A.T. Papageorghiou

• University of Oxford

Purpose The PREgnancy Care Integrating translational Science, Everywhere Network was established to investigate specific placental disorders (pregnancy hypertension, preterm birth, fetal growth restriction and stillbirth) in sub-Saharan Africa. We created a repository of clinical and social data with associated biological samples from pregnant and...

(Abstracted from BJOG 2024;131:1673–1683) Fetal growth restriction (FGR) occurs when a fetus grows slower than expected for gestational age. Severe early-onset cases are associated with stillbirth, neonatal death, and developmental disorders.

Accurate standard plane acquisition in fetal ultrasound (US) videos is crucial for fetal growth assessment, anomaly detection, and adherence to clinical guidelines. However, manually selecting standard frames is time-consuming and prone to intra- and inter-sonographer variability. Existing methods primarily rely on image-based approaches that captu...

Accurate standard plane acquisition in fetal ultrasound (US) videos is crucial for fetal growth assessment, anomaly detection, and adherence to clinical guidelines. However, manually selecting standard frames is time-consuming and prone to intra- and inter-sonographer variability. Existing methods primarily rely on image-based approaches that captu...

Introduction There is increasing awareness of the role of the maternal cardiovascular system in complicated pregnancies. Despite the high disease burden, noninvasive cardiac output monitors have not been used extensively in low‐ and middle‐income countries. The aim of this study was to evaluate the quality control of the use of the ultrasonic cardi...

Community engagement (CE) has been recommended as an important ethical consideration for health research to enhance informed consent and exchange knowledge between researchers and community members. The purpose of this paper is to describe how CE was developed and delivered for the PRECISE prospective pregnancy cohort study in Kenya. PRECISE enroll...

Congenital Heart Disease (CHD) is one of the leading causes of fetal mortality, yet the scarcity of labeled CHD data and strict privacy regulations surrounding fetal ultrasound (US) imaging present significant challenges for the development of deep learning-based models for CHD detection. Centralised collection of large real-world datasets for rare...

Background Accurate gestational age (GA) estimation is essential for prenatal care, guiding fetal growth assessment and medical interventions. Ultrasound-based biometric measurements, though more reliable than last menstrual period, require high sonographic expertise and are time-consuming, posing challenges, especially in resource-limited settings...

Objectives To examine the relationship of ophthalmic artery (OA) Doppler indices with uterine artery (UtA) Doppler indices, selected maternal hemodynamic parameters and gestational age, and to evaluate the intraobserver reproducibility of OA Doppler indices. Methods This was a prospective cohort study of women recruited between 11 + 0 and 23 + 6 w...

Abstract: Objectives: To assess whether fetal surface anatomy can be examined in the first trimester using a 4D cine clip of a moving fetus. Methods: This was a prospective observational study of women attending a routine first trimester ultrasound scan between November 2021 and August 2023. A routine two-dimensional (2D) first trimester scan was...

Objective To examine the relationship between etiologically-based preterm birth sub-groups and early postnatal growth according to gestational age at birth. Methods Prospective, multinational, cohort study involving 15 hospitals that monitored preterm newborns to hospital discharge. Measures/exposures: maternal demographics; etiologically-based pr...

The pathways involved in the pathophysiology of fetal growth restriction (FGR) and small for gestational age (SGA) are incompletely understood. We conduct a systematic review to identify metabolomic signatures in maternal and newborn tissues and body fluids samples associated with FGR/SGA. Here, we report that 825 non-duplicated metabolites were si...

Background The WHO’s recommendations on antenatal care underscore the need for ultrasound assessment during pregnancy. Given that maternal and perinatal mortality remains unacceptably high in underserved regions, these guidelines are imperative for achieving better outcomes. In recent years, portable ultrasound devices have become increasingly popu...

Background Severe early-onset intrauterine growth restriction is associated with stillbirth, neonatal death and neurodevelopmental impairment. There is no treatment for intrauterine growth restriction with timely delivery being the only management option. Placentas from intrauterine growth restriction pregnancies often show failure to remodel mater...

