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

2020年，英国有464，437人。分娩，其中三分之一是通过紧急剖腹产或助产（产钳或真空抽吸）分娩的。这些干预措施往往是在正常工作时间以外在麻醉下进行的长时间劳累的劳动之后进行的。这种复杂的分娩在高龄母亲、肥胖母亲以及婴儿小或大的母亲中更为常见。它们与婴儿入院新生儿病房的增加有关，婴儿的大脑受到感染和损伤，如缺氧缺血性脑病（HIE）。母亲可能会大出血，骨盆底受伤，随后出现尿失禁和/或大便失禁/渗漏，性交疼痛和创伤后应激障碍，对身心健康造成终身影响。大约17%的女性有选修课（ElCS），在英国只有50%的女性。无辅助阴道分娩。EmCS或辅助分娩的主要原因是担心婴儿在分娩中的健康，与功能不良的胎盘有关的妥协以及婴儿通过产道的困难（头盆不称，CPD）。在分娩开始之前，目前很难准确预测哪些婴儿会遇到困难，或者确定有CPD风险的怀孕。其他因素，如母亲的年龄和体重也很重要。在妊娠结束时为女性创建EmCS或辅助分娩的个体化风险将大大改善患者/临床医生的联合决策，有可能避免难产，并改善孕产妇和新生儿结局。我们计划在妊娠晚期，即妊娠36周后（GA）使用一种称为磁共振成像（MRI）的技术，以识别难产风险增加的母亲。这种成像不使用辐射，对母亲和婴儿都是安全的。目前广泛应用于临床诊断胎儿畸形，耐受性良好。我们将扫描500名具有较高不良分娩风险的妇女，并将母亲骨盆、胎头和胎位的联合收割机测量与胎儿能量储备和心脏功能以及胎盘功能的评估相结合。我们将在大约20周GA时与母亲接触这项研究。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，亲属和医生讨论这项研究。MRI扫描将在KCL的St托马斯医院进行，大约需要一个小时，中途休息。将注意确保母亲在扫描过程中感到舒适，并可以在整个过程中与成像团队交谈。我们将在同一次访视期间进行超声扫描。父母将看到他们宝宝的照片并提供副本。如果在成像上有任何已知会影响分娩管理的偶然发现，例如低位胎盘，将与母亲讨论并与产科和助产团队分享。我们将收集作为常规产前护理的一部分获得的临床数据。从分娩和分娩以及母亲和婴儿的结果中获得信息。我们将在婴儿出生后六周内与母亲联系，询问她们的身心健康、喂养方法和婴儿健康状况等信息。我们将根据每个孕妇的所有可用信息，使用最新的数据建模工具来确定哪些因素与难产的可能性较高有关。这应该提供最有价值的数据，需要产生一个个人的风险评分，可用于前瞻性的妇女在高风险的EmCS或辅助分娩。我们的最终目标是减少EmCS和辅助分娩的数量，从而改善母亲和婴儿的短期和长期健康和福祉。

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.