Pregnancy Complications
Fetal Growth Restriction and preventing stillbirth
A case study into New Ultrasound Parameters (NUPs) at the Manchester Placenta ClinicOverview
Stillbirth is consistently associated with the failure of baby growth within the womb, called Fetal Growth Restriction (FGR), which in turn is associated and thought to be caused by abnormal placental development. We have recently developed a streamlined approach on how to predict babies that are at risk of stillbirth.
The Manchester Placenta Clinic was set up to examine if paying more attention to the placenta, together with other ultrasound features, will allow
us to better predict baby growth throughout pregnancy and therefore improve outcomes. New Ultrasound Parameters have been set up at the clinic to examine the role of 3D ultrasound technology in predicting final baby birth weight.
Problem
If a baby fails to grow sufficiently in the womb, the risk of poor outcome and stillbirth increases. Poor growth does not occur until the third
trimester of pregnancy, and currently the only detection method is a manual examination by the midwife. Evidence tells us that this method only detects 20 per cent of affected pregnancies.
Although ultrasound scans are far better at estimating baby size, the ability to predict growth beyond two weeks is limited.
What we have achieved to date
In the last decade improved ultrasound and computer technology has enabled more accurate examinations of pregnancy at earlier gestations. This has demonstrated that that parameters such as fetal length in the first trimester and placental volume, correlate with eventual birth weights. Centile charts determined from fetal and placental parameters such as fetal renal volume could be created that would allow the identification of at risk pregnancies. There is some evidence that this is possible in the early third trimester, but this has not been attempted at earlier gestation.
What we aim to achieve
The New Ultrasound Parameters (NUPs), which is run within the Manchester Placenta Clinic, is examining the role of 3D ultrasound technology in predicting final baby weight. Two additional scans are performed in the early second and third trimesters, at which time various 3D volume and other ultrasound measurements are obtained. The ethical permission for the study has kept exactly which measurements deliberately broad so as to allow for the incorporation of new techniques (which are being developed all the time) as the study progress.The aim of our study is to build a cohort of sufficient size to produce a normal distribution of measurements, as compared to eventual birth weights and then add this data to our existing Fetal Growth Restriction screening tools being prospectively trialed in the Manchester Placenta Clinic setting.
If successful, NUPs will allow us to predict which babies are at risk of Fetal Growth Restriction later in pregnancy, before it actually occurs. This will enable us to direct more resources into later pregnancy care and should enable us to prevent stillbirth and poor outcomes.