Background Findings from the Maternal Vitamin D Osteoporosis Study (MAVIDOS) trial demonstrated a positive effect of gestational cholecalciferol supplementation on offspring bone mineral density (BMD) at age 4 y. Demonstrating the persistence of this effect is important to understanding whether maternal vitamin D supplementation could be a useful p...

Artificial intelligence (AI) has significant potential to transform healthcare and improve patient care. However, successful development and integration of AI models requires careful consideration of study designs and sample size calculations for development and validation of models, publishing standards, prototype development for translation and c...

Background There is an emerging need to systematically investigate the causes for the increased cesarean section rates in Greece and undertake interventions so as to substantially reduce its rates. To this end, the ability of the participating Greek obstetricians to follow evidence-based guidelines and respond to other educational and behavioral in...

3D pose estimation from a 2D cross-sectional view enables healthcare professionals to navigate through the 3D space, and such techniques initiate automatic guidance in many image-guided radiology applications. In this work, we investigate how estimating 3D fetal pose from freehand 2D ultrasound scanning can guide a sonographer to locate a head stan...

Introduction Selective fetal growth restriction (sFGR) in monochorionic twin pregnancy, defined as an estimated fetal weight (EFW) of one twin <10th centile and EFW discordance ≥25%, is associated with stillbirth and neurodisability for both twins. The condition poses unique management difficulties: on the one hand, continuation of the pregnancy ca...

Objectives Accurate assessment of gestational age (GA) is important at both individual and population levels. The most accurate way to estimate GA in women who book late in pregnancy is unknown. The aim of this study was to externally validate the accuracy of equations for GA estimation in late pregnancy and to identify the best equation for estima...

Objectives To assess whether fetal anatomy can be examined using 2D image slices extracted from a 3D volume taken at this gestation. Methods This was a prospective observational study of women attending a routine first trimester ultrasound scan between November 2021 and April 2022. A routine 2D first trimester scan was performed, followed by a 3D v...

Background Fetal growth restriction is associated with perinatal morbidity and mortality. Early identification of women having at-risk fetuses can reduce perinatal adverse outcomes. Objectives To assess the predictive performance of existing models predicting fetal growth restriction and birthweight, and if needed, to develop and validate new mult...

Auditory and visual signals are two primary perception modalities that are usually present together and correlate with each other, not only in natural environments but also in clinical settings. However, audio-visual modelling in the latter case can be more challenging, due to the different sources of audio/video signals and the noise (both signal-...

Objective To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies. Design Cross‐sectional survey. Setting International. Population Clinicians involved in the management of MCDA twin pregnancies with sFGR. Methods A structured, self‐administered survey. Ma...

Objective Severe early‐onset fetal growth restriction (FGR) causes stillbirth, neonatal death and neurodevelopmental impairment. Poor maternal spiral artery remodelling maintains vasoactive responsiveness but is susceptible to treatment with sildenafil, a phosphodiesterase type 5 (PDE5) inhibitor, which may improve perinatal outcomes. Design Super...

Background Household air pollution might lead to fetal growth restriction during pregnancy. We aimed to investigate whether a liquefied petroleum gas (LPG) intervention to reduce personal exposures to household air pollution during pregnancy would alter fetal growth. Methods The Household Air Pollution Intervention Network (HAPIN) trial was an ope...

We present a statistical characterisation of fetal anatomies in obstetric ultrasound video sweeps where the transducer follows a fixed trajectory on the maternal abdomen. Large-scale, frame-level manual annotations of fetal anatomies (head, spine, abdomen, pelvis, femur) were used to compute common frame-level anatomy detection patterns expected fo...

These guidelines may have been translated, from the originals published by ISUOG, by recognized experts in the field and have been independently verified by reviewers with a relevant first language. Although all reasonable endeavors have been made to ensure that no fundamental meaning has been changed the process of translation may naturally result...

Background Knowledge of gestational age (GA) is key in clinical management of individual obstetric patients, and critical to be able to calculate rates of preterm birth and small for GA at a population level. Currently, the gold standard for pregnancy dating is measurement of the fetal crown rump length at 11–14 weeks of gestation. However, this is...

