BACKGROUND:Distinguishing pathological fetal growth restriction (FGR) from constitutionally small-for-gestational-age (SGA) fetuses remains clinically challenging. The maternal soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratio reflects placental angiogenic imbalance and may assist recognition of placental insufficiency. OBJECTIVES:To assess the performance of the maternal sFlt-1/PlGF ratio for differentiating FGR from SGA and appropriate-for-gestational-age (AGA) pregnancies. SEARCH STRATEGY:PubMed, Scopus, Web of Science, Embase, Cochrane CENTRAL and Google Scholar were searched from inception to 14 January 2025 using MeSH and text terms for "sFlt-1", "PlGF", "fetal growth restriction", and "small-for-gestational-age". SELECTION CRITERIA:Peer-reviewed human studies reporting maternal sFlt-1/PlGF ratios in pregnancies classified as FGR, SGA or AGA. DATA COLLECTION AND ANALYSIS:Two reviewers independently screened records; one reviewer extracted data and assessed quality with second-reviewer verification (> 30%). Owing to heterogeneity, findings were synthesised narratively, with a meta-analysis restricted to studies directly comparing FGR and SGA. MAIN RESULTS:Forty observational studies (> 25 000 pregnancies) were included. Across gestation, FGR consistently showed higher sFlt-1/PlGF ratios than AGA. SGA exhibited modest or no elevation. Four studies (n = 614) enabled pooling: log-transformed ratios were significantly higher in FGR than SGA (SMD 0.58, 95% CI 0.35-0.81) with low heterogeneity. Ratios were most discriminatory in early-onset placental FGR. CONCLUSIONS:The sFlt-1/PlGF ratio is best considered an adjunctive indicator of placental insufficiency. Normal results can support expectant management in SGA when ultrasound and Doppler are reassuring, whereas elevated values warrant closer surveillance.

The stillbirth rate of Australian Aboriginal and Torres Strait Islander infants remains almost twice the rate for non-Indigenous infants. There is a paucity of research giving voice to Aboriginal and Torres Strait Islander women and families experiences pregnancy loss and stillbirth. This qualitative study aimed explored the experiences of five Australian Aboriginal women in North Queensland. Women identified the need for timely, clear, concise, and sensitive communications with culturally responsive health professionals throughout their experience of stillbirth. Women also want to be consulted and supported during and beyond their experience of stillbirth. Australian Aboriginal women want to be informed and included in their care by culturally responsive health professionals during and beyond their stillbirth experiences. These findings will inform maternity and neonatal standard care guidelines, and health professionals' training and education programs to support culturally responsive plans for continuity of care of regional, rural and remote Indigenous women and families.

Introduction: Glomerular injury may occur during pregnancy as a consequence of systemic disease and pregnancy-related medical complications. While urinary nephrin has been shown to provide early identification of preeclampsia (PE) in high-risk pregnancies, the role of urinary nephrin in determining glomerular injury in pregnant women is yet to be explored. This study aimed to investigate the use of urinary nephrin as a predictor for early glomerular injury in a study conducted at the Townville University Hospital. Methods and Materials: A cross-sectional study was conducted. All pregnant women with a full dataset (n = 273) were classified into three categories according to their urinary albumin-to-creatinine ratio (ACR): normoalbuminuria, microalbuminuria and macroalbuminuria. Continuous variables were compared between groups, and the cut-off value for the urinary nephrin-to-creatinine ratio (NCR) was determined to predict albuminuria as an indirect indicator of early glomerular injury. The percentages of pregnant women who had elevated nephrinuria were calculated for each of the ACR categories. Results: Urinary NCR positively correlated with urinary ACR (r = 0.29, p < 0.0001). Urinary NCR increased comparably in women with normoalbuminuria, microalbuminuria and macroalbuminuria. Using a cut-off value of 14 ng/mg, nephrinuria was detected in 65% of women with normoalbuminuria, 95% with microalbuminuria and 100% with macroalbuminuria. Of the normoalbuminuric women who had an elevated urinary NCR (> 14 ng/mg), 78% were diagnosed with a hypertensive disorder and 63% were diagnosed with diabetes in pregnancy. In women with PE, urinary NCR and ACR were significantly higher when compared to women who did not develop PE. The AUC of the ROC for urinary NCR was 0.74 (95% CI: 0.650-0.824), with a sensitivity of 97% and a specificity of 36% to predict glomerular injury and a sensitivity of 93% and specificity of 42% to predict glomerular injury of PE. Conclusion: The study found that urinary NCR were elevated not only in women with micro- and macroalbuminuria but also in pregnant women with normoalbuminuria. Increased urinary NCR without increased urinary albumin may be associated with early glomerular injury. Urinary NCR may be a more sensitive marker than microalbuminuria to detect early glomerular injury in women with systemic disease and adverse pregnancy outcomes.

