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Heazell A.,Maternal and Fetal Health Research Center
Anaesthesia and Intensive Care Medicine

Perinatal death or cerebral palsy are devastating outcomes of pregnancy for families. In an attempt to prevent these outcomes fetal wellbeing is assessed by a variety of means in the antenatal and intrapartum settings. In this review, the most common means to confirm fetal wellbeing, the rationale for their use and evidence of their efficacy in each of these settings are discussed. With respect to labour, the indications for continuous electronic fetal monitoring are presented, together with a guide to interpretation of cardiotocograph (CTG) or fetal blood samples (FBS). © 2013 Published by Elsevier Ltd. Source

Singh H.,University of Manchester | Singh H.,Prince Henrys Institute of Medical Research | Aplin J.D.,University of Manchester | Aplin J.D.,Maternal and Fetal Health Research Center
Molecular Human Reproduction

Implantation failure is one of the major causes of infertility and remains a major barrier to assisted reproduction success. Initial receptivity to implantation is regulated by the endometrial luminal epithelium under maternal hormonal control. Identification of epithelial cell surface components involved in embryo attachment will have translational applications in early pregnancy failure, infertility and contraception. In this study, vectorial biotinylation has been used to characterize the apical glycoproteome of Ishikawa cells, a polarized cell line that serves as a model of the implantation-receptive human endometrial luminal epithelium. Of 46 surface-associated glycoproteins detected by mass spectrometry, half are newly reported in this cell type; a subgroup of these were chosen for evaluation in tissue, and all were shown to be expressed apically in vivo in the mid-secretory (implantation) phase of the menstrual cycle, thus validating the model. Eleven adhesion molecules were detected, some already known to be involved in implantation, others novel. Cadherin 6, desmoglein 2 and plexin b2 were surprisingly found in the apical as well as the lateral membrane domain; their knock-down compromised epithelial integrity. This method of targeting glycosylated apical surface moieties in a polarized epithelial culture model shows excellent selectivity and identifies candidate cell adhesion molecules that are also present in vivo in secretory phase endometrial epithelium. © The Author 2014. Source

Wareing M.,University of Manchester | Wareing M.,Maternal and Fetal Health Research Center
Journal of Obstetrics and Gynaecology Research

Aim: The human fetoplacental vasculature has been suggested to be a low resistance/high flow system, but the mechanisms by which this state is achieved are unclear. Methods: This study assessed the effects of intraluminal flow and local oxygenation on isolated human placental chorionic plate arteries and veins at term using pressure myography. Results: Chorionic plate arteries and veins exhibit myogenic tone. A small but significant arterial vasodilatation was observed following exposure to hypoxia; chorionic plate veins contracted to a similar hypoxic stimulus. Under physiological conditions of pressure and oxygenation, increased luminal flow induced contraction in both chorionic plate arteries and veins. [Correction added after online publication 15th November 2011: 'induced vasodilatation' has been changed to 'induced contraction'] Conclusions: Human fetoplacental vascular tone can be manipulated by local physical factors. © 2011 Japan Society of Obstetrics and Gynecology. Source

Edozien L.C.,Maternal and Fetal Health Research Center
Journal of Obstetrics and Gynaecology

On the labour ward, the key to achieving patient safety is the intershift handover, which affords an opportunity for the team to undertake a baseline assessment of the current situation, anticipate problems, plan contingencies and subsequently maintain situational awareness. If optimised, the handover has immense potential not only for enhancing patient safety but also for reducing stress to staff. The handover should be regarded not as an end but as the beginning of the process of maintaining individual and team situational awareness throughout the shift. Each maternity unit should have a Structured Multidisciplinary Intershift Handover (SMITH) protocol, which encompasses pre-handover, handover and post-handover guidance. This paper describes the underlying principles, benefits and content of a SMITH protocol. © 2011 Informa UK, Ltd. Source

Wright C.,Maternal and Fetal Health Research Center | Sibley C.P.,University of Manchester | Baker P.N.,University of Manchester
Archives of Disease in Childhood: Fetal and Neonatal Edition

The role of magnetic resonance imaging (MRI) in fetal imaging is expanding. The depth of structural information provided by MRI means it is more than just a useful adjunct to ultrasound, as several structures are more clearly visualised and many of the limitations of ultrasound are avoided. Currently, MRI is most frequently utilised with reference to the fetal central nervous system and is valuable in ventriculomegaly, agenesis of the corpus callosum and posterior fossa abnormalities. Outside this, MRI remains primarily a research tool; there is increasing interest in applying it to thoracic abnormalities and also scope for development in other niche areas. MRI is able to accurately determine fetal organ volumes and weight, although whether such measurements could play a role in conditions such as fetal growth restriction, has yet to be fully established. Techniques such as diffusion weighted imaging, magnetic resonance spectroscopy and functional imaging are also being remodelled for use in the fetus, improving our knowledge of in utero metabolism and development. Source

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