Preventing Term Stillbirth: How Important is Fetal Size?

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The presentation will seek to differentiate the nutritional (food) and respiratory (oxygen) functions of the placenta and discuss which assessments are more strongly associated and predictive of pregnancies at high risk of stillbirth.

Professor Basky ThilaganathanProfessor Basky Thilaganathan was appointed Director of Fetal Medicine at St George’s Hospital in 1999. His research interests are focused on Maternal-Fetal medicine, with a particular interest on placental dysfunction and preeclampsia (TED talk: http://bit.ly/2i1SqDk). He undertook his undergraduate training at King’s College London, where he obtained a BSc in Genetic Engineering (1985) and MBBS (1988). He completed his postgraduate training at King’s College London and St Bartholomew’s Hospitals, culminating in attainment of MRCOG (1995), MD in Fetal Medicine (1996) and Certificate of Completion of Training (1998). He was awarded the Fellowship of the Royal College of Obstetricians and Gynaecologists (FRCOG) and an Honorary Doctorate (PhD) from Uppsala University in 2007.

He has authored two undergraduate and six postgraduate text books in obstetrics and fetal medicine. He is the Clinical Director of the Tommy’s National Centre for Maternity Improvement located at the RCOG/RCM and is Editor Emeritus of Ultrasound in Obstetrics and Gynaecology, the medical journal affiliated to ISUOG. He is a Council Member on the Royal College of Obstetrics and Gynaecology (RCOG) and represents the RCOG on the UK National Screening Committee and the DH Saving Babies Lives Care Bundle oversight committee. He is also the Clinical Lead for the development of the first dedicated high-throughput cfDNA screening NHS lab to undertake cfDNA aneuploidy screening in pregnancy (www.theSAFEtest.co.uk).

He has authored over 300 peer-reviewed publications in indexed journals. His major research interest is placental dysfunction leading to pre-eclampsia, fetal growth restriction and stillbirth. He currently holds research and commercial grants to the value of £1.5m – including EU-funded research. He has led on the implementation of algorithm-based screening at St Georges which has led to a 80% reduction in preterm pre-eclampsia – the severest form of the disease  

Professor Thilaganathan has disclosed that he does not have any real or perceived conflicts of interest in making this presentation.

This presentation was part of the Stillbirth Summit 2021.   This individual lecture will be awarded .5 hours of continuing education credit to include viewing the lecture and completing evaluation and post-test.  Once received a certificate will be emailed to the address you provide in the post-test.  If you did not register for the Summit WITH Continuing Education, you can purchase the continuing education by clicking here.  This purchase will provide you access to all Stillbirth Summit 2021 lectures including continuing education credit. There is no charge for viewing the presentation.

To receive continuing education credit for this lecture, the participant must complete the evaluation and post-test.

Please feel free to ask questions of the presenter.  We will obtain their answers/comments and provide them here as received.  

8 Responses

  1. Linda Ernst:
    my experience in autopsy is congruous with what you present. Most term stillbirths are not SGA. But many have small placentas. Why don’t we try to estimate placental weight!!

    1. Professor Thilaganathan’s reply:
      Yes, placental weight is one of the techniques being assessed as a marker of fetal wellbeing. However, please remember that an observed statistical association is not necessarily guaranteed to make for a good predictive test (c.f. maternal age and trisomy 21).

  2. Jane Warland
    Basky. Thankyou for a very informative presentation. If SFH is measured and plotted on an intergrowth chart and you see the growth crossing centiles does that indicate the baby may be FGR and a CPR needs to be done or do we throw out the SFH measurment and just do a routine Ultrasound?

    1. Professor Thilaganathan’s reply:
      SFH plots whether single/serial of on conventional/customized charts have a very poor sensitivity (40%) for the prediction of SGA birth. Basing the need for ultrasound/Doppler assessment on this screening tool will further lower our pickup of FGR babies at risk of stillbirth.

  3. Annie Kearns
    To clarify, does Dr Thilaganathan obtain dopplers and CPR on every patient at 36 weeks, regardless of EFW?

    1. Professor Thilaganathan’s reply:
      In my unit, all women get an ultrasound scan with Doppler assessment at around 37 weeks’ gestation.

  4. Marjorie Francois
    I understand that SGA fetuses are most at risks but what about really big baby.. I was told that monitoring would have made no difference and that I was not monitored because I was not at risks. What do you think? what about big babies?

    1. Professor Thilaganathan’s reply:
      Yes, there is an increased risk of adverse outcomes in larger babies too. It is uncertain how these babies should be monitored or managed to avoid these risks.

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