This case study describes the first use of a novel nanosynthetic bone graft, OssDsign'" Catalyst, in a Spinal fusion patient. This new bone graft consists of na­noscale calcium phosphate containing silicate substitution (5.8wt% silicon) which is capable of regenerating bone via the endochondral ossification route in challenging animal models result...

Background Household air pollution exposure is a risk factor for severe pneumonia. The effect of replacing biomass cooking with liquefied petroleum gas (LPG) cookstoves on severe infant pneumonia is uncertain. Methods We conducted a randomized controlled trial among 3,200 pregnant women aged 18-34 years and 9 to <20 weeks gestation in India, Guate...

Background: Household air pollution is associated with stunted growth in infants. Whether the replacement of biomass fuel (e.g., wood, dung, or agricultural crop waste) with liquefied petroleum gas (LPG) for cooking can reduce the risk of stunting is unknown. Methods: We conducted a randomized trial involving 3200 pregnant women 18 to 34 years o...

Background The WHO’s recommendations on antenatal care underscore the need for ultrasound assessment during pregnancy. Given that maternal and perinatal mortality remains unacceptably high in low- and middle-income countries (LMICs), these guidelines are imperative for achieving better outcomes. In recent years, portable ultrasound devices have bec...

( Lancet . 2023;401:447–457) In 2021, COVID-19 during pregnancy was reported to be associated with an increased risk of maternal and neonatal outcomes. The SARS-CoV-2 virus has undergone genetic mutations since then and the subsequent impact of the omicron variant on maternal and neonatal health wasunknown. This study aimed to analyze the effects o...

Background Treatment with vaginal progesterone reduces the risk of miscarriage and preterm birth in selected high‐risk women. The hypothesis that vaginal progesterone can reduce the risk of hypertensive disorders of pregnancy (HDP) is unexplored. Objectives To summarise the evidence on the effectiveness of vaginal progesterone to reduce the risk o...

Maturation of the human fetal brain should follow precisely scheduled structural growth and folding of the cerebral cortex for optimal postnatal function ¹ . We present a normative digital atlas of fetal brain maturation based on a prospective international cohort of healthy pregnant women ² , selected using World Health Organization recommendation...

Automated segmentation of anatomical structures in fetal ultrasound video is challenging due to the highly diverse appearance of anatomies and image quality. In this paper, we propose an ultrasound video anatomy segmentation approach to iteratively memorise and segment incoming video frames, which is suitable for online segmentation. This is achiev...

Out-of-distribution (OOD) detection is essential to improve the reliability of machine learning models by detecting samples that do not belong to the training distribution. Detecting OOD samples effectively in certain tasks can pose a challenge because of the substantial heterogeneity within the in-distribution (ID), and the high structural similar...

Monitoring the healthy development of a fetus requires accurate and timely identification of different maternal-fetal structures as they grow. To facilitate this objective in an automated fashion, we propose a deep-learning-based image classification architecture called the COMFormer to classify maternal-fetal and brain anatomical structures pres...

In this work, we exploit multi-task learning to jointly predict the two decision-making processes of gaze movement and probe manipulation that an experienced sonographer would perform in routine obstetric scanning. A multimodal guidance framework, Multimodal-GuideNet, is proposed to detect the causal relationship between a real-world ultrasound vid...

Background: Fetal growth restriction (FGR) is a condition of poor growth of the fetus in utero. One of the causes of FGR is placental insufficiency. Severe early-onset FGR at < 32 weeks of gestation occurs in an estimated 0.4% of pregnancies. This extreme phenotype is associated with a high risk of fetal death, neonatal mortality, and neonatal mor...

Background: Anaemia in pregnancy is a global health problem with associated maternal and neonatal morbidity and mortality. We aimed to investigate the association between maternal haemoglobin concentrations during pregnancy and the risk of adverse maternal and neonatal outcomes. Methods: In this prospective, observational, multinational, INTERBI...