Maternal Graves' autoantibodies are well known to cause fetal and neonatal thyroid disturbances. Despite radioiodine therapy, Graves' autoantibodies are known to persist, which can cross the placenta and cause hyperthyroidism in the fetus. We present the case of a 26-year-old woman in her first pregnancy, clinically and biochemically euthyroid with history of treated Graves' disease, where the fetus showed signs of hyperthyroidism on antenatal scans. This was confirmed by amniotic fluid testing as fetal blood sampling was not feasible and successfully treated with maternal carbimazole whilst continuing thyroxine for the mother (block-replacement). We discuss the challenges in the diagnosis of fetal hyperthyroidism and treatment whilst maternal thyroid status is maintained on thyroxine.

The significance of intergenerational impacts on fetal and infant kidney development and function remains to be fully understood. This is particularly relevant for certain populations, for example the Indigenous Australians since their risk of developing chronic kidney disease (CKD) is twice that of non-Indigenous Australians. The aim of this study was to assess the impact of maternal health and kidney size and function on infant kidney development. This study was open to all pregnant women receiving antenatal care at Townsville University Hospital, Australia. It presents data from a larger, ongoing prospective, longitudinal cohort study which commenced August 2019, involving mother-infant dyads. This manuscript reports on term mother-infants’ dyads from singleton pregnancies. Ultrasound was used to measure renal parenchymal thickness, a surrogate for nephron number, of the mother and their newborn. Kidney function was assessed using serum cystatin C and creatinine. Analysis was conducted on 80 mother-infant dyads, 17 Indigenous and 63 non-Indigenous. Multivariate regression modeling showed maternal renal parenchymal thickness (ß = 0.31, p = 0.004), smoking (ß = − 0.70, p = 0.022) and maternal serum cystatin C (ß = − 0.34, p = 0.014) significantly predicted newborn renal parenchymal thickness. No significant differences were found between the maternal and newborn renal parenchymal thickness and function between Indigenous and non-Indigenous participants. Our study suggests that maternal kidney size and function has a significant intergenerational effect on kidney development of their infants. Newborn renal parenchymal thickness was positively associated with maternal renal parenchymal thickness and negatively associated with smoking and maternal serum cystatin C.

Background Both early recognition of glomerular injury and diagnosis of renal injury remain important problems in clinical settings, and current diagnostic biomarkers have limitations. The aim of this review was to determine the diagnostic accuracy of urinary nephrin for detecting early glomerular injury. Methods A search was conducted through electronic databases for all relevant studies published until January 31, 2022. The methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Pooled sensitivity, specificity, and other estimates of diagnostic accuracy were determined using a random effect model. The Summary Receiver Operating Characteristics (SROC) was used to pool the data and to estimate the area under the curve (AUC). Results The meta-analysis included 15 studies involving 1587 participants. Overall, the pooled sensitivity of urinary nephrin for detecting glomerular injury was 0.86 (95% CI 0.83–0.89) and specificity was 0.73 (95% CI 0.70–0.76). The AUC-SROC to summarise the diagnostic accuracy was 0.90. As a predictor of preeclampsia, urinary nephrin showed a sensitivity of 0.78 (95% CI 0.71–0.84) and specificity of 0.79 (95% CI 0.75–0.82), and as a predictor of nephropathy the sensitivity was 0.90 (95% CI 0.87–0.93), and specificity was 0.62 (95% CI 0.56–0.67). A subgroup analysis using ELISA as a method of diagnosis showed a sensitivity of 0.89 (95% CI 0.86–0.92), and a specificity of 0.72 (95% CI 0.69–0.75). Conclusion Urinary nephrin may be a promising marker for the detection of early glomerular injury. ELISA assays appear to provide reasonable sensitivity and specificity. Once translated into clinical practice, urinary nephrin could provide an important addition to a panel of novel markers to help in the detection of acute and chronic renal injury. Graphical abstract

