Asma Khalil

Maternal age and adverse pregnancy outcome: a cohort study

To examine the association between maternal age and a wide range of adverse pregnancy outcomes after adjustment for confounding factors in obstetric history and maternal characteristics.

Changes in fetal Doppler indices as a marker of failure to reach growth potential at term

To evaluate whether changes in the middle cerebral artery (MCA), umbilical artery (UA) and cerebroplacental ratio (CPR) Doppler indices at term might be used to identify those appropriate‐for‐gestational‐age (AGA) fetuses that are failing to reach their growth potential (FRGP).

New aids for the non‐invasive prenatal diagnosis of achondroplasia: dysmorphic features, charts of fetal size and molecular confirmation using cell‐free fetal DNA in maternal plasma

To improve the prenatal diagnosis of achondroplasia by constructing charts of fetal size, defining frequency of sonographic features and exploring the role of non‐invasive molecular diagnosis based on cell‐free fetal deoxyribonucleic acid (DNA) in maternal plasma.

Brain abnormalities and neurodevelopmental delay in congenital heart disease: systematic review and meta‐analysis

Studies have demonstrated an association between congenital heart disease (CHD) and neurodevelopmental delay. Neuroimaging studies have also demonstrated a high incidence of preoperative brain abnormalities. The aim of this study was to perform a systematic review to quantify the non‐surgical risk of brain abnormalities and of neurodevelopmental delay in infants with CHD.

First-trimester markers for the prediction of pre-eclampsia in women with a-priori high risk

To investigate the predictive value of the combination of first‐trimester serum placental protein 13 (PP13), uterine artery Doppler pulsatility index (PI) and pulse wave analysis (augmentation index at a heart rate of 75 beats per min (AIx‐75)), and to evaluate concurrent and contingent strategies using this combination for assessing the risk of pre‐eclampsia in high‐risk women.

First trimester maternal serum placental protein 13 for the prediction of pre-eclampsia in women with a priori high risk.

To evaluate whether first trimester maternal serum PP13 can predict pre‐eclampsia among women with a priori high risk.

Poor neonatal acid–base status in term fetuses with low cerebroplacental ratio

To determine whether small‐ and appropriate‐for‐gestational‐age (SGA and AGA) term fetuses with a low cerebroplacental ratio (CPR) have worse neonatal acid–base status than those with normal CPR.

Pulse wave analysis: a preliminary study of a novel technique for the prediction of pre-eclampsia

Objective  To investigate whether first‐trimester arterial pulse wave analysis (PWA) can predict pre‐eclampsia.

Antihypertensive Therapy and Central Hemodynamics in Women With Hypertensive Disorders in Pregnancy

OBJECTIVE: To estimate the changes in central hemodynamics features of pregnant women presenting with hypertensive disorders and to analyze the effects of standard antihypertensive treatment on maternal central hemodynamics. METHODS: Applanation tonometry was used to record the radial artery pulse waveform in 80 women presenting with preeclampsia or gestational hypertension and 80 normotensive controls matched for gestational age. In each case, an averaged aortic waveform was derived and analyzed to calculate augmentation pressure and augmentation index at heart rate 75 beats per minute (bpm). RESULTS: In women with preeclampsia and gestational hypertension, both augmentation pressure (P<.001 and P<.05, respectively) and augmentation index at heart rate 75 bpm (P<.001 and P<.001, respectively) were significantly higher than in controls. Augmentation pressure and augmentation index at heart rate 75 bpm were significantly higher in early- compared with late-onset preeclampsia (P<.001) and in severe compared with mild preeclampsia (P<.001). Antihypertensive therapy with alpha methyldopa resulted in a significant fall in both augmentation pressure and augmentation index at heart rate 75 bpm in preeclampsia (P<.001) but not in gestational hypertension. CONCLUSION: Arterial stiffness is increased in women with hypertensive disorders of pregnancy compared with normotensive controls. In preeclampsia, vascular stiffness was significantly improved by antihypertensive treatment with alpha methyldopa, but remained higher than in normotensive controls. LEVEL OF EVIDENCE: II

Pulse Wave Analysis in Normal Pregnancy: A Prospective Longitudinal Study

Background Outside pregnancy, arterial pulse wave analysis provides valuable information in hypertension and vascular disease. Studies in pregnancy using this technique show that vascular stiffness is raised in women with established pre-eclampsia. We aimed to establish normal ranges for parameters of pulse wave analysis in normal pregnancy and to compare different ethnic groups. Methodology/Principal Findings This prospective study was conducted at The Homerton University Hospital, London between January 2006 and March 2007. Using applanation tonometry, the radial artery pulse waveform was recorded and the aortic waveform derived. Augmentation pressure (AP) and Augmentation Index at heart rate 75/min (AIx-75), measures of arterial stiffness, were calculated. We recruited 665 women with singleton pregnancies. Women who developed pre-eclampsia (n = 24, 3.6%) or gestational hypertension (n = 36, 5.4%) were excluded. We also excluded 47 women with other pregnancy complications or incomplete follow-up, leaving 541 healthy normotensive pregnant women for subsequent analysis. In the overall group of 541 women, there were no significant changes in AP or AIx-75 as pregnancy progressed. In 45 women followed longitudinally, AP and AIx-75 fell significantly from the first to the second trimester, then rose again in the third (P<0.001). The two main ethnic groups represented were Caucasian (n = 229) and Afrocaribbean (n = 216). There were no significant differences in AP or AIx-75 in any trimester between these two ethnic groups. Conclusions This study is the largest to date of pulse wave analysis in normal pregnancy, the first to report on a subset of women studied longitudinally, and the first to investigate the effect of ethnicity. These data provide the foundation for further investigation into the potential role of this technique in vascular disorders in pregnancy.