Priority Area Two

Developing new approaches for identifying women at increased risk of stillbirth

Priority Area Two leads: Professor Euan Wallace, Professor Vicki Clifton, Professor Sailesh Kumar

Novel tests to improve antenatal detection of women at increased risk of stillbirth are needed. Many of the unexplained stillbirths that occur in high-income countries may be due to problems with how the placenta develops and functions. Such problems may contribute to stillbirth, even in babies who appear to be growing well during pregnancy. By assessing the function of the placenta, it may be possible to predict which babies have a greater chance of stillbirth. We may then be able to intervene before stillbirth occurs.

As well as identifying babies who might be at-risk of stillbirth, assessing the function of the placenta and looking at placental biomarkers may help to detect babies who have an increased chance of experiencing distress during labour. Babies who experience distress during labour are at-risk of developing brain injury and resulting disability, such as cerebral palsy. Therefore, detecting babies who have an increased chance of experiencing distress during labour may help to reduce both stillbirth and childhood disability.

A national collaboration is being established to identify novel placental biomarkers for pre-clinical testing. An initial one-day workshop held in Brisbane in July 2017 confirmed support for this national project and ongoing workshops throughout the life of the CRE will continue to progress this work and foster new collaborations.

  • Identifying novel placental biomarkers

    Leads: Prof Vicki Clifton; Prof Euan Wallace

    This is a national consortium of placental biologists and clinicians working on placental mechanisms and circulating biomarkers that may be early indicators of pregnancies at risk of a stillbirth.

    Part of this work involves developing a national database of placental samples to promote and facilitate collaborative placental research, as well as standardised processes for the collection and analysis of placental samples. Collection protocols are designed as a basic minimal guide to placental tissue collection for biobank storage that meets the agreed standards of the Stillbirth Centre for Research Excellence. Current protocols and procedures are listed below.

    >>Protocol: Human placental tissue collection

     

    >>REDCap Placental Data Collection - Human Samples

     

    >> Coming Soon: REDCap Placental Data Collection - Animal Samples

    >>Coming soon: documents and videos outlining the protocol for rodent placental collection.

  • Evaluating prediction strategies for adverse outcomes at term

    Lead: Prof Sailesh Kumar

    PhD students: Mr Chris Flately

    This study aims to evaluate strategies for detecting mothers and babies at an increased-risk of late-pregnancy stillbirth and other adverse pregnancy outcomes. Specific aims include:

    • Improving understanding and prediction of decreased fetal movements
    • Assessing the role of routine third-trimester ultrasound scanning in reducing adverse outcomes
    • Examining the role of PlGF (placental growth factor) in identifying women at-risk
    • Assessing barriers to morphology scanning
  • Biomarkers in pregnancies affected by decreased fetal movements

    Lead: Prof Vicki Flenady

  • ReMIT-2: Reduced Fetal Movement Intervention Trial (Australian arm)

    Leads: Prof Sailesh Kumar, Prof Alexander Heazell