Preterm birth is associated with significant mortality and a risk for lifelong morbidity. The complex multifactorial aetiology hampers accurate prediction and thus optimal care. A pipeline consisting of bespoke machine learning methods for data imputation, feature selection, and regression models to predict gestational age (GA) at birth was developed and evaluated from comprehensive multi-modal morphological and functional fetal MRI data from 333 control cases and 93 preterm birth cases. The GA at birth predictions were classified into term and preterm categories and their accuracy, sensitivity, and specificity were reported. An ablation study was performed to further validate the design of the pipeline. Performance was evaluated using stratified 10-fold cross-validation. The pipeline achieves an R2 score of 0.13 and a mean absolute error of 2.74 weeks. It also achieves a 0.77 accuracy, 0.59 sensitivity, and 0.82 specificity across folds. The predominant features selected by the pipeline include cervical length and statistics derived from placental T2* values. The confluence of fast, motion-robust and multi-modal fetal MRI techniques and machine learning prediction allowed the prediction of the gestation at birth. This information is essential for any pregnancy. To the best of our knowledge, preterm birth had only been addressed as a classification problem in the literature. Therefore, this work provides a proof of concept. Future work will increase the cohort size to allow for finer stratification within the preterm birth cohort. Our code is available at https://github.com/dfajardorojas/ml-for-preterm-birth-.

OBJECTIVE:To identify factors associated with unsuccessful transabdominal cerclage (TAC) insertion, defined as delivery before 32 weeks, including maternal demographics, preterm birth risk factors, operative details (laparoscopic or open, pre-pregnancy or during pregnancy) and subsequent cervical length. DESIGN:Observational cohort study. SETTING:A tertiary-level London hospital. SAMPLE:Women who underwent TAC between 2011 and 2024 and consented to inclusion in the Preterm Clinical Network (PCN) Database. METHODS:Data were collected from the PCN database and maternity records. MAIN OUTCOME MEASURES:Characteristics of women delivering before versus after 32 weeks were compared using student's t-test where data were continuous and chi-squared where data were categorical (SPSS version 29.0). RESULTS:Among 125 pregnancies following TAC, eight (6.4%) delivered before 32 weeks. Previous trachelectomy was strongly associated with preterm delivery (p < 0.0001). Mean cervical length differed significantly between groups: first trimester (19.3 mm vs. 33.8 mm, p < 0.001) and second trimester (18.8 mm vs. 31.9 mm, p < 0.001). Of 30 women with prior pregnancies using the same TAC, 80% (24/30) achieved at least one term birth and 13.3% (4/30) had two or more term deliveries. CONCLUSION:TAC is highly effective, with over 90% of women delivering beyond 32 weeks. Factors linked to unsuccessful TAC include prior trachelectomy and short cervical length in early pregnancy. Effectiveness persists across subsequent pregnancies, with many women achieving multiple term births using the same TAC.

Placental histopathology is central to good perinatal care, offering insight into antepartum and intrapartum events, informing neonatal management and supporting counselling for future pregnancies. Despite clear national guidance, many placentas that meet criteria are not sent for evaluation. Reasons are multifactorial, including inconsistent awareness of indications and unclear post-delivery processes. Two UK maternity units, St Thomas’ Hospital in London and the Royal Berkshire Hospital in Reading, identified local variations in practice that led to placentas not being appropriately sent. At St Thomas’ Hospital, a baseline audit performed as part of a preterm birth research study revealed only 80% of eligible deliveries had placental examination. At the Royal Berkshire Hospital, a coroner’s inquest after an unexpected neonatal death, highlighted the absence of indicated placental histology, prompting a recommendation for 48-hour retention of all placentas. A quality improvement project using Plan Do Study Act cycles was implemented at both sites. Interventions included installation of dedicated labour ward fridges for 48-hour storage with temperature monitoring, targeted education on indications for placental histology and daily cross-checking of neonatal admissions to ensure eligible placentas were sent. The primary outcome was the proportion of placentas meeting criteria sent for histopathology, focusing on deliveries <32 weeks and intrauterine deaths >18 weeks. National investigation reports at St Thomas’ Hospital were also reviewed for missing histology. Labour ward storage proved feasible and effective. At the Royal Berkshire Hospital, submission rates improved from 88% to 97% for intrauterine deaths and from 71% to 100% for very preterm births. At St Thomas’ Hospital, preterm submissions increased from 80% to 96% after education and 98% after storage, with intrauterine death remaining at 100%. Missing histology in national investigations reduced from 12% to 0%. Short-term placental storage is a low-cost, scalable intervention aligned with national maternity safety priorities.

