What is the Study About?
Improving the Prediction and Detection of Risk Factors for Term Stillbirth
Babies that are born small have an increased risk of problems in late pregnancy, and around the time of delivery. Babies are considered small if they are found to be under the 10th centile, that is, in the bottom 10% of birthweight for their gestational age. While many babies born small are healthy, some of these babies are small because the placenta is not working well to supply oxygen and nutrition efficiently to the baby. These babies have a higher chance of becoming stressed in labour and, extremely rarely, these babies are lost in late pregnancy, resulting in stillbirth.
While measuring the baby at each pregnancy visit identifies many small babies, some are missed. It would help if we could find a simple test that could tell us if the placenta is starting to fail. If we knew this in advance, it would mean we could watch the baby closely in late pregnancy and organise for delivery to occur before the baby experienced any complications.
In this study, we wish to look at two new ways of identifying babies who are not growing well. The first involves a blood test, and the second involves ultrasound, both performed in the last 3 months of pregnancy.
What are we looking for with the blood test?
In our laboratory, we have been looking at genetic messengers that come from the placenta and are released into the mother's blood stream. Our studies so far suggest that the placenta increases some genetic markers in response to low oxygen levels (or hypoxia) that can then be measured in the mother's blood. These results are very encouraging, but we need to confirm these findings in a bigger study. If a simple blood test could tell us if the placenta is starting to fail, this would be a major breakthrough. By knowing in advance, we could watch the baby closely in late pregnancy and organise for delivery to occur before the baby experienced any complications.
What are we looking for with ultrasound?
It is possible that the placenta may not work perfectly in late pregnancy, resulting in slowing of fetal growth in late pregnancy, but these babies are still found to be above the 10th centile when they are born. Our previous studies suggest that some of these babies behave like small babies (that is, babies under the 10th centile), with changes in their blood flow patterns in late pregnancy, and becoming more stressed than usual in labour. If we can confirm in a larger study that slowing of fetal growth is an important measure of placental function, this would be useful to know, because these babies may need closer surveillance as they approach term.
Anthropometry and Peapod Measurements
After birth, body composition measurements of our participating babies will provide useful information correlating placental function with fat distribution. Measurements have either been captured by skinfold thickness and/or the neonatal PEAPOD.
Please refer to this brochure that explains how the neonatal PeaPod is used in this study.
The FLAG Team:
Professor Sue Walker Head Perinatal Medicine, Perinatal Medicine
Professor Stephen Tong Professor and Head, Translational Obstetrics Group
Dr Teresa McDonald PhD Candidate, Translational Obstetrics Group
Dr Lisa Hui Associate Professor, Maternal Fetal Medicine
Dr Alice Robinson FRANZCOG, Mercy Hospital for Women
Dr Clare Whitehead MRANZCOG trainee and Post Doctorate Scientist
Kirsten Dane Research Midwife, University Department
Anna Middleton Research Midwife, University Department
Valerie Kyritsis Research Midwife, University Department
Elizabeth Lockie Researcher, University of Melbourne
Special thanks to the following staff that have greatly assisted throughout the project:
Translational Obstetrics Group Staff: Roxanne Hastie, Minh Deo, Sally Beard, Tu'Uhevaha Lino, Ping Cannon, Vi Nguyen, and Minh Nguyen
University Research Midwives: Gay Pell, Genevieve Christophers, Deb Jinks, Rachel Murdoch
University of Melbourne Staff: Sue Hill, Heather Hanson
Austin Pathology Staff
Health Information Services Staff
Outpatient, Postnatal and Birth Suite Midwives
Private Consultants and assisting staff: Dr Alison Fung, Dr Charlotte Elder, Dr Carol Vance, Dr Owen Stock, Dr Lenore Ellet, Lynn Bullock
How is the Study Progressing?
Telephone: +613 8458 4354
Address: University Department
Mercy Hospital for Women
Level 4/163 Studley Road
Heidelberg VIC 3084