Background Preterm birth impairs nephrogenesis, leading to a reduced nephron endowment which is inextricably linked to hypertension and chronic kidney disease in adults. The aim of this study was to compare nephron endowment between preterm infants to that of intrauterine fetuses at the same gestational age (GA) using a novel indirect ultrasound measurement of the renal parenchymal thickness. We hypothesized that extrauterine and intrauterine renal parenchymal thickness would differ based on altered renal growth environments. Methods In this observational study, appropriately grown preterm infants (birth weight of between the 5th and 95th percentile) born <32 weeks, admitted to the neonatal department were eligible to participate. Renal parenchymal thickness of the infants was measured at 32- and 37-weeks postmenstrual age (PMA). These measurements were compared to the intrauterine renal parenchymal thickness of appropriately grown fetuses (control). Results At 32-weeks PMA, the preterm infants had a significantly thinner renal parenchyma compared to fetuses at 32-weeks GA suggesting they had less nephrons, however by 37-weeks there was no significant difference in renal parenchymal thickness. Conclusions We propose that the differences in the extrauterine growth of the renal parenchyma in preterm infants may be due to a reduced number of nephrons and compensatory hyperfiltration. Impact This article provides insight into the effects of prematurity on nephrogenesis by comparing extrauterine renal parenchymal growth of born preterm infants to the ideal intrauterine fetal growth. Renal parenchyma thickness measurement using ultrasonography is a novel non-invasive measurement of renal development for the determination of nephron endowment. Differences in the renal parenchymal thickness of the preterm infants may be due to a deficit in nephron number and compensatory hyperfiltration.

Introduction The study objectives were to develop standard charts for fetal renal artery blood flow to define normal ranges and to assess the reliability of the measurements. Methods This prospective, longitudinal study reviewed 72 low-risk singleton pregnancies who had serial ultrasound examinations. Pulse wave Doppler was used to obtain the resistivity and pulsatility indices of the fetal renal arteries. Standard charts of the fetal renal arteries were created using mixed effects modelling and the intra- and interobserver reliability for the renal blood flow measurements was analysed. Results Standard charts of the normal ranges of the renal artery resistive index (RI) and pulsatility index (PI) of the fetal renal arteries were created. The 3rd, 5th, 10th, 50th, 90th, 95th and 97th centiles were calculated. The intraclass correlation coefficient was acceptable for intraobserver reliability (RI = 0.66, PI = 0.88) and poor for interobserver reliability (RI = 0.11, PI = -0.56). Conclusions These novel charts demonstrate the change of the fetal renal artery blood flow during pregnancy. These may be used in clinical practice to detect variations from these normal ranges and be useful in future studies of kidney function projection.

Preterm infants suffer from a higher incidence of acute diseases such as necrotising enterocolitis and sepsis. This risk can be mitigated through probiotic prophylaxis during admission. This reduction in risk is likely the result of acute modulation of the gut microbiome induced by probiotic species, which has been observed to occur up until discharge. We aimed to determine if this modulation, and the associated probiotic species, persisted beyond discharge. We conducted both a cross-sectional analysis ( n = 18), at ~ 18 months of age, and a longitudinal analysis ( n = 6), from admission to 18 months of the gut microbiome of preterm infants using both shotgun metagenomics and 16S rRNA profiling respectively. The 16S amplicon sequencing revealed that the microbial composition of the probiotic-supplemented infants changed dramatically over time, stabilising at discharge. However, species from the probiotic Infloran ® , as well as positive modulatory effects previously associated with supplementation, do not appear to persist beyond discharge and once prophylaxis has stopped. Conclusions : Although differences exist between supplemented and non-supplemented groups, the implications of these differences remain unclear. Additionally, despite a lack of long-term colonisation, the presence of probiotics during early neonatal life may still have modulatory effects on the microbiome assembly and immune system training. What is Known: • Evidence suggests modulation of the microbiome occurs during probiotic prophylaxis, which may support key taxa that exert positive immunological benefits. • Some evidence suggests that this modulation can persist post-prophylaxis. What is New: • We present support for long-term modulation in association with probiotic prophylaxis in a cohort of infants from North Queensland Australia. • We also observed limited persistence of the probiotic species post-discharge.