There is emerging evidence that caesarean section in labour is associated with an increased risk of recurrent mid-trimester loss (MTL) and spontaneous preterm birth (sPTB) in subsequent pregnancies. This is likely due to inadvertent damage to the cervical tissue at the time of caesarean section. Transvaginal cerclage (TVC) has been demonstrated to be less successful in this high-risk cohort of women. However, transabdominal cerclage (TAC) may be more effective as the suture is placed above the level of cervical caesarean damage. A TAC can be placed before or during early pregnancy, although placement during pregnancy may be less effective. To determine the optimal clinical management for women with this risk factor, the ABOVE trial will evaluate the effectiveness of TAC compared to TVC in women who have experienced a MTL or sPTB following an in-labour caesarean section. ABOVE is a multicentre randomised control trial comparing TAC or TVC as a preventative strategy for sPTB in women with history of an in-labour CS and subsequent MTL (14+ 0 -23+ 6 weeks) or sPTB (< 30 weeks). Participants will be allocated to one of two groups - Group A (currently pregnant < 14 weeks’ gestation) and Group B (planning a pregnancy) - and randomised 1:1 to TAC or TVC within each group. The ABOVE trial will investigate the efficacy of known interventions in the prevention of preterm birth, TVC and TAC, in women who have had a previous in-labour CS and subsequent MTL or sPTB. The trial will inform the development of evidence-based practice guidelines to optimise the care offered to this cohort of high-risk women. With escalating rates of CS and the increased recognition of the relationship between caesarean cervical damage and sPTB and MTL, this work is key. ISCRTN 10977996 (17/05/2024).

PURPOSE:Altered placental capillary blood flow is closely linked to obstetric complications, yet quantifying capillary-scale blood velocity remains challenging with existing imaging methods. This is partially because capillary networks form disordered microvascular beds at the voxel scale, rather than coherent, directional vessels. Here, we combine Monte Carlo (MC) simulations with machine learning to estimate placental capillary blood velocity directly from diffusion MRI (dMRI) data. METHODS:MC simulations incorporating perfusion and diffusion were performed to generate signal dictionaries for supervised machine learning regressors (random forest [RF] and multilayer perceptron [MLP]) to estimate velocity, perfusion fraction and diffusivity. The trained regressors were applied to simulated and in vivo dMRI data, with intravoxel incoherent motion (IVIM)-based estimates as baselines for comparison. RESULTS:Our approach outperformed IVIM-based methods on simulated test data in recovering ground-truth parameters. Among the evaluated models, the MC-based MLP approach produced physiologically reasonable estimates of velocity in in vivo placentas, in agreement with previously reported measures and exhibited greater sensitivity than IVIM-generated methods. CONCLUSION:This study presents an approach to characterize capillary perfusion that alternates conventional IVIM models, particularly in organs such as the placenta, where pseudo-diffusion coefficient can be similar to tissue diffusion coefficient, limiting reliable IVIM parameter separation. Our method could enable detection of capillary blood-flow alterations, which could help identify pathological placental blood-flow conditions and potentially diagnosis relevant diseases, such as preeclampsia and fetal growth restriction. More broadly, the approach may translate to other organs where microscale blood-flow changes are key indicators of underlying pathologies.

While slice-to-volume registration and super-resolution reconstruction laid the foundation for motion-corrected 3D T2-weighted fetal brain magnetic resonance imaging (MRI) more than two decades ago, advances in deep learning are now enabling automation across acquisition planning, segmentation, biometry, and image quality control. In this narrative review, we highlight these emerging techniques and analyse their strengths and limitations in the context of clinical translation. We examine the major barriers to widespread clinical adoption of artificial intelligence tools and outline future directions at the clinical interface that may further transform the diagnostic role of fetal MRI. Together, these developments underscore a shifting landscape towards more comprehensive, quantitative in-utero assessment, with the potential to enhance diagnostic accuracy and workflow efficiency, and broaden the clinical applications of fetal MRI in prenatal care.

