Ramachandran Thiruvengadam

Background: In this study, we use quantitative and qualitative assessments to evaluate the feasibility and usability of an obstetric ultrasound video colour overlay to assist placenta localisation and hence risk stratify high-risk pregnancies that have a low-lying placenta. The colour overlay (designed in a previous study) simplifies clinical interpretation of ultrasound video to support screening for pregnant women in rural and low- and middle-income country (LMIC) settings who do not receive care, partly because of a trained operator shortage. Methods: For feasibility, we assessed risk stratification (or checking for a low-lying placenta) of a trained sonographer (6.5 years of experience) using the combined video and colour overlay compared with a hospital freehand scan without a colour overlay. For usability, we recruited 31 Indian healthcare system clinicians in both north and south India hospital sites. We assessed clinical opinions and perceptions of the colour overlay over four study rounds of written questionnaires and a single round of oral interviews. In each round, participants interacted with 20 colour overlays on a portable tablet computer. Results: For feasibility, the sonographer successfully risk stratified the 2 low-lying, high-risk placentas out of a cohort of 55 unique pregnancies (1 video per pregnancy). However, this approach also resulted in 18 false positives (normal placentas that were incorrectly labelled as low-lying). Future feasibility assessment would need to use a larger cohort of pregnancies to strengthen the preliminary findings reported here. For usability, participants gave positive written responses and reported an increase in both confidence when using the colour overlay, and trust in the colour overlay post-study compared to pre-study. From qualitative coding of interview transcripts (1,643 codes and 13 themes generated), the colour overlay was overwhelmingly perceived as an effective risk stratification tool and usable by healthcare workers in rural and LMIC settings. Non-trivial perceived challenges to translation included compliance of the colour overlay with India’s current fetal sex determination law (Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994), including compliance of targeted users of rural healthcare workers (who cannot currently legally use ultrasound devices), and ultrasound device purchase and maintenance costs. Conclusions: Overall, the colour overlay was perceived favourably by clinicians. For successful adoption of the technology in the Indian healