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Publications
Publications (401)
Prenatal genomic sequencing, which can provide a significantly increased diagnostic rate for fetal structural anomaly (FSA) compared with karyotype and microarray, is not available uniformly across Australia. PreGen, a 5‐year translational research program, has identified significant barriers to implementation including access to funding, the avail...
Introduction
Spontaneous preterm birth is a major cause of perinatal morbidity and mortality and has traditionally been viewed as an inevitable event affecting a small proportion of pregnancies. Clinical practice guidelines recommend measures to predict pregnancies at risk of spontaneous preterm birth and prophylactic treatments. We performed this...
Objective
To assess the performance of the Fetal Medicine Foundation (FMF) first‐trimester competing‐risks screening model for small‐for‐gestational‐age (SGA) fetuses requiring delivery at < 37 weeks' gestation, in a large cohort of women receiving maternity care in Australia.
Methods
This was a retrospective analysis of prospectively collected da...
Background
Preterm birth (PTB) is associated with significant neonatal mortality and morbidity. Universal measurement of cervical length has been proposed as a screening tool to direct intervention to prevent PTB.
Aim
To assess the impact of the introduction of sonographic mid-trimester cervical length screening on the use of cervical cerclage and...
Introduction
We showed in a phase II randomised controlled trial (RCT) that oral sildenafil citrate in term labour halved operative birth for fetal distress. We outline the protocol for a phase III RCT (can i ntrapartum S ild E nafil safely A vert the R isks of C ontraction-induced H ypoxia? (iSEARCH)) of 3200 women in Australia to assess if silden...
INTRODUCTION
Preterm birth continues to be one of the most significant contributors to perinatal death. This study aims to evaluate the quality of antenatal care provided to women delivering preterm.
METHODS
This was a retrospective, descriptive, longitudinal review of all women who had antenatal care within a single Australian tertiary hospital a...
Background
Australian rates of adverse obstetric outcomes have improved little despite guidelines recommending history‐based screening and intervention. The first trimester provides a unique opportunity to predict and prevent complications, yet population‐based screening has failed to be translated into broad clinical practice.
Aims
This study aim...
Objective
To examine the prenatal profiles of pregnancies affected by an atypical chromosomal aberration, focusing on pathogenic copy number variants (pCNVs). Further, we wanted to quantify the performance of combined first‐trimester screening (cFTS) and a second‐trimester anomaly scan in detecting these conditions. Finally, we aimed to estimate th...
Background
Prediction of pregnancies at risk of preterm birth (PTB) may allow targeted prevention strategies.
Objectives
To assess quality of clinical practice guidelines (CPGs) and identify areas of agreement and contention in prediction and prevention of spontaneous PTB.
Search Strategy
We searched for CPGs regarding PTB prediction and preventi...
Objectives
To develop a semi‐automated tool for measuring fetal abdominal wall thickness (AWT). To validate the software using images captured by other centers and create a nomogram for fetal AWT between 18 and 20 weeks.
Methods
A semiautomated tool that measured AWT was developed using images captured at the routine 20‐week morphology scan. The s...
Although cell-free DNA (cfDNA) prenatal screening is widely used and has high sensitivity and specificity, there are circumstances in which the screening does not provide an interpretable result. Although this is relatively uncommon, it happens enough that clinical implications and potential reasons for follow-up should be studied and assessed. Thi...
Objective
One goal of prenatal genetic screening is to optimize perinatal care and improve infant outcomes. We sought to determine whether high‐risk cfDNA screening for 22q11.2 deletion syndrome (22q11.2DS) affected prenatal or neonatal management.
Methods
This was a secondary analysis from the SMART study. Patients with high‐risk cfDNA results fo...
Objectives:
To examine the distribution of nuchal translucency thickness (NT), free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A) in pregnancies with a fetal 22q11.2 aberration. Further, the performance of combined first-trimester screening (cFTS) in detecting affected pregnancies and a new risk algorith...
Background
Mounting evidence shows the risk of COVID‐19 on perinatal outcomes, as well as the safety and efficacy of vaccination during pregnancy. However, little is known about vaccine uptake among pregnant women in Australia, including women who are culturally and linguistically diverse (CALD), and about sources of information pregnant women use...
Objective:
Traditional obstetric practice has relied upon history-based assessment to screen for preeclampsia and guide preventative therapies but is hampered by low sensitivity, high false positive rates and low treatment rates. First-trimester screening algorithms represent the most efficacious approach for risk prediction and could target early...
Purpose:
To assess the performance of cell-free DNA (cfDNA) screening to detect sex chromosome aneuploidies (SCA) in an unselected obstetrical population with genetic confirmation.
Methods:
This was a planned secondary analysis of the multicenter, prospective SMART study. Patients receiving cfDNA results for autosomal aneuploidies and who had co...
Objectives:
To examine early pregnancy risk factors for preterm prelabour rupture of membranes (PPROM) and develop a predictive model.
Study design:
Retrospective analysis of a cohort of mixed-risk singleton pregnancies screened in the first and second trimesters in three Danish tertiary fetal medicine centres, including a cervical length measur...
Background:
The clinical implications of non-reportable cfDNA screening results are uncertain, but this may reflect poor placental implantation in some cases and be associated with adverse obstetrical and perinatal outcomes.
Objective:
To assess the outcomes of pregnancies with non-reportable cell-free DNA (cfDNA) screening in a cohort of patien...
Pre-eclampsia is a life-threatening disease of pregnancy unique to humans and a leading cause of maternal and neonatal morbidity and mortality. Women who survive pre-eclampsia have reduced life expectancy, with increased risks of stroke, cardiovascular disease and diabetes, while babies from a pre-eclamptic pregnancy have increased risks of preterm...
Multiple pregnancies are associated with higher risks for both mother and babies. Women with multiple pregnancies have an increased risk of miscarriage, anemia, hypertensive disorders, haemorrhage, and postnatal illness. These pregnancies are more likely to need an operative delivery, and maternal mortality is generally 2.5 times that of singleton...
Introduction
COVID-19 infection in pregnancy is associated with increased morbidity and mortality for the mother as well as complications for the baby. In July 2021, the Australian Technical Advisory Group on Immunisation and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommended that pregnant women should be p...
Introduction:
Preterm prelabour rupture of membranes (PPRoM) is a significant cause of maternal and perinatal morbidity and mortality. The aim of this project was to identify interventions that reduce the prevalence of PPRoM.
Methods:
Search strategy included a systematic literature search of MEDLINE, EMBASE, PubMed and Cochrane Library. The sel...
Objectives:
To standardize the measurement of shear wave elastography for assessment of cervical stiffness and its relationship with gestational age and cervical length.
Methods:
A prospective cross-sectional study was conducted from September 2017 to March 2019. Data from 125 unselected women (at 11-13 + 6, 18-22 and 24-28 weeks' gestation) and...
Introduction
We showed in a Phase 2 RCT that oral Sildenafil during term labour halves the need for operative birth for suspected fetal distress. To assess if Sildenafil reduces adverse perinatal outcomes, we describe a Phase 3 RCT (iSEARCH) and the rationale for an individual participant data prospective meta-analysis (IPD PMA) of RCTs in high-inc...
(Abstracted from Ultrasound Obstet Gynecol 2021;58:264–277)
One of the risk factors for perinatal mortality and morbidity is abnormal fetal growth. The goal of this study was to study the prediction of adverse perinatal outcomes in preterm and term babies based on 3 birth weight (BW) standards (Australian population-based, Fenton, and INTERGROWTH-2...
Background:
Maternal nutrition is associated with epigenetic and cardiometabolic risk factors in offspring. Research in humans has primarily focused on assessing the impact of individual nutrients.
Objective:
We sought to assess the collective impact of maternal dietary monounsaturated (MUFA), polyunsaturated (PUFA), and saturated fat (SFA) on e...
Background
Cell-free DNA (cfDNA) non-invasive prenatal screening for trisomy (T) 21, 18, and 13 has been rapidly adopted into clinical practice. However, prior studies are limited by lack of follow up genetic testing to confirm outcomes and accurately assess test performance, particularly in women at low-risk for aneuploidy.
Objective
To compare t...
Background
Prenatal screening has historically focused primarily on detection of fetal aneuploidies. Cell-free DNA (cfDNA) now enables noninvasive screening for subchromosomal copy number variants, including 22q11.2 deletion syndrome (22q11.2DS or DiGeorge syndrome), which is the most common microdeletion and a leading cause of congenital heart def...
The nonlinear mechanical behaviour of cervical tissue causes unpredictable changes in measured elastograms when pressure is applied. These uncontrolled variables prevent the reliable measurement of tissue elasticity in a clinical setting. Measuring the nonlinear properties of tissue is difficult due to the need for both shear modulus and strain to...
Objective
To assess pregnancy outcomes following first trimester combined screening for preterm preeclampsia in Australia.
Methods
We compared pregnancy outcomes of women with singleton pregnancies who underwent first trimester combined preeclampsia screening with the Fetal Medicine Foundation algorithm between 2014 and 2017 in Melbourne and Sydne...
