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Welcome to the Obstetrics Resource Centre, with free access to the latest research in the field. 
All content is independently selected by the Editors, Professor James O. Drife from Leeds, UK, and Professor Jim Thornton from Nottingham. The Obstetrics Resource Centre provides you with original articles, reviews, selected must-reads, lectures and a congress planner.

 


From the other journals

  • Editor's comment: Prof. Jim Thornton: Closing in on the “pre-eclampsia gene”

    The InterPregGen group of researchers performed genome wide sequencing studies on 2,658 offspring from pre-eclamptic pregnancies and controls, using cohorts collected from UK, Iceland, Finland and Norway.  After testing over 7 million sequence variations they identified one, rs4769613, which was associated with the disease at the P = 3.2 x 10-8 significance level. Unlike previous purported associations this one is likely to be real. rs4769613 is located near the FLT1 locus.

    Variants in the fetal genome near FLT1 are associated with risk of preeclampsia

    McGinnis R et al.

    Nature Genetics, Volume:49,Pages:1255–1260, 2017
  • Editor's comment: Prof. Jim Thornton: ASPRE trial

    It has long been known that low dose aspirin (typically 75mg daily) prevents pre-eclampsia, although the effect is modest, only a 10% reduction. The ASPRE trial identified women at increased risk of pre-eclampsia using a screening algorithm and randomised then to aspirin 150mg at night or placebo from 14 weeks at the latest.  Although the screening algorithm performed somewhat less well than anticipated, the aspirin was more effective than previous trials in preventing pre-term pre-eclampsia (Odds ratio 0.38; 95% confidence interval, 0.20 - 0.74).

    Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia

    Rolnik DL, Wright D, Poon LC, O’Gorman N, Syngelaki A, de Paco Matallana C, et al.

    N Engl J Med. 2017 Aug 17;377(7):613-622. doi: 10.1056/NEJMoa1704559. Epub 2017 Jun 28.

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Selected AJOG Papers

Editor’s comment: Prof. Yves Ville: An ounce of prevention is worth a pound of cure
(Editor's comment relates to the AJOG articles below)

The fall issues of AJOG are rich in preventive measures.(1,2)

Multivitamins (3 or more vitamins or minerals in tablets or capsules) in pregnancy are often regarded to be at best a more palatable way to deliver folic acid and iron in pregnancy. A systematic review and meta-analysis gives us more incentive to encourage supplementation.(2)

The risk of giving birth to a small baby for gestational age (SGA) is reduced with multivitamin use. (RR :0.77 (95% CI, 0.63-0.93,...

Editor’s comment: Prof. Dan Farine: Towards normal birth – but at what cost by Hans Peter Dietz and Stuart Campbell
(Editor's comment relates to the AJOG article below)

I read with interest the clinical opinion paper “Towards normal birth – but at what cost” by Hans Peter Dietz and Stuart Campbell that was published in the October edition of the American Journal of Ob/Gyn. The article is interesting for a variety of different reasons; the authors seem to be passionate about the topic. They provide well thought and well researched references to support their arguments; most practicing obstetricians can relate to the fact that often patients are biased towards CD (both ways) and that proper education and informed consent are very time consuming and in certain setting are very difficult to provide.

Editor’s comment: Prof. Yves Ville: The street light effect of Down syndrome screening in pregnancy. Time to broaden risk assessment in early pregnancy.
(Editor's comment relates to the AJOG articles below)

Our present prenatal screening and diagnostic approach remains directed predominantly at identifying Down syndrome. However there are far more prevalent and serious conditions that have become amenable to prenatal screening and diagnosis.

Editor’s comment: Prof. Dan Farine: Exercise in Pregnancy the Norwegian outlook
(Editor's comment relates to the AJOG article below)

The issue of exercise in pregnancy has been studied extensively in the last 30 years with some researchers such as James Clapp the 3rd and Raoul Artal devoting a large portion of their careers to this issue.  The data generated by them and others showed generally that exercise in pregnancy had a variety of positive effects on associated diseases (diabetes hypertension etc.) and specific pregnancy outcomes. Concerns that extensive physical activity would lead to poor outcomes were shown to be non-true in studies such as James Clapp’s who found that Olympians had better outcomes than sedentary pregnant women.

Editor’s comment: Prof. Dan Farine: CMV in pregnancy what is new?
(Editor's comment relates to the AJOG article below)

This study provides more details on the diagnosis and probably more importantly the prognosis of CMV.  The paper starts with a statement that the CMV infection occurs in 0.7% of all births. Although this is probably the best current estimate it is important to note that in North America there is no routine screening for CMV. This in turn alters the presentation of the disease as few patients are screened for CMV (and these are obviously at a higher risk) and even fewer are tested for CMV. Many series are therefore skewed by the entry point of severe ultrasound findings. The question of the need for routine screening for CMV was obviously not addressed in this French study and still remains open. 