INTRODUCTION:Term full dilatation cesarean delivery (FDCD) is associated with an increased risk of subsequent spontaneous preterm birth (sPTB). The impact of preterm FDCD on recurrent sPTB is unknown. We investigated the relationship between recurrent sPTB and the mode of prior sPTB. MATERIAL AND METHODS:This is a retrospective cohort study of singleton pregnant women attending two high-risk preterm birth surveillance clinics (University College London Hospital and St Thomas' Hospital London, UK), with one previous sPTB (24-36 + 6 weeks). Women were categorized according to their mode of birth in the index sPTB pregnancy: (1) preterm FDCD, (2) preterm vaginal birth and (3) preterm cesarean delivery at <10 cm cervical dilatation (CD < 10 cm). The primary outcome was recurrent sPTB <37 weeks of gestation. Secondary outcomes included sPTB <34 weeks, <28 weeks, spontaneous late miscarriage and short cervical length (≤25 mm). In a subgroup of women with preterm FDCD, CD scar characteristics were assessed during the second trimester of pregnancy using transvaginal ultrasound. RESULTS:Median gestation of prior sPTB was similar across all groups (32 weeks; p = 0.454). Recurrent sPTB <37 weeks was significantly more common in women with previous preterm FDCD, 38.1% (8/21) compared to vaginal birth, 15.1% (16/106) or CD < 10 cm, 13.8% (15/109); aOR 4.4 (95% CI 1.3-14.9; p = 0.023) and 5.1 (95% CI 1.6-16.5; p = 0.022), respectively. Recurrent sPTB <34 weeks was even higher in the previous preterm FDCD group, 23.8% (5/21) compared to vaginal birth 4.7% (5/106) or CD < 10 cm 8.3% (9/109); aOR 16.6 (95% CI 2.8-97.2; p = 0.016) and 5.7 (95% CI 1.4-23.1; p = 0.022), respectively. CD scar location was assessed in 15 women with preterm FDCD in one centre. Scar visualization was 87%, with 77% (10/13) of scars being located within the cervix or <5 mm above the internal cervical os. CONCLUSIONS:Women undergoing FDCD following preterm labor have a significantly higher risk of recurrent sPTB at <37 and <34 weeks of gestation compared to women with previous preterm vaginal birth or CD prior to the second stage of labor. These findings suggest that preterm FDCD may further compromise cervical function. It is important that clinicians are aware of this increased risk of recurrent sPTB to guide patient counseling and management accordingly.

Magnetic resonance imaging (MRI)-based volumetry of the fetus, placenta, and amniotic fluid is clinically valuable but rarely used due to labor-intensive manual segmentation of motion-corrupted two-dimensional (2-D) stacks. Existing deep learning approaches are typically limited to single structures and 2-D data, while no robust automated solution exists for whole-uterus volumetry in reconstructed three-dimensional (3-D) MRI, and normative reference ranges are lacking. To develop an automated pipeline for whole-uterus volumetry in 3-D T2-weighted fetal MRI and derive normative growth models for fetal, placental, and amniotic fluid volumes. Motion-corrupted T2-weighted stacks (0.55–3-T field strength) were reconstructed into 3-D isotropic images using deformable slice-to-volume reconstruction, followed by automated segmentation with a 3-D U-Net. The method was applied to 357 normal-control datasets with confirmed term birth (16–41 weeks gestational age range) to derive quadratic normative growth curves. Performance and clinical utility were further evaluated on 43 independent datasets. Segmentation was highly accurate (Dice: fetus 0.997, placenta 0.995, amniotic fluid 0.998) with low volume errors (<1