Background: Aspirin has been shown to reduce prevalence of both early-onset pre-eclampsia (ePET) and fetal growth restriction (FGR).
Aims: To determine whether aspirin prescribed for risk of ePET reduces the prevalence of small for gestational age (SGA) neonates.
Material and methods: Two prospective cohorts were consecutively recruited in a larg...
Background
Cesarean delivery rates continue to rise globally the reasons for which are incompletely understood.
Objectives
We aimed to characterize attributable factors for increasing cesarean delivery rates over a 30-year period within our health network.
Study Design
This was a planned observational cohort study across two hospitals (a large te...
Introduction:
The aim of this study was to obtain expert consensus on the content of a curriculum for learning chorionic villus sampling (CVS) and amniocentesis (AC) and the items of an assessment tool to evaluate CVS and AC competence.
Methods:
We used a 3-round iterative Delphi process. A steering committee supervised all processes. Seven inte...
About half of Australian women have a body mass index in the overweight or obese range at the start of pregnancy, with serious consequences including preterm birth, gestational hypertension and diabetes, caesarean section, stillbirth, and childhood obesity. Trials to limit weight gain during pregnancy have had limited success and reducing weight be...
Background
Abnormal fetal growth is a risk factor for perinatal mortality and morbidity. There is considerable debate about the choice and performance of growth charts to classify newborns as small or large for gestational age (SGA and LGA) as a proxy for the at-risk infants. Several international charts have been proposed to be adopted worldwide....
Background:
Fetal occiput transverse position in the second stage of labor is associated with adverse maternal and perinatal outcomes. Prophylactic manual rotation in the second stage of labor is considered a safe and easy to perform procedure that has been used to prevent operative deliveries.
Objective:
To determine the efficacy of prophylacti...
Introduction
Inconsistent reporting practices in third trimester ultrasound, the choice of reference charts in particular, have the potential to misdiagnose abnormal fetal growth. But this may lead to unnecessary anxiety and confusion amongst patients and clinicians and ultimately influence clinical management. Therefore, we sought to determine the...
Fetal growth restriction is a leading cause of stillbirth that often remains undetected during pregnancy. Identifying novel biomarkers may improve detection of pregnancies at risk. This study aimed to assess syndecan-1 as a biomarker for small for gestational age (SGA) or fetal growth restricted (FGR) pregnancies and determine its molecular regulat...
Objective:
To evaluate three birthweight standards (Australian population-based, Fenton, and INTERGROWTH-21st ) and three estimated-fetal-weight [EFW] standards (Hadlock, INTERGROWTH-21st , and WHO) for classifying SGA, LGA, and predicting adverse perinatal outcomes in preterm and term babies METHODS: A nationwide population-based study was conduc...
Objective: To determine whether vaginal progesterone reduces spontaneous preterm birth (sPTB) before 37 weeks in asymptomatic high-risk women with a singleton pregnancy and normal mid-gestation cervical length.
Study design: Databases were searched (from inception to December 2020) with the search terms “progesterone” and “premature birth” or “pret...
Objective:
To evaluate the discrepancy between historical and more recent descriptions of the first stage of labour by testing whether the statistical techniques used recently (repeated measures polynomial and interval censored regression) were appropriate for detection of periods of rapid acceleration of cervical dilatation as might occur at the...
Objective:
The study aimed to investigate the association between placental growth factor (PlGF) and adverse obstetric outcomes in a mixed-risk cohort of pregnant women screened for preeclampsia (PE) in the first trimester.
Methods:
We included women with singleton pregnancies screened for PE between April 2014 and September 2016. Outcome data w...
Preeclampsia (PE) is associated with long-term morbidity in mothers and lifelong morbidities for their children, ranging from cerebral palsy and cognitive delay in preterm infants, to hypertension, diabetes and obesity in adolescents and young adults. There are several processes that are critical for development of materno-fetal exchange, including...
Introduction:
We aim to evaluate the supplementary predictive value of soft tissue markers, including fetal limb volumes, for fetal birth weight and fat tissue weight.
Methods:
This is a prospective study of 60 patients undergoing term induction of labor. Ultrasound was performed 48 h before birth, and 2D sonographic measurements, subcutaneous t...
Objective: Caesarean delivery rates continue to rise globally the reasons for which are poorly understood. We aimed to characterize attributable factors for increasing caesarean delivery rates over a 30-year period within our health network. Design: Observational cohort study. Setting: Two hospitals (large tertiary referral hospital and metropolita...
Background
Persistent occiput posterior position in labor is associated with adverse maternal and perinatal outcomes. Prophylactic manual rotation from the occiput posterior to the occiput anterior position in the second stage of labor is considered a safe and easy to perform procedure which in observational studies has shown promise as a method fo...
Background:
Aspirin has been shown to reduce prevalence of both early-onset pre-eclampsia (ePET) and fetal growth restriction (FGR).
Aims:
To determine whether aspirin prescribed for risk of ePET reduces the prevalence of small for gestational age (SGA) neonates.
Material and methods:
Two prospective cohorts were consecutively recruited in a l...
We read with interest the recent article on the effects of aspirin on utero-placental hemodynamics,1 as this has been an area of interest to us since presenting our findings on this subject five years ago,2 although our conclusions2,3 were the opposite to those of your publication. Two recent publications had similar findings to ours.4,5 It is not...
Objective:
To evaluate time of diagnosis of 22q11.2 deletion and 22q11.2 duplication as well as trisomies 21, 13, and 18 before and after introduction of a prenatal screening program including combined first-trimester screening (cFTS) for the trisomies in Denmark in 2004.
Method:
Cross-sectional, population-based register study employing The Dan...
Background:
Induction of labour (IOL) and caesarean section (CS) rates continue to increase in Australia, New Zealand and globally. There is evidence that CS rates are decreased in the context of medically indicated and elective IOL; therefore, the emerging concept of using IOL as means of preventing CS warrants investigation.
Aims:
To assess ob...
Objective
To report on the findings of a survey of sonographer skill‐teaching practices in Australia using the SonoSTePs tool.
Method
A cross‐sectional survey of all qualified sonographers registered with the Australian Sonographer Accreditation Registry.
Results
The 528 responses showed the use of a two‐step skill‐teaching approach to teach scan...
( Aust N Z J Obstet Gynaecol . 2019;59:791–798)
The cesarean delivery (CD) rate in Australia is ∼34%, and the most common indication for a woman’s first cesarean is slow labor progress. Another 29% of women undergo labor induction. Previous studies have demonstrated that induction of labor (IOL) reduces the risk of CD at 40 weeks gestation or later...
Objectives:
Preeclampsia causes substantial maternal and neonatal mortality and morbidity. In addition to a personal impact on women, children and their families, preeclampsia has a significant economic impact on our society. Recent research suggests that a first trimester multivariate model is highly predictive of preterm (<37 weeks' gestation) p...
Objective
To report the qualitative findings of the inaugural survey of sonographer skill‐teaching practices in Australia using the SonoSTePs tool.
Method
A national cross‐sectional survey of all qualified sonographers registered with the Australian Sonographer Accreditation Registry. A mix of quantitative and qualitative data was collected. This...
Objectives:
Placental related adverse pregnancy outcomes such as fetal growth restriction have significant short- and long-term implications for both mother and fetus. This study aimed to determine if conventional and novel early first trimester ultrasound measures are associated with small for gestational age (SGA) neonates. In addition, we aimed...
Objectives
Women who had hypertensive disorders of pregnancy (HDP) are twice as likely to experience maternal cardiovascular disease later in life. The primary aim of this study (BP²) is to compare outcomes of 3 different management strategies (including lifestyle behaviour change (LBC) in the first 12 months postpartum in women who had HDP in thei...
Objectives
To prepare more accurate population‐based Australian birthweight centile charts by using the most recent population data available and by excluding pre‐term deliveries by obstetric intervention of small for gestational age babies.
Design
Population‐based retrospective observational study.
Setting
Australian Institute of Health and Welf...
Introduction: The fetus that fails to meet its ideal growth trajectory has increased risks of poor health outcomes throughout life. “Gold standard” methods of anthropometric assessment such as measurement of percentage body fat can be difficult to apply across populations and other biomarkers such as serum concentration of umbilical cord blood lept...
The mechanical characteristics of tissue can reflect its biochemical content and, therefore, be a powerful tool in the diagnosis of diseases. Many different methods have been developed for testing the mechanical properties of tissue, such as aspiration, indentation and shear wave elastography. Soft tissues are, however, more complex in behaviour th...
Background and objective
Hypertensive disorders of pregnancy (HDPs) affect 5%–10% of pregnancies and have been associated with excess maternal cardiovascular disease (CVD) risk. The primary aim of this study was to reliably estimate absolute and relative risks of CVD after HDP.
Methods
A retrospective cohort of women who had singleton pregnancies...
Birthweight is the most commonly used proxy marker but does not adequately define true nutritional status. Modalities like DXA (dual energy x-ray absorptiometry) and TOtal Body Electric Conductivity (TOBEC) have been validated to assess body composition but their accuracy in neonates has not been established. The PEAPOD (COSMED, Rome Italy) has bee...