Editor’s comment: Prof. Yves Ville: Non-invasive whole fetal genome sequencing : Putting the cart before the horse ?
(Editor's comment relates to the AJOG article below)

The development of next-generation sequencing (NGS) technologies (ie, new high-throughput and massively parallel DNA sequencing technologies) has substantially reduced both the cost and the time required to sequence an entire human genome.  Its application to the human fetus has become a reality that is close to clinical implementation. (Lefkowitz R. et al) It is therefore both critical and urgent to be prepared for a shift in paradigm in prenatal screening and diagnosis.

Editor’s comment: Prof. Dan Farine: Disclosure of possible conflicts and other pitfalls waiting those who publish
(Editor's comment relates to the AJOG article below)

In this interesting paper the major finding is that 68% of physicians submitting a paper to the Society of Gynecological Surgery (SGS) did not properly disclose their full relationship to industry. Interestingly, the way that the under-reporting was found was based on earlier disclosure of these physicians of such a relationship.

Publishing is a way to achieve recognition as an expert and academic promotion. Publications are the major way to disseminate new information and improve medical practice. Individuals may feel pressure to publish for these reasons. The editors and readers want to see the best information published and they want to be sure that biases are optimally eliminated or at least disclosed...

Editor’s comment: Prof. Dan Farine: Acidemia with Normal pH:
(Editor's comment relates to the AJOG article below)

This interesting study looks retrospectively at the rare occurrence of acidemia and/or low base access in babies with normal Apgar scores. The “common sense approach” has been to assume that the test is erroneous as the baby was doing well and ignore it. In Medico-Legal conferences the rationale for pushing for universal cord pH testing has been that it may identify the group of interest for asphyxia (low pH and Apgar scores). According to this approach it was even more interesting to identify the neonates with a normal pH and base excess. These babies may have been exposed to a hostile intra-uterine environment based on history and/or abnormal fetal heart rates and possibly to less than optimal care. However, since they were not acidotic they would not go on to develop cerebral palsy based on the McLennan dogma that was adopted by the major obstetrical societies (FIGO, ACOG, UK guidelines Australian-NZ ones etc.)...

Editor’s comment: Prof. Yves Ville: To know the chance, a chance to know.
(Editor’s comment relates to the 3 AJOG articles below…)

Advanced screening for fetal aneuploidies using fetal DNA in maternal blood represents a major technical breakthrough that is still struggling to find a pragmatic place within the screening algorithms in most countries, after 4 years of clinical use. The wide and sometimes wild dissemination of the test stresses the critical need for the prescribers of the test to understand the difficulties of its interpretation.

Editor’s comment: Prof. Yves Ville: An unsuspected enemy is doubly dangerous (L. Frank Baum)
(Editor’s comment relates to the 3 AJOG articles below: Aubry et al, Khalifeh et al & Saade et al)
Over a third of infant deaths arise from complications related to preterm births, making prematurity the most frequent cause of infant mortality. Health complications are also a lifelong burden of survivors including mental retardation, cerebral palsy, learning and behavioral problems, respiratory problems, vision and hearing loss, but also diabetes, high blood pressure, and heart disease. This inventory has become a classic lament of perinatologists facing the implacable consequences of prematurity.

Trends in prematurity have been either on the rise (1990-2006) or flattening (2006-2013) with medically indicated « late » prematurity as the main adjustment variable. However around 1/25 pregnancies still face unexpected delivery before 33 weeks’ and roughly half of them are primigravidas without anticipated risk factors...

Editor’s comment: Prof. Yves Ville: Is the due date becoming overdue ?
(Editor’s comment relates to the 3 AJOG articles below: Gibson et al, Melamed et al & Masoudian et al)

In vitro fertilization using egg donation (ED) is being used increasingly for women requiring assisted reproduction techniques (ART) with a delivery rate per transfer of around 40%. Initially designed to overcome infertility in young women with hypergonadotropic hypogonadism, this technique is now also increasingly used to achieve pregnancy in older women.

Multiple studies have documented that ED pregnancies are associated with a higher incidence of pregnancy-induced hypertension and placental dysfunction, including small for gestational age, and preterm delivery. However, multiple gestations, advanced age, and underlying polycystic ovary syndrome are constant confounding factors for all studies examining the association between assisted reproductive techniques (ARTs) and hypertensive disorders in pregnancy...

  • Editor’s comment: Prof. Dan Farine: The twin study
    This is a very important study as it complements the initial results of the Twins Birth Study. Both of these studies are likely to reflect a world-wide results of twins delivery as this a rigorously designed RCT looked at patients in a multitude of centers around the world. As opposed to a common belief before the study, that Caesarean delivery is the “easy way out” in twins’ birth (as in many other conditions), these were not the results of this study. Neither the short term results nor the long term ones showed benefit of an elective Caesarean delivery in term or late preterm twins where the first twin is in a vertex presentation. This may be important to the young mother who has to take care of two babies who do not need to be hampered by inconvenience and possible complications of a Caesarean delivery. There is a new keen and justified interest in the long term effect of Caesarean deliveries. There is an impressive set of data correlating Caesarean birth with increased risks of: diabetes, asthma and increased weight. It is important to mention that this association does not necessarily mean causation. In contrast, there is also an alarming data about the rising rates of adhesive placentas (accreta and percreta). These are definitely related to the scar in the uterus. Luckily, the study by Silver from the MFM network in the USA suggested that this risk is increased mainly after 3 Caesarean deliveries.