Background:Volumetric assessment of the fetus, placenta and amniotic fluid is clinically valuable, but MRI volumetry is rarely performed in clinical practice because of the required labour-intensive manual segmentation of motion-corrupted 2-dimensional (2-D) stacks. Existing deep-learning approaches typically segment single structures in 2-D motion-corrupted stacks, are, however limited in accuracy by slice misalignment. No current method provides a reliable automated solution for whole-uterus volumetry in 3-D reconstructed MRI. Furthermore, normative ranges for computation of centiles are currently missing. Objective:To develop an automated pipeline for whole-uterus volumetry in 3-D T2-weighted fetal MRI and to generate normative growth models for fetal, placental and amniotic fluid volumes in healthy pregnancies with confirmed delivery at term. Materials and methods:Deformable slice-to-volume 3-D reconstruction was applied to motion-corrupted T2-weighted (T2W) stacks from 0.55T-3T MRI, and a 3-D UNet was trained to segment fetus, placenta and amniotic fluid on the resulting reconstructed 3-D images. A reporting tool generates centiles, z-scores and structured HTML outputs. Automated segmentation was performed in 357 healthy control datasets from 16-41 weeks gestational age (GA) range with confirmed delivery at term. After visual checks of segmeted labels and minor refinements, GA-based quadratic normative volumetry models were derived and correlations with maternal and fetal characteristics assessed. The utility of the pipeline for clinical research was further evaluated using 95 longitudinal scans from 42 fetuses and 86 preterm (≤ 32 weeks at delivery) pregnancies. Results:Automated segmentation produced accurate 3-D labels, with only small local corrections (< 1% volume difference) required in the control cohort(< 25% of the datasets). Fetal and placental volumes increased across gestation, while amniotic fluid volume peaked mid-pregnancy and declined toward term. Volumes and centiles correlated with maternal size and birth weight. Longitudinal scans showed individual fetal and placental trajectories closely following the normative curves, with greater variability in amniotic fluid. Preterm pregnancies showed significantly lower fetal, placental and amniotic fluid volumes and centiles than the controls with confirmed delivery at term. Conclusion:This study introduces an automated whole-uterus volumetry pipeline and corresponding normative 3-D MRI growth models. The method provides robust, standardised volumetric assessment of fetal, placental and amniotic fluid development and offers a practical tool for evaluating growth patterns in both normal and high-risk pregnancies.

OBJECTIVE:This study aims to determine the incidence, risk factors - including maternal demographics and intrapartum characteristics - and maternal and neonatal outcomes of fully dilated caesarean sections (FDCS) with impacted fetal head (IFH) compared to those without. It also seeks to evaluate the management techniques used in FDCS cases complicated with IFH. METHODS:Retrospective cohort study of singleton, cephalic pregnancies undergoing FDCS over one year (October 2024 - October 2025). Cases with and without IFH were compared using student's t-test, Mann-Whitney U and chi-squared tests (SPSS version 29.0). Where IFH occurred, additional techniques were recorded and summarized as frequencies and proportions. RESULTS:Of 1,134 category 1 and 2 emergency caesarean sections with documented cervical dilatation, 105 (9%) were performed at full dilatation. IFH was documented in 58% of FDCS. There was no observed difference in intrapartum characteristics (i.e. induction of labour, oxytocin use, trial of instrumental) between groups. Additional techniques were required in 42% of IFH cases, most commonly vaginal push up (52%). IFH was associated with longer incision-to-delivery time (27% (16/59) taking ≥ 3 min versus 0% (0/43) , p < 0.001), surgical time (31% (18/59) taking over one hour versus 9% (4/43) those without, p = 0.01) and lower Apgar scores at 1 min (8 [1-9] versus 9 [5-10], p = 0.003) ; other operative, postnatal and neonatal outcomes demonstrated no meaningful difference across groups. CONCLUSION:IFH at FDCS was commonly documented (58%), and greater than previously reported, likely due to variation in definitions and increased recognition. Findings highlight the need for a refined, consensus definition of IFH and enhanced clinical training to manage this important obstetric emergency and optimise outcomes.

A transvaginal cerclage (TVC) identified high in the cervix is associated with prolongation of pregnancy. However, the relative position of the TVC (length above the cerclage/total cervical length) may be a better predictor of cerclage success as it is proportional of total cervical length. This study evaluates the relative position of TVC and its association with spontaneous preterm birth, comparing its predictive value against other post-cerclage ultrasound parameters. A retrospective cohort study was conducted of singleton pregnancies with TVC. Demographic and ultrasound data were collected. Differences in TVC characteristics between those who delivered preterm (< 37 weeks) and term, including relative position of cerclage, were assessed using Student’s t-test where data was continuous and chi-squared test where categorical. Receiver operator curves were generated to evaluate predictive performance (SPSS version 29.0). Among 53 women, 25

Term full dilatation cesarean delivery (FDCD) is associated with an increased risk of subsequent spontaneous preterm birth (sPTB). The impact of preterm FDCD on recurrent sPTB is unknown. We investigated the relationship between recurrent sPTB and the mode of prior sPTB. This is a retrospective cohort study of singleton pregnant women attending two high-risk preterm birth surveillance clinics (University College London Hospital and St Thomas' Hospital London, UK), with one previous sPTB (24–36 + 6 weeks). Women were categorized according to their mode of birth in the index sPTB pregnancy: (1) preterm FDCD, (2) preterm vaginal birth and (3) preterm cesarean delivery at <10 cm cervical dilatation (CD < 10 cm). The primary outcome was recurrent sPTB <37 weeks of gestation. Secondary outcomes included sPTB <34 weeks, <28 weeks, spontaneous late miscarriage and short cervical length (≤25 mm). In a subgroup of women with preterm FDCD, CD scar characteristics were assessed during the second trimester of pregnancy using transvaginal ultrasound. Median gestation of prior sPTB was similar across all groups (32 weeks; p  = 0.454). Recurrent sPTB <37 weeks was significantly more common in women with previous preterm FDCD, 38.1% (8/21) compared to vaginal birth, 15.1% (16/106) or CD < 10 cm, 13.8% (15/109); aOR 4.4 (95% CI 1.3–14.9; p  = 0.023) and 5.1 (95% CI 1.6–16.5; p  = 0.022), respectively. Recurrent sPTB <34 weeks was even higher in the previous preterm FDCD group, 23.8% (5/21) compared to vaginal birth 4.7% (5/106) or CD < 10 cm 8.3% (9/109); aOR 16.6 (95% CI 2.8–97.2; p  = 0.016) and 5.7 (95% CI 1.4–23.1; p  = 0.022), respectively. CD scar location was assessed in 15 women with preterm FDCD in one centre. Scar visualization was 87%, with 77% (10/13) of scars being located within the cervix or <5 mm above the internal cervical os. Women undergoing FDCD following preterm labor have a significantly higher risk of recurrent sPTB at <37 and <34 weeks of gestation compared to women with previous preterm vaginal birth or CD prior to the second stage of labor. These findings suggest that preterm FDCD may further compromise cervical function. It is important that clinicians are aware of this increased risk of recurrent sPTB to guide patient counseling and management accordingly.

OBJECTIVES:Despite sonography studies being integral to routine high quality antenatal care, clinical research in this field is less commonly initiated or led by sonography professionals. It is also unclear what the research priorities are for service users within the UK's sonography screening and diagnostic pathway. METHODS:Here, we present a national priority setting partnership project, which included 2 surveys, coproduced with the oversight of a stakeholder priority setting partnerships (PSP) group, comprising service users and healthcare professionals, n = 12. RESULTS:From the surveys, there were 348 individual responses and 616 validated research questions/uncertainties submitted. The top-ranked 26 indicative questions were discussed at a final joint stakeholder meeting (n = 17) and the top 10 research priorities for pregnancy scanning research were voted for and agreed by consensus. These fell into 6 main themes: (1) maternal and parental experience; (2) emerging technology; (3) screening, prediction, and diagnosis, (4) role of pregnancy MRI, (5) continued professional development, training and education, and (6) service delivery and workforce. CONCLUSIONS:We envisage this PSP will support teams of researchers and clinicians with important and achievable targets to move the field of pregnancy scanning forward. ADVANCES IN KNOWLEDGE:This is the first coproduced antenatal scanning priority setting partnership highlighting real world issues and lines of enquiry as proposed by service users and health care professionals.

