Prediction of Complications in Multiple Pregnancies (version 1.0)
Research type
Research Study
Full title
Prediction of Complications in Multiple Pregnancies
IRAS ID
195129
Contact name
Kypros Nicolaides
Contact email
Sponsor organisation
King's College London
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
This is a prospective study to evaluate the circulatory changes in the mother, fetuses and placenta in women with multiple pregnancies.
There are two parts to this study; Study A aims to investigate the blood flow changes in the mother's heart in multiple pregnancies.
The commonest clinical outcome of poor placental formation is preeclampsia (PE), a condition of high blood pressure and protein loss in the urine. Women with multiple pregnancies are at 2-4 times greater risk of such complications, compared to singleton pregnancies. Early changes in heart function of pregnant women precede the clinical symptoms of PE, hence the evaluation of the maternal heart function can lead to effective early detection of PE, potentially preventing the condition minimising the long-term negative heart effects in both the mother and infants.
This would be performed by using a noninvasive heart monitor NICOM® involving 4 ECG-like sensors on the woman's back. This allows us to compare longitudinally the maternal cardiac function in monochorionic(i.e. identical) versus dichorionic(i.e. non-identical) pregnancies and also in complicated versus uncomplicated multiple pregnancies.
Study B focuses on monochorionic pregnancy, in which 10% are complicated by twin-to-twin-transfusion syndrome(TTTS) and selective fetal growth restriction(sFGR).
In TTTS, excessive amniotic fluid exerts pressure on the placenta and maternal vessels, demonstrated in worsening blood flow changes in the mother's heart. The normally grown fetus also develops a hyperdynamic circulation as large amount of blood is transfused to the growth restricted fetus due to the connecting vessels, this undue stress on the fetuses' hearts could be detected by speckle tracking echocardiography. In addition,the angiogenic activity of placentation could also be studied from the maternal serum.
We hypothesise that a combined model incorporating maternal-fetal cardiac profiles and maternal biochemical factors can be an effective tool to risk-stratify pregnancies which are destined to develop TTTS and/or sFGR.
REC name
London - Fulham Research Ethics Committee
REC reference
16/LO/0611
Date of REC Opinion
6 May 2016
REC opinion
Further Information Favourable Opinion