    It is interesting to see that the results of this study could be interpreted in exactly the opposite way. Women who prefer a Caesarean birth for whatever reason (worries about double vaginal births, apprehension of the small risk of having both vaginal and Caesarean deliveries, need to plan delivery time etc.) may be reassured that a caesarean approach does not increase mortality or major neurological deficits. The same may apply to the obstetricians who are very uncomfortable with the delivery of the second twin. In other words this study is good for both the vaginal and CS camps.

    Twin Birth Study: 2-year neurodevelopmental follow-up of the randomized trial of planned cesarean or planned vaginal delivery for twin pregnancy

    Elizabeth V. Asztalos MD, Mary E. Hannah MD, CM, Eileen K. Hutton PhD, Andrew R. Willan PhD, Alexander C. Allen MD, CM, B. Anthony Armson MD, Amiram Gafni DSc, K.S. Joseph MD, PhD, Arne Ohlsson MD, Susan Ross PhD, J. Johanna Sanchez MIPH, Kathryn Mangoff BSc, Jon F.R. Barrett MB BCh, MD

    American Journal of Obstetrics and Gynecology, In Press, Corrected Proof, Available online 29 January 2016, Available online 29 January 2016

  • Editor’s comment: Prof. Dan Farine: Reduced fetal movements
    This is another interesting development in the saga of reduced fetal movements. The Canadian (1) and Australian NZ (2) guidelines ask women to monitor for Reduced Fetal Movements (RFM) while the British (3) and the American (4) ones make it an option and not a recommendation. These divergent approaches are interesting and maybe concerning as there is a large study from Norway (5) that showed that in a large cohort that Monitoring and managing RFM may eliminate one 1/3 of stillbirths. The current study goes beyond assessing RFM as it looked at the women that had repeated RFM. There was very limited data on repeated RFM prior to this study and most of us managed the subsequent episode similarly to the first one. In this study a subset of the patient had more than 1 episode of RFM. These women had a high incidence of placental insufficiency as well as high incidence of SGA (close to 50%) that was often not there in the first episode of the RFM. AS the authors outline this suggests that placental insufficiency as associated and possibly the cause of both RFM and growth restriction.

    This study may have very important clinical implications. Women may need to be advised that repeated episodes of RFM may carry an increased risk to the baby and clinicians may consider a change in mat on the form of either increased fetal surveillance or delivery close to term.

    Number of episodes of reduced fetal movement at term: association with adverse perinatal outcome

    Carolina Scala MD, Amar Bhide MD, FRCOG, Alessandra Familiari MD, Giorgio Pagani MD, Asma Khalil MD, MRCOG, Aris Papageorghiou MD, FRCOG, Basky Thilaganathan PhD, FRCOG

    Am J Obstet Gynecol. 2015 Nov;213(5):678.e1-6. doi: 10.1016/j.ajog.2015.07.015. Epub 2015 Jul 20.

  • Editor’s comment: Prof. YvesVille: Cerebral Palsy: the changing face of an old enemy
    Cerebral palsy (CP) encompasses a heterogeneous group of early-onset, non-progressive, neuromotor disorders that affect the developing fetal or infant brain. CP has become our enemy but also our curse since Little linked this condition to birth asphyxia in the mid-19th century. Freud attributed the disorder to brain injury from various causes, including prenatal events, and emphasised that extended labour was not the exclusive or even principal cause, therefore increasing our responsibility not to say our feeling of guilt. Although our practice has been hugely influenced by this threat over the last 50 years, mainly through an increase in cesarean section rates. An update on the prevalence of cerebral palsy through a systematic review and meta-analysis gauging the prevalence of CP over time has shown that it has remained depressingly and frustratingly stable over the last 10 years at around 2 per 1,000 births. (Oskoui et al, 2013) The main illustration of this catch-22 situation in developed nations is largely explained by an increase in survival of very premature and low-birthweight babies together with higher numbers of multiple births, which often result in preterm births. This has therefore led to a new generation of people affected with CP, probably because of vulnerability of the immature brain, especially in babies with intraparenchymal or intraventricular bleeds or periventricular white-matter abnormalities. The increase in such high-risk situations may contribute to mask teh factors that may contribute to decrease the prevalence of CP, such as the use of antenatal corticosteroids, cooling for term-born asphyxiated infants, and the use of magnesium sulphate...

    Cerebral palsy: causes, pathways, and the role of genetic variants

    Alastair H. MacLennan MD, FRANZCOG, Suzanna C. Thompson MBBS, FRACP, Jozef Gecz PhD

    American Journal of Obstetrics and Gynecology, Volume 213, Issue 6, December 2015, Pages 779 - 788

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