Magnetic resonance Imaging of mother and fetus in late gestation to inform and optimise BIRTH management: the MIBIRTH study

对妊娠晚期母亲和胎儿进行磁共振成像，以告知和优化分娩管理：MIBIRTH 研究

基本信息

批准号：
MR/X010007/1
负责人：
Mary Ann Rutherford
金额：
$ 297.77万
依托单位：
King's College London
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2023
资助国家：
英国
起止时间：
2023 至无数据
项目状态：
未结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FX010007%2F1
关键词：
Magnetic resonance Imaging mother fetus

项目摘要

In 2020 there were 464,437 U.K. births, of which one third were delivered by Emergency Caesarean Section ( EmCS) or assisted delivery (forceps or vacuum extraction). These interventions often follow a prolonged exhausting labour with a procedure performed under anaesthetic outside normal working hours. Such complex births are more common in older mothers, mothers who are obese and those with small or large babies. They are associated with an increase in baby's admission to the neonatal unit with infection and injuries to the baby's brain, such as hypoxic -ischaemic encephalopathy (HIE). Mothers may suffer excessive bleeding, pelvic floor injuries with subsequent urinary and/or faecal incontinence/leaking, painful sexual intercourse and post-traumatic stress disorder, with lifelong impacts to physical and emotional health. Approximate 17% of women have an elective section (ElCS), leaving only 50% of women in the U.K. having unassisted vaginal deliveries. The main reasons for EmCS or assisted delivery are concerns about baby's wellbeing in labour with compromise relating to a poorly functioning placenta and difficulties with the baby fitting through the birth canal (cephalopelvic disproportion, CPD). Before labour starts, it is currently difficult to accurately predict which babies will get into difficulty or to identify pregnancies at risk of CPD. Other factors such as the mother's age and weight are also important. Creating an individualised risk for EmCS or assisted delivery for a woman at the end of pregnancy would dramatically improve joint patient/clinician decision-making with the potential to avoid a difficult delivery, and improve maternal and neonatal outcome.We plan to use a technique called magnetic resonance imaging (MRI) in late pregnancy, after 36 weeks of gestation (GA), to identify mothers at increased risk of a difficult delivery. This imaging does not use radiation and is safe for both mother and baby. It is currently widely used in clinical practice to diagnose fetal abnormalities and well tolerated. We will scan 500 women who have a higher risk of an adverse delivery and combine measures of the maternal pelvis, fetal head and fetal position with assessment of fetal energy reserves and heart function, and placental function. We will approach mothers at around 20 weeks GA about the study. This will allow them time to read the patient information sheet, watch a video about antenatal MR scanning, and discuss the study with their partners, relatives and doctors. The MRI scan will be performed at St Thomas' Hospital, KCL, taking about one hour with a comfort break halfway through. Attention will be paid to ensure the mother is comfortable during the scan and can talk with the imaging team throughout. We will perform an ultrasound scan during the same visit. Parents will be shown images of their baby and copies provided. If there are any incidental findings on the imaging that are known to influence the management of the birth or delivery, such as a low lying placenta, these will be discussed with the mother and shared with the obstetric and midwifery team. We will collect clinical data acquired as part of routine antenatal care. with information from the labour and delivery and the mothers and baby's outcome. Six weeks after birth we will contact and ask mothers for information about their physical and mental wellbeing, feeding method and baby's health.With all available information for an individual pregnancy we will use the latest data modelling tools to determine which factors relate to a higher chance of a difficult delivery. This should provide the most valuable data required to produce an individual risk score that can be used prospectively in women at high risk for EmCS or assisted delivery. Our ultimate aim is to reduce the numbers of EmCS and assisted deliveries, thereby improving the short and long-term health and wellbeing of both mothers and babies.

2020年，有464,437英国的出生，其中三分之一由急诊剖腹产（EMC）或辅助分娩（镊子或真空提取）交付。这些干预措施通常经过长时间的精疲力尽的劳动，并在正常工作时间以外的麻醉下进行的手术。这种复杂的出生在年长的母亲，肥胖的母亲和小婴儿或大婴儿的母亲中更为常见。它们与婴儿进入新生儿单位的吸收和对婴儿大脑受伤的增加有关，例如低氧 - 缺血性脑病（HIE）。母亲可能会遭受过多的出血，骨盆底损伤，随后的尿和/或粪便失禁/泄漏，性交痛苦，性交和创伤后应激障碍，对身体和情感健康产生终生影响。大约17％的妇女有一个选修区（ELC），英国只有50％的女性进行了无助的阴道分娩。 EMC或辅助交付的主要原因是关注婴儿在劳动中的福祉，并妥协胎盘功能较差以及在出生管中的婴儿配合的困难（头孢菌病不成比例，CPD）。在劳动开始之前，目前很难准确预测哪些婴儿会遇到困难或确定患有CPD风险的怀孕。母亲的年龄和体重等其他因素也很重要。在怀孕结束时为女性造成个性化的EMC或辅助分娩风险将显着改善联合患者/临床医生的决策，从而避免难以交付，并改善孕产妇和新生儿的结果。我们计划在妊娠晚期（GA）（GA）中使用一种称为磁共振成像（MRI）的技术（GA），以使MATHEATS（GA）的交付率增加了一定的风险。这种成像不使用辐射，对母亲和婴儿都安全。目前，它在临床实践中被广泛用于诊断胎儿异常和耐受性良好。我们将扫描500名女性，这些女性患不良分娩的风险较高，并结合了母体骨盆，胎儿头和胎儿位置的措施，并评估胎儿能量储备和心脏功能以及胎盘功能。我们将在20周GA大约在GA上与母亲有关这项研究。这将使他们有时间阅读患者信息表，观看有关产前MR扫描的视频，并与他们的伴侣，亲戚和医生讨论这项研究。 MRI扫描将在KCL的St Thomas医院进行，大约一小时的时间在中途休息了一个小时。将引起注意以确保母亲在扫描过程中感到舒适，并可以与成像团队进行交谈。我们将在同一访问期间进行超声扫描。将向父母展示其婴儿的图像和提供的副本。如果已知成像上有任何偶然发现会影响出生或分娩的管理，例如低说谎的胎盘，则将与母亲讨论这些发现并与产科和助产士团队共享。我们将收集作为常规产前护理的一部分获得的临床数据。从工党和分娩以及母亲和婴儿的结果中获得信息。出生后六个星期，我们将与母亲联系，并向母亲提供有关其身体和心理健康，喂养方法和婴儿健康的信息。对于单个怀孕的所有可用信息，我们将使用最新的数据建模工具来确定哪些因素与较高的困难交付机会有关。这应该提供产生单个风险评分所需的最有价值的数据，该数据可前瞻性地用于EMCS高风险或辅助交付的女性中。我们的最终目的是减少EMC和辅助交付的数量，从而改善母亲和婴儿的短期健康和健康状况。