BACKGROUND:Royal College of Obstetricians and Gynaecologists (RCOG) Green-top Guidelines (GTGs) provide evidence-based recommendations in women's health. Even where evidence is considered high quality, it is uncertain whether factors known to influence maternity outcomes are reflected in study design. OBJECTIVES:To determine distribution of recommendation grades across obstetric GTGs. For Grade A recommendations, to evaluate if supporting studies reported equity-relevant design features and methodological robustness. DESIGN:Review of RCOG obstetric GTGs. SETTING:United Kingdom. SAMPLE:All RCOG non-archived obstetrics GTGs published up to 20 April 2025. METHODS:Frequencies of Grade A-D recommendations and Good Practice Points were recorded. For Grade A recommendations, underpinning studies were assessed for health equity and generalisability. All primary studies underpinning every Grade A recommendation were included; where a single study supported multiple recommendations, it was included every time and mapped to each relevant recommendation. The median health equity and generalisability score for each recommendation (if > 1 supporting studies) and a median score of all Grade A recommendations per guideline was calculated. MAIN MEASURE OUTCOMES:Distribution of recommendation grades: health equity and methodological robustness scores for studies underpinning Grade A recommendations. RESULTS:Variable frequencies of Grade A, B, C, D recommendations and GPP from 37 eligible guidelines were noted. Only 28 GTGs had Grade A recommendations, with median health equity and generalisability scores of 1 of 13 and 6 of 10 respectively across those recommendations. CONCLUSIONS:Twenty-four percent of obstetric GTGs have no Grade A recommendations. Of those that do, consideration of health equity and generalisability in associated studies is limited. These design and reporting features should be considered in future research to improve applicability of clinical guidance to all patient groups.

Abstract Regional volumetric assessment of perinatal brain development is currently limited by the lack of consistent high quality multi-regional segmentation methods applicable to both fetal and neonatal MRI. We present Multi-BOUNTI, a deep learning pipeline for automated multi-lobe segmentation of fetal and neonatal T2w brain MRI. The method is based on a dedicated 43-label parcellation protocol and a 3D Attention U-Net trained on brain MRI datasets of subjects spanning 21–44 weeks gestational/postmenstrual age. The pipeline integrates preprocessing, segmentation and volumetric analysis, and was evaluated on independent datasets, demonstrating fast (< 10 min/case) and accurate performance with high agreement to manually refined labels. We demonstrate the application of the framework with 267 fetal and 593 neonatal MRI datasets from the developing Human Connectome Project without reported clinically significant brain anomalies to derive normative volumetric growth models across 21–44 weeks GA/PMA. These models were used to characterise developmental trajectories, assess differences between fetal and preterm neonatal cohorts, and analyse longitudinal changes. The resulting normative models were integrated into an automated reporting framework enabling subject-specific volumetric assessment via centiles and z-scores. Multi-BOUNTI provides a unified and scalable approach for perinatal brain segmentation and volumetry, supporting large-scale studies and facilitating future clinical translation. The full pipeline is publicly available at https://github.com/SVRTK/perinatal-brain-mri-analysis .

Necrotising enterocolitis (NEC) is a disorder characterised by intestinal ischaemia and inflammation. It predominantly impacts preterm and low birthweight infants and carries a high burden of mortality and both short and long-term morbidity for survivors. Postnatal factors such as abnormal bacterial colonisation of the gut (dysbiosis) and formula feeding are known to predispose to the development of NEC. The contribution of the antenatal period to the subsequent development of NEC is poorly understood. Although it is known that fetuses with growth restriction, particularly those with abnormal blood flow in the umbilical cord (absent or reversed end diastolic flow), are at increased risk, these alterations are not a prerequisite for its development. Predictive tests in other high-risk groups, such as fetuses who go on to deliver spontaneously preterm, are even more limited. The difficulties in prognosticating the risk of NEC during the antenatal period are compounded by the aetiology not yet being fully elucidated and being multifactorial. This review examines current evidence on how antenatal factors contribute to the development of necrotising enterocolitis.

