Association between reduced stillbirth rates in England and regional uptake of accreditation training in customised fetal growth assessment

Objective: To assess the effect that accreditation training in fetal growth surveillance and evidence-based protocols had on stillbirth rates in England and Wales. Design: Analysis of mortality data from Office of National Statistics. Setting: England and Wales, including three National Health Service (NHS) regions (West Midlands, North East and Yorkshire and the Humber) which between 2008 and 2011 implemented training programmes in customised fetal growth assessment. Population: Live births and stillbirths in England and Wales between 2007 and 2012. Main: outcome measure Stillbirth. Results: There was a significant downward trend (p=0.03) in stillbirth rates between 2007 and 2012 in England to 4.81/1000, the lowest rate recorded since adoption of the current stillbirth definition in 1992. This drop was due to downward trends in each of the three English regions with high uptake of accreditation training, and led in turn to the lowest stillbirth rates on record in each of these regions. In contrast, there was no significant change in stillbirth rates in the remaining English regions and Wales, where uptake of training had been low. The three regions responsible for the record drop in national stillbirth rates made up less than a quarter (24.7%) of all births in England. The fall in stillbirth rate was most pronounced in the West Midlands, which had the most intensive training programme, from the preceding average baseline of 5.73/1000 in 2000–2007 to 4.47/1000 in 2012, a 22% drop which is equivalent to 92 fewer deaths a year. Extrapolated to the whole of the UK, this would amount to over 1000 fewer stillbirths each year. Conclusions: A training and accreditation programme in customised fetal growth assessment with evidence-based protocols was associated with a reduction in stillbirths in high-uptake areas and resulted in a national drop in stillbirth rates to their lowest level in 20 years

Maternal and fetal risk factors for stillbirth : population based study

Objective: To assess the main risk factors associated with stillbirth in a multiethnic English maternity population. Design: Cohort study. Setting: National Health Service region in England. Population: 92 218 normally formed singletons including 389 stillbirths from 24 weeks of gestation, delivered during 2009-11. Main outcome measure: Risk of stillbirth. Results: Multivariable analysis identified a significant risk of stillbirth for parity (para 0 and para ≥3), ethnicity (African, African-Caribbean, Indian, and Pakistani), maternal obesity (body mass index ≥30), smoking, pre-existing diabetes, and history of mental health problems, antepartum haemorrhage, and fetal growth restriction (birth weight below 10th customised birthweight centile). As potentially modifiable risk factors, maternal obesity, smoking in pregnancy, and fetal growth restriction together accounted for 56.1% of the stillbirths. Presence of fetal growth restriction constituted the highest risk, and this applied to pregnancies where mothers did not smoke (adjusted relative risk 7.8, 95% confidence interval 6.6 to 10.9), did smoke (5.7, 3.6 to 10.9), and were exposed to passive smoke only (10.0, 6.6 to 15.8). Fetal growth restriction also had the largest population attributable risk for stillbirth and was fivefold greater if it was not detected antenatally than when it was (32.0% v 6.2%). In total, 195 of the 389 stillbirths in this cohort had fetal growth restriction, but in 160 (82%) it had not been detected antenatally. Antenatal recognition of fetal growth restriction resulted in delivery 10 days earlier than when it was not detected: median 270 (interquartile range 261-279) days v 280 (interquartile range 273-287) days. The overall stillbirth rate (per 1000 births) was 4.2, but only 2.4 in pregnancies without fetal growth restriction, increasing to 9.7 with antenatally detected fetal growth restriction and 19.8 when it was not detected. Conclusion: Most normally formed singleton stillbirths are potentially avoidable. The single largest risk factor is unrecognised fetal growth restriction, and preventive strategies need to focus on improving antenatal detection

Prenatal Application of the Individualized Fetal Growth Reference

The individualized reference for defining small for gestational age (SGA) at birth has gained popularity in recent years. However, its utility on fetal assessment has not been evaluated. The authors compare an individualized with an ultrasound reference in predicting poor perinatal outcomes. Data from a large clinical trial in predominantly white US women (1987–1991) with singleton pregnancies (n = 9,526) were used. The individualized reference classified fewer SGA fetuses than the ultrasound reference, but the risks of adverse outcomes were similar between fetuses classified by both references. The risk increased substantially only when the percentiles fell below the 5th percentile (likelihood ratio positive at birth = 2.68 (95% confidence interval (CI): 2.00, 3.58) and 3.13 (95% CI: 2.34, 4.18) for ultrasound and individualized references, respectively). SGA fetuses defined by either the individualized or ultrasound reference alone had risk ratios of adverse outcomes of 1.91 (95% CI: 0.77, 4.77) and 1.18 (95% CI: 0.37, 3.77), respectively, compared with normal fetuses (the difference between these 2 risk ratios, P = 0.71). The authors conclude that neither the ultrasound-based nor the individualized reference does well in predicting adverse perinatal outcomes. The 5th percentile may be a better cutpoint than the 10th percentile in defining SGA

Maximize Contact Availability of SmallSat Clusters through MSPA Technique on GSaaS