Household air pollution from solid cooking fuel use during gestation has been associated with adverse pregnancy and birth outcomes. The Household Air Pollution Intervention Network (HAPIN) trial was a randomized controlled trial of free liquefied petroleum gas (LPG) stoves and fuel in Guatemala, Peru, India, and Rwanda. A primary outcome of the mai...

Background: Household air pollution (HAP) from solid fuel use is associated with adverse birth outcomes, but data for exposure-response relationships are scarce. We examined associations between HAP exposures and birthweight in rural Guatemala, India, Peru, and Rwanda during the Household Air Pollution Intervention Network (HAPIN) trial. Methods:...

Early fetal anatomical assessment can detect a large proportion of congenital abnormalities but requires significant operator skill. In this study we aimed to understand the clinical value of using 3D ultrasound as an adjunct to standard examination. This was a prospective observational study of pregnant people presenting for routine first trimeste...

We propose a novel way of creating graphs from multiple ultrasound (US) video sweeps. A three-node graph models three video sweeps which are obtained from a fetal US sweep protocol. The nodes are assigned binary sequences which represent the frame-level detection of the fetal head across all video frames in a sweep. We build 382 subject-level graph...

Accurate estimation of gestational age is an essential component of good obstetric care and informs clinical decision-making throughout pregnancy. As the date of the last menstrual period is often unknown or uncertain, ultrasound measurement of fetal size is currently the best method for estimating gestational age. The calculation assumes an averag...

We present a method for classifying human skill at fetal ultrasound scanning from eye-tracking and pupillary data of sonographers. Human skill characterization for this clinical task typically creates groupings of clinician skills such as expert and beginner based on the number of years of professional experience; experts typically have more than 1...

Objective: The aim of this study was to determine the quality of fetal biometry and pulsed-wave Doppler ultrasound measurements in a prospective cohort study in Uganda. Methods: This was an ancillary study of the Ending Preventable Stillbirths by Improving Diagnosis of Babies at Risk (EPID) project, in which women enroled in early pregnancy unde...

In the Maternal Vitamin D Osteoporosis Study (MAVIDOS) randomized trial, vitamin D supplementation in pregnancy did not lead to greater neonatal bone mass across the trial as a whole, but, in a prespecified secondary analysis by season of birth, led to greater neonatal bone mass among winter-born babies. Demonstrating persistence of this effect int...

We present a method for skill characterisation of sonographer gaze patterns while performing routine second trimester fetal anatomy ultrasound scans. The position and scale of fetal anatomical planes during each scan differ because of fetal position, movements and sonographer skill. A standardised reference is required to compare recorded eye-track...

Visualising patterns in clinicians' eye movements while interpreting fetal ultrasound imaging videos is challenging. Across and within videos, there are differences in size an d position of Areas-of-Interest (AOIs) due to fetal position, movement and sonographer skill. Currently, AOIs are manually labelled or identified using eye-tracker manufactur...

Ultrasound(US)-probe motion estimation is a fundamental problem in automated standard plane locating during obstetric US diagnosis. Most recent existing recent works employ deep neural network(DNN) to regress the probe motion. However, these deep regression-based methods leverage the DNN to overfit on the specific training data, which is naturally...

Objective: Despite decades of obstetric scanning, the study of sonographer workflow remains largely unexplored. In the second trimester for example, sonographers use scan guidelines to guide their acquisition of standard planes and structures; however, the scan acquisition order is not prescribed. Using deep learning-based video analysis, the aim...

This study presents a novel approach to automatic detection and segmentation of the Crown Rump Length (CRL) and Nuchal Translucency (NT), two essential measurements in the first trimester US scan. The proposed method automatically localises a standard plane within a video clip as defined by the UK Fetal Abnormality Screening Programme. A Nested Hou...

Background: Among nonpregnant individuals, diabetes mellitus and high body mass index increase the risk of COVID-19 and its severity. Objective: This study aimed to determine whether diabetes mellitus and high body mass index are risk factors for COVID-19 in pregnancy and whether gestational diabetes mellitus is associated with COVID-19 diagnosis....