Late preterm birth, defined as delivery between 34 + 0 and 36 + 6 weeks' gestation, accounts for the largest proportion of preterm births worldwide and is increasingly recognised as a distinct high-risk group. Historically, research and clinical attention have focused on very preterm infants because of their high mortality and severe morbidity. However, accumulating evidence demonstrates that infants born late preterm experience significantly higher morbidity and mortality compared with those born at term, reflecting persistent physiological and developmental immaturity across multiple organ systems. This review synthesises the current literature on the epidemiology, aetiology, short- and long-term morbidity, and mortality associated with late preterm birth. Late preterm infants have consistently higher rates of neonatal complications, including respiratory morbidity, hypoglycaemia, jaundice, feeding difficulties, temperature instability, neonatal unit admission, and hospital readmission after discharge. Infectious and neurological complications are also more frequent than in term-born infants. Beyond the neonatal period, late preterm birth is associated with increased risks of chronic respiratory disease, cardiometabolic disorders, chronic kidney disease, and adverse neurodevelopmental, behavioural, and educational outcomes. Importantly, excess mortality risk may persist into adulthood. Although late preterm infants constitute the majority of preterm births, they remain an under-recognized population. Enhanced dissemination of information to families, educational professionals, and health visitor reviewers is recommended to increase awareness of potential concerns and to facilitate the timely identification of the short- and long-term effects associated with late preterm birth across the life course.

Preterm prelabour rupture of the membranes poses maternal and perinatal risks including maternal sepsis, placental abruption, preterm labour and its sequelae, perinatal mental health complications, and mortality. Optimum management is not well understood. Most recent UK guidance suggested outpatient management may be appropriate, but guidance was not given on frequency or mode of monitoring, and outcomes following this are not well understood. This study aimed to determine monitoring practices and outcomes of women whose pregnancies complicated by preterm prelabour rupture of the membrane who are cared for in the outpatient setting, and to understand their experience. Retrospective data collection including patient demographics, preexisting risk factors, diagnosis and outpatient monitoring (including maternal observations, biochemistry and ultrasound findings), delivery outcomes and placental histopathology. Counselling of women was assessed at two timepoints: diagnosis and first review by a consultant. All women were invited to participate in a service evaluation. Across six units, 233 women were cared for in outpatient services for PPROM. Median gestation at diagnosis was 32 weeks (IQR 28 + 1 - 34 + 3 weeks). 34% had an equivocal diagnosis. Counselling on outcomes varied across units. Spontaneous preterm birth occurred in 41% of cases with a further 18% being delivered preterm for suspected chorioamnionitis. All units used maternal heart rate, temperature, C-reactive protein and white cell count to monitor for infection although neither absolute values at delivery nor trends in any of these were predictive of histological chorioamnionitis. Most women felt that their outpatient care was acceptable, but highlighted deficiencies in emotional support offered.

BACKGROUND:Fetal bowel remains challenging to assess antenatally. Ultrasound assessment is limited to its echogenicity and luminal diameter. Although MRI has been used to visualise fetal bowel, uncertainties remain and reference ranges for 2D diameter of large bowel have only recently been reported. Advanced MRI techniques now facilitate motion-corrected 3D analysis of fetal abdominal structures. This study aimed to apply these techniques to fetal large bowel enabling generation of high-resolution datasets for volumetric visualisation and quantification. METHODS:All participants underwent fetal MRI on a 3T system, with T2-weighted images acquired in multiple orthogonal planes. Motion-correction pipelines were applied to obtain 3D reconstruction of fetal abdomen, and manual segmentation of five large bowel regions was performed to generate a 3D reconstruction of large bowel facilitating volumetric measurements. To assess reproducibility, intra- and inter-observer variability were performed using intraclass correlation coefficient (ICC). Linear regression was used to assess relationship between large bowel volume and gestation. RESULTS:Forty datasets from fetuses between 16 and 38 weeks' gestation were analysed. The whole fetal large bowel was identified in 100% of datasets. Intra- and inter-observer agreement were good to excellent. Volume increased linearly with advancing gestational age in all five large bowel segments. Model-derived estimates of total large bowel volume increased from 1266 cm3 at 18 weeks' gestation to 13,550 cm3 at 38 weeks (p<0.001). CONCLUSION:This study demonstrates 3D reconstruction and volumetric assessment of fetal large bowel is a feasible and reproducible technique in all large bowel regions. This technique may improve understanding of normal fetal bowel development enabling antenatal identification of pathologies, currently rarely detected antenatally.