Background:Preterm birth is associated with the development of both acute and chronic disease, and the disruption of normal gut microbiome development. Recent studies have sought to both characterize and understand the links between disease and the microbiome. Probiotic treatment may correct for these microbial imbalances and, in turn, mitigate disease. However, the criteria for probiotic supplementation in NICU's in North Queensland, Australia limits its usage to the most premature (<32 weeks gestation) and small for gestational age infants (<1,500 g). Here we use a combination of amplicon and shotgun metagenomic sequencing to compare the gut microbiome of infants who fulfill the criteria for probiotic-treatment and those who do not. The aims of this study were to determine if probiotic-supplemented preterm infants have significantly different taxonomic and functional profiles when compared to non-supplemented preterm infants at discharge.Methods:Preterm infants were recruited in North Queensland, Australia, with fecal samples collected just prior to discharge (36 ± 0.5 weeks gestation), to capture potential changes that could be probiotic induced. All samples underwent 16S rRNA gene amplicon sequencing, with a subset also used for shotgun metagenomics. Mixed effects models were used to assess the effect of probiotics on alpha diversity, beta diversity and taxonomic abundance, whilst accounting for other known covariates.Results:Mixed effects modeling demonstrated that probiotic treatment had a significant effect on overall community composition (beta diversity), characterized by greater alpha diversity and differing abundances of several taxa, including Bifidobacterium and Lactobacillus, in supplemented infants.Conclusion:Late preterm-infants who go without probiotic-supplementation may be missing out on stabilizing-effects provided through increased alpha diversity and the presence of commensal microbes, via the use of probiotic-treatment. These findings suggest that late-preterm infants may benefit from probiotic supplementation. More research is needed to both understand the consequences of the differences observed and the long-term effects of this probiotic-treatment.

BACKGROUND:The stillbirth rate for Australian Aboriginal and Torres Strait Islander infants remains higher than non-Indigenous rates. Risks for stillbirth include maternal factors such as ethnicity, age, geographic location, and physical health. Fetal risk factors include gestational age, birthweight and congenital anomalies. The total stillbirth rate for all babies born at the Townsville University Hospital during the study period was 11 per 1000 births.AIMS:To identify Aboriginal and Torres Strait Islander stillbirth rates, risk factors and causes in North Queensland.MATERIALS AND METHODS:A retrospective chart audit was conducted to identify Indigenous women who had experienced stillbirth in the Townsville University Hospital between January 2005 and December 2014.RESULTS:Thirty-two charts were available for audit. The stillbirth rate for non-Indigenous infants was 10.3 per 1000 births. The stillbirth rate for Indigenous infants was 11.7 per 1000 births. Almost half of the women lived in rural, remote or very remote areas. Maternal risk factors included poorer physical health, such as obesity, diabetes, hypertension, and smoking, fertility issues and lack of antenatal care. Fetal risk factors included congenital anomalies, including cardiac and skeletal abnormalities, placental disorders, and preterm birth.CONCLUSIONS:Stillbirth risk remains higher for Aboriginal and Torres Strait Islander women and their babies. Supporting women to enhance their health is paramount, particularly during pregnancy. Further, increasing awareness of stillbirth risk factors through education for both women and healthcare professionals will support culturally responsive care for women and their families to mitigate stillbirth risk and enhance pregnancy outcomes in non-urban Queensland.

