FUSC: Fetal Ultrasound Semantic Clustering of Second Trimester Scans Using Deep Self-supervised Learning

Ultrasound is the primary imaging modality in clinical practice during pregnancy. More than 140M fetuses are born yearly, resulting in numerous scans. The availability of a large volume of fetal ultrasound scans presents the opportunity to train robust machine learning models. However, the abundance of scans also has its challenges, as manual labeling of each image is needed for supervised methods. Labeling is typically labor-intensive and requires expertise to annotate the images accurately. This study presents an unsupervised approach for automatically clustering ultrasound images into a large range of fetal views, reducing or eliminating the need for manual labeling. Our Fetal Ultrasound Semantic Clustering (FUSC) method is developed using a large dataset of 88,063 images and further evaluated on an additional unseen dataset of 8,187 images achieving over 92% clustering purity. The result of our investigation hold the potential to significantly impact the field of fetal ultrasound imaging and pave the way for more advanced automated labeling solutions. Finally, we make the code and the experimental setup publicly available to help advance the field

Pravastatin for early-onset pre-eclampsia:a randomised, blinded, placebo-controlled trial

Objective: Women with pre-eclampsia have elevated circulating levels of soluble fms-like tyrosine kinase-1 (sFlt-1). Statins can reduce sFlt-1 from cultured cells and improve pregnancy outcome in animals with a pre-eclampsia-like syndrome. We investigated the effect of pravastatin on plasma sFlt-1 levels during pre-eclampsia. Design: Blinded (clinician and participant), proof of principle, placebo-controlled trial. Setting: Fifteen UK maternity units. Population: We used a minimisation algorithm to assign 62 women with early-onset pre-eclampsia (24 +0–31 +6 weeks of gestation) to receive pravastatin 40 mg daily (n = 30) or matched placebo (n = 32), from randomisation to childbirth. Primary outcome: Difference in mean plasma sFlt-1 levels over the first 3 days following randomisation. Results: The difference in the mean maternal plasma sFlt-1 levels over the first 3 days after randomisation between the pravastatin (n = 27) and placebo (n = 29) groups was 292 pg/ml (95% CI −1175 to 592; P = 0.5), and over days 1–14 was 48 pg/ml (95% CI −1009 to 913; P = 0.9). Women who received pravastatin had a similar length of pregnancy following randomisation compared with those who received placebo (hazard ratio 0.84; 95% CI 0.50–1.40; P = 0.6). The median time from randomisation to childbirth was 9 days [interquartile range (IQR) 5–14 days] for the pravastatin group and 7 days (IQR 4–11 days) for the placebo group. There were three perinatal deaths in the placebo-treated group and no deaths or serious adverse events attributable to pravastatin. Conclusions: We found no evidence that pravastatin lowered maternal plasma sFlt-1 levels once early-onset pre-eclampsia had developed. Pravastatin appears to have no adverse perinatal effects. Tweetable abstract: Pravastatin does not improve maternal plasma sFlt-1 or placental growth factor levels following a diagnosis of early preterm pre-eclampsia #clinicaltrial finds

Cardiotocograph interpretation

Cardiotocographs (CTGs) are a form of electronic fetal monitoring (EFM) used both in the antenatal period and during labour to provide a guide to fetal wellbeing. CTG traces are a continuous recording of fetal heart rate (FHR) combined with a recording of uterine activity. The basic principle of EFM is to detect developing fetal hypoxia with the aim of preventing subsequent acidaemia and cell damage. </jats:p

A review of prenatally detected femoral abnormalities

Antenatally detected femoral abnormalities are a rare finding, and form a heterogeneous group in terms of diagnosis and prognosis. The objective of this study is to evaluate the management and outcome of fetuses after prenatal detection of femoral abnormalities in a tertiary care Fetal Medicine Unit over a 5-year period, thus facilitating accurate diagnosis and appropriate counseling. Patients were identified through a Regional Fetal Anomaly Database or clinician recall. Information was collected on whether the abnormality was an isolated or generalized skeletal abnormality, whether nonskeletal abnormalities were detected, what prognosis was counselled, whether referral to clinical genetics occurred, what investigations were performed, what was the eventual outcome and whether a final diagnosis was reached. A definitive diagnosis was made in 68% (28 of 41) of cases. However, a correct diagnosis was only achieved in 19% (eight of 41) of cases before delivery. Prognosis was correctly predicted in 83% (34 of 41) of cases. Families found the degree of uncertainty difficult, with 67% (six of nine) of patients where the prognosis was 'uncertain' electing to terminate the pregnancy. Eighty percent (eight of 10) of those where the condition was deemed 'lethal' also elected to end the pregnancy. In conclusion, it is difficult to achieve a correct diagnosis before delivery when a femoral abnormality is identified; however, detailed antenatal assessment may aid the differential diagnosis and help to determine prognosis. This was more likely to be achieved if the patient was seen in association with a clinical geneticist. A multidisciplinary team approach involving fetal medicine, genetics, paediatric radiology, and pathology is advocated. Fetal examination, medical photography, chromosomes and DNA storage, postnatal radiography and postmortem facilitate postnatal diagnosis and counseling

A comparison of the contractile properties of myometrium from singleton and twin pregnancies.

OBJECTIVE: Over half of twin pregnancies in US and UK deliver prematurely but the reasons for this are unclear. The contractility of myometrium from twin pregnancies has not been directly investigated. The objective of this research was to determine if there are differences in the contractile activity and response to oxytocin, between myometrium from singleton and twin pregnancies, across a range of gestational ages. Furthermore, we wished to determine if contractile activity correlates with increasing level of stretch, using neonatal birth weights as a marker of uterine stretch. METHODS: This was an in vitro, laboratory based study of myometrial contractility in women pregnant with one or two babies, using biopsies obtained from non-labouring women undergoing Caesarean section. Spontaneous, oxytocin-stimulated and depolarization induced contractile activity was compared. RESULTS: Direct measurements of myometrial contractility under controlled conditions show that the frequency of contractions and responses to oxytocin are significantly increased in twins compared to singletons. The duration of contraction however was significantly reduced. We find that contractile activity correlates with increasing levels of stretch, using neonatal birth weights as a surrogate for uterine stretch, with response to oxytocin being significantly positively correlated with birth weight. CONCLUSIONS: We have found significant differences in contractile properties between myometrium from singleton and twin pregnancies and that increasing uterine stretch can alter the contractile properties of myometrium. We discuss the implication of these findings to preterm delivery and future studies