrum (PAS). Soleymani Majd H. et al, (2024), Eur J Obstet Gynecol Reprod Biol, 299, 148 - 155.
The research team
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Sam Mathewlynn
Clinical Research Training Fellow & DPhil Student
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Theophilus Adu-bredu
Research Sonographer
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Mohammadreza Soltaninejad
Computer Scientist in Ultrasound Image Analysis
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Katja Shipp
Research Midwife
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Jessica Farmer
Research Midwife
Members of the team external to WRH
- Stephen Gerry - Centre for Statistics in Medicine, University of Oxford
- Stavros Petrou - Nuffield Department of Primary Care Health Sciences, University of Oxford
- Professor Kypros Nicolaides, The Fetal Medicine Centre, London
- Professor David Wright, The University of Exeter
How can you help?
We are committed to providing healthcare professionals with the tools and knowledge to aid the diagnosis and management of placenta-related adverse outcomes in pregnancy. If you wish to learn more or support our work please visit our contact us page or email Professor Sally Collins.