BACKGROUND:Conflicting findings and the analysis of unpublished and retracted data have led to controversy on the safety of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in people with COVID-19 infection. This meta-analysis examined the association of prescription of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) with the outcome from COVID-19.METHODS:A systematic search was conducted to find published studies that reported the outcome of COVID-19 in relation to prescription of ACEI or ARB. Two authors (MF and AD) independently screened and extracted data and assessed study quality and strength of association using standardised tools. The endpoints for the meta-analyses were severe or critical disease outcome and mortality based on standardised criteria.RESULTS:Twenty-six studies including 8389 people prescribed ACEI or ARB and 20,989 people not prescribed these medications were included. The quality of studies varied, and the overall strength of association was poor with a high risk of confounding bias. Patients prescribed ACEI or ARB had a greater prevalence of risk factors. Meta-analysis found an association between prescription of ACEI or ARB with severe or critical disease outcome (risk ratio, RR, 1.23, 95% confidence interval, CI, 1.06 to 1.42, p = 0.006, I2 = 88%) but this association was lost in sensitivity analyses. There was no association between ACEI or ARB prescription and mortality (RR 1.18, 95% CI 0.92 to 1.50, p = 0.19, I2 = 82%).CONCLUSIONS:This meta-analysis suggests that people prescribed ACEI or ARB more commonly had severe or critical disease outcome, but not mortality, in published cohorts of patients diagnosed with COVID-19. This finding is most likely due to a greater prevalence of risk factors in these patients rather than due to exposure to angiotensin pathway inhibitors.

Background Accurate repeat assessment of the diameter of an abdominal aortic aneurysm (AAA) is important. This study investigated the reproducibility of different methods of measuring AAA diameter from ultrasound images. Methods Fifty AAA patients were assessed by ultrasound. Maximum AAA diameter was measured independently by three trained observers on two separate occasions using a standardised protocol. Five diameters were measured from each scan, three in the anterior–posterior (AP) and two in the transverse (TV) plane, including inner-to-inner (ITI), outer-to-outer (OTO) and leading edge-to-leading edge (LETLE). Intra- and inter-observer reproducibility were reported as reproducibility coefficients. Statistical comparison of methods was performed using linear mixed effects models. Results Intra-observer reproducibility coefficients (AP LETLE 2.2 mm; AP ITI 2.4 mm; AP OTO 2.6 mm) were smaller than inter-observer reproducibility coefficients (AP LETLE 4.6 mm: AP ITI 4.5; and AP OTO 4.8 mm). There was no statistically significant difference in intra-observer reproducibility of three types of measurements performed in the AP plane. Measurements obtained in the TV plane had statistically significant worse intra-observer reproducibility than those performed in the AP plane. Conclusions This study suggests that the comparison of maximum AAA diameter between repeat images is most reproducibly performed by a single trained observer measuring diameters in the AP plane.

Background:The gut microbiome plays a critical role in the healthy development, immunity and metabolism of infants. Preterm birth disrupts microbiome development and can contribute to acute and chronic disease. To promote microbial and infant development, and to mitigate the risk of disease, premature infants may be treated with probiotics. Here we used 16S rRNA high throughout sequencing to characterize the bacterial microbiome of probiotic-supplemented premature infants. The study aimed to identify and understand variation in bacterial gut flora, including changes from admission to discharge, and the effect of several clinical variables using a combination of univariate and mixed effects analyses.Results: Infants born <32 weeks gestation and <1500 g were recruited in North Queensland, Australia, with faecal samples collected at admission ( n = 71) and at discharge ( n = 63). Our research builds on previous research and supports significant changes over time in the preterm infant microbiome, and in response to several variables. Univariate analysis showed admission and discharge samples had significantly different microbial populations, with Staphylococcus enriched at admission and Enterobacter , Lactobacillus , Colstridium sensu stricto 1 and Veillonella at discharge. From the mixed effects modeling we observed significantly lower alpha diversity in infants diagnosed with either sepsis or retinopathy of prematurity (ROP), and those that only received formula milk. Chorioamnionitis, preeclampsia, sepsis, necrotizing enterocolitis and ROP were also all associated with differential abundance of several taxa.Conclusions:Our study builds on previous research and supports significant changes in the preterm microbiome over time and in association with several factors. The fact that several associations were observed, and some in ways that counter previous work, highlights the complexity of microbiome ecology.