The Mission Launch date: 07 November 2021 Mission name: KSM1 (Kleos Scouting Mission) Satellites names: KSM1-A, KSM1-B, KSM1-C, KSM1-D NORAD-ID: 46912, 46914, 46906, 46907 Application: RF Reconnaissance and Geospatial Intelligence Mission characteristics: Kleos Space SA (KSS) Scouting Mission (KSM) first cluster of spacecraft, was launched on the 7th of November 2021, comprising four 6U cubesat flying in a close formation. The formation maintains the along and across track distance between the four spacecraft, enabling KSS proprietary algorithms to geolocate Radio Frequency transmitters. GSaaS: Leaf Space provides communication through their Leaf Line GSaaS (Ground Segment as-a-Service) with stations in Italy and Spain supporting the mission with UH

Use of Microsoft Power BI to display pregnancy related performance statistics within NHS trusts

Objective We wanted to create a dashboard that allowed midwives and doctors to monitor the performance of their NHS Trust by viewing the statistics relating to their performance in identifying babies at risk due to not growing well in the womb (small for gestational age, SGA), the single largest cause of stillbirths and subject to national guidelines and reporting requirements. Antenatal detection of SGA allows clinicians to undertake further investigations and plan for a timely delivery. Method The use of Power BI instead of a solution requiring software development allowed the data analysis team to be in control of creating the application and facilitate a streamlined updating process. We used the dashboard feature, dropdowns and radio buttons to display statistics relating to the rate of identification of SGA at antenatal ultrasound scan as a proportion of all babies that are SGA at birth (sensitivity) as well as false positivity. The dashboard is contained within the web-based application to monitor growth during antenatal care. Applying the row level security feature with DAX formula, we were able to personalise the report for each Trust depending on who logged into the web-app. Results The application facilitates monitoring performance of the service in real time, longitudinally by month, quarter and year as well benchmark cross-sectionally against network/regional and national averages. The dashboard lets clinicians access their information in a clear and secure manner without the need for a separate link. The ready availability of data allows Trusts to enact policies to improve their performance and ultimately prevent avoidable deaths, and has contributed to the year on year decline in stillbirth rates in units that have been running this application. Conclusion Development of this dashboard has resulted trusts being more aware of their own data to promote improvements in antenatal care

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term.

Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) - a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. The cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term. CPR is an independent predictor of intrapartum fetal distress, admission to the neonatal unit at term, stillbirth, perinatal death and neonatal morbidity. Raised uterine artery Doppler resistance in the third trimester is independently associated with significantly lower birthweight and CPR. The combination of the estimated fetal weight, CPR and uterine Doppler in the third trimester can identify the majority of fetuses at risk of stillbirth

Slow Cooking of Photonic Microresonators

New techniques to improve the fabrication precision of microphotonic devices is required to develop their applications in optical signal processing, telecommunication and quantum computing. In addition, advances in microfluidic sensing using WGM (whispering gallery mode) spectroscopy, has shown to be a worthwhile endeavour to achieve ultrahigh sensing of biological, chemical and mechanical processes, reaching single molecule detection. This thesis simultaneously advances these fields via the incorporation of microfluidics on the SNAP (surface nanoscale axial photonics) platform. This work has culminated in the discovery of the slow cooking phenomenon which originates from the silica-water interaction at a water-filled microcapillary fibre. Chapter 1 presents a background to WGM microfluidic sensing and a review of the known silica-water interaction processes. In Chapter 2, we offer the theoretical background to SNAP technology [1,2], which uses nanoscale modifications of the effective radius variation (ERV) of optical fibres to develop photonic microresonator devices such as frequency comb generators [3,4], delay lines [5], optical buffers [6], and, tunable [7] and transient [8] microresonators. We characterize the discovered slow-cooking phenomenon in Chapter 3, measuring the temporal and spatial variations of the cut-off resonant wavelength (CWV). Our experimentally simple setup uses two microfibres (MF) to couple into a water-filled capillary fibre. The first MF excites WGMs in the fibre to detect the CWV of the resonant wavelength. The second MF is used for optical heating by broadband light of optical power 56-100 mW, which evanescently penetrates into and becomes absorbed by water to induce heating [9] and water motion [10]. We demonstrate the fabrication of SNAP microresonators over hour-long optical heating durations, which displays linear growth for sufficient heating power and time. However, for higher slow-cooking powers and durations, the growth becomes nonlinear and nonmonotonic. We advance our fabrication precision by reducing the slow-cooking duration in Chapter 4, to achieve precision in CWV of 1.3 pm/10mins limited by the OSA resolution. We propose that further reduction of the slow-cooking duration can achieve 0.02 pm/10secs in CWV corresponding to precision of just 0.6 pm in ERV. This estimated fabrication precision improves the developed laser post-processing techniques [11,12] on the SNAP platform by two orders of magnitude. Throughout the thesis we attempt to relate the observed CWVs to known silica-water interaction processes. Most prominently, we suggest the observations of the de- and re-hydroxylation at ambient temperatures [13] in Chapter 3 and the structural relaxation of silica after heating ceases in Chapter 4. To our knowledge, these are the first experimental demonstration of these processes using WGM spectroscopy. Overall, the demonstrated integration of microfluidics with SNAP technology produces a multitude of avenues worthy of pursuit, summarized in Chapter 5. These include advances in the fabrication of the aforementioned photonic devices and enhancement of microfluidic sensing capabilities which can be applied to a variety of fields of interest