BACKGROUND:Preterm birth is associated with the development of acute and chronic disease, potentially, through the disruption of normal gut microbiome development. Probiotics may correct for microbial imbalances and mitigate disease risk. Here, we used amplicon sequencing to characterise the gut microbiome of probiotic-treated premature infants. We aimed to identify and understand variation in bacterial gut flora from admission to discharge and in association with clinical variables.METHODS:Infants born <32 weeks gestation and <1500 g, and who received probiotic treatment, were recruited in North Queensland Australia. Meconium and faecal samples were collected at admission and discharge. All samples underwent 16S rRNA short amplicon sequencing, and subsequently, a combination of univariate and multivariate analyses.RESULTS:71 admission and 63 discharge samples were collected. Univariate analyses showed significant changes in the gut flora from admission to discharge. Mixed-effects modelling showed significantly lower alpha diversity in infants diagnosed with either sepsis or retinopathy of prematurity (ROP) and those fed formula. In addition, chorioamnionitis, preeclampsia, sepsis, necrotising enterocolitis and ROP were also all associated with the differential abundance of several taxa.CONCLUSIONS:The lower microbial diversity seen in infants with diagnosed disorders or formula-fed, as well as differing abundances of several taxa across multiple variables, highlights the role of the microbiome in the development of health and disease. This study supports the need for promoting healthy microbiome development in preterm neonates.IMPACT:Low diversity and differing taxonomic abundances in preterm gut microbiota demonstrated in formula-fed infants and those identified with postnatal conditions, as well as differences in taxonomy associated with preeclampsia and chorioamnionitis, reinforcing the association of the microbiome composition changes due to maternal and infant disease. The largest study exploring an association between the preterm infant microbiome and ROP. A novel association between the preterm infant gut microbiome and preeclampsia in a unique cohort of very-premature probiotic-supplemented infants.

Diabetes in pregnancy is thought to adversely affect the developing fetal kidneys. The rate of gestational diabetes is increasing globally with major consequences for future renal function. Very little is known about the impact of hyperglycaemia on the fetal renal parenchyma which contains the developing nephrons. The aim of this study was to measure the fetal renal parenchymal thickness and evaluate whether diabetes during pregnancy affects the growth of the fetal kidneys. This prospective, observational study used serial ultrasound measurements to evaluate the fetal renal parenchymal growth of 55 pregnancies with diabetes compared to 72 control pregnancies. Mixed effects modelling was used to analyse the data. The renal parenchyma of fetuses from mothers with gestational diabetes was significantly thicker than those from the control group (LR Chisq = 4.8, df = 1, p = 0.029), however, the difference was proportional to the larger size of these fetuses. Fetuses of pregestational diabetics demonstrated no significant difference in renal parenchymal thickness compared to the control group even though they were also larger fetuses. Parenchymal growth slowed with increasing abdominal circumference in the pregestational diabetic group, suggesting an adverse effect on nephrogenesis, however this did not reach statistical significance. Our study provides unique data on how diabetes during pregnancy influences fetal kidney growth. Appropriate management of diabetic pregnancies may mitigate some of the adverse effects on the fetal kidneys. Increasing degrees of hyperglycaemia, as seen sometimes in pregestational diabetes, may affect nephrogenesis; however larger studies are needed.

OBJECTIVE:The objective of this study was to develop new standard growth charts for fetal renal parenchymal thickness, length, and volume to define normal ranges for use in clinical practice and to assess the reliability of these measurements.METHODS:This was a prospective, longitudinal study of 72 low-risk singleton pregnancies undergoing serial ultrasound examinations at least every four weeks. Multiple renal measurements were performed on both kidneys at each scan. The renal parenchymal thickness was measured in the mid-sagittal plane. Standard charts were developed and the intra and interobserver reliability for the renal measurements was analysed.RESULTS:Standard charts were developed for fetal renal parenchymal thickness, length, and volume.CONCLUSION:We present novel charts, which demonstrate the growth of the fetal renal parenchyma during pregnancy. They will be useful in clinical practice to identify any alterations from these normal ranges, which may be an important criterion for assisting prenatal diagnosis of renal pathologies and future studies in the prediction of kidney function.

Chronic kidney disease continues to be under recognised and is associated with a significant global health burden and costs. An adverse intrauterine environment may result in a depleted nephron number and an increased risk of chronic kidney disease. Antenatal ultrasound was used to measure the foetal renal parenchymal thickness (RPT), as a novel method to estimate nephron number. Foetal renal artery blood flow was also assessed. This prospective, longitudinal study evaluated the foetal kidneys of 102 appropriately grown and 30 foetal growth-restricted foetuses between 20 and 37 weeks gestational age (GA) to provide vital knowledge on the influences foetal growth restriction has on the developing kidneys. The foetal RPT and renal artery blood flow were measured at least every 4 weeks using ultrasound. The RPT was found to be significantly thinner in growth-restricted foetuses compared to appropriately grown foetuses [likelihood ratio (LR) = 21.06, P ≤ 0.0001] and the difference increases with GA. In foetuses with the same head circumference, a growth-restricted foetus was more likely to have a thinner parenchyma than an appropriately grown foetus (LR = 8.9, P = 0.0028), supporting the principle that growth-restricted foetuses preferentially shunt blood towards the brain. No significant difference was seen in the renal arteries between appropriately grown and growth-restricted foetuses. Measurement of the RPT appears to be a more sensitive measure than current methods. It has the potential to identify infants with a possible reduced nephron endowment allowing for monitoring and interventions to be focused on individuals at a higher risk of developing future hypertension and chronic kidney disease.

Introduction Abnormal fetal growth can adversely impact renal development and is associated with increased risks of developing hypertension and chronic kidney disease later in life. A non-invasive, sensitive method of assessing normal and abnormal fetal kidney development is required. We hypothesise that the fetal renal parenchymal thickness could be used to evaluate the development of the fetal kidneys and provide an indirect estimate of fetal nephron number. This study uses antenatal ultrasound to assess fetal renal parenchymal growth and blood flow to determine if these are affected by abnormal fetal growth. Methods A longitudinal, observational study was conducted at the Townsville Hospital, Townsville, Australia between May 2017 to December 2018. Mixed risk women with an accurately dated, singleton pregnancy underwent a pregnancy ultrasound scan at least every four weeks between 16 and 40 weeks gestation. Renal parenchymal thickness and echogenicity, renal volume, fetal growth biometries, amniotic fluid measurements, renal artery Doppler and other fetal Dopplers were assessed in appropriately grown, fetal growth restriction or large for gestational age fetuses. Results 155 participants were recruited, with 7 participants excluded due to fetal abnormalities. Mixed effects modelling was used so that variations between gestational ages within fetuses and between fetuses was considered. A reference graph was developed for normal fetal renal parenchymal growth. In growth restricted fetuses the renal parenchymal thickness was found to be significantly less when compared to the parenchymal thickness of appropriately grown fetuses. Conclusions Measurement of the renal parenchymal thickness is an innovative method to evaluate the development of the fetal kidneys. This new chart of fetal renal parenchymal thickness may be useful for the diagnosis of nephropathologies and the identification of infants at risk of kidney disease. Fetal growth restriction was found to adversely affect the renal parenchymal growth. This suggests growth restricted fetuses are born with fewer nephrons and are therefore likely to be more susceptible to hypertension and early onset kidney disease later in life.

Background The stillbirth rate for Australian Aboriginal and Torres Strait Islander infants is twice that for non-Indigenous infants. Autopsy is the gold standard for fetal investigation; however, parental consent is often not given. There is little research investigating the drivers of parents' decision-making for autopsy after stillbirth. Aims The current study explored the reasons why Aboriginal and Torres Strait Islander women did or did not give permission to autopsy after stillbirth. Materials and Methods Five Aboriginal and/or Torres Strait Islander women participated in semi-structured interviews. Thematic analysis was conducted within a phenomenological framework. Results Five themes were identified as reasons for giving permission - to find out why the baby died; to confirm diagnosis; to understand future risk; to help others; and doubt about maternal causes. Four themes were identified as reasons for declining permission - not asked in a sensitive manner; not enough time to think; distress about the autopsy procedure; and unwilling to agree. There was a lack of acceptability of the lengthy timeframe for the availability of autopsy results as families usually wait between three and nine months. This lengthy waiting period negatively impacted upon families' health and wellbeing. Conclusions It is important for health professionals to understand the factors that parents consider when giving permission for autopsy after stillbirth. It is hoped that an increase in autopsy rate will enhance the understanding of the causes of stillbirth and ultimately decrease the stillbirth rate for Aboriginal and Torres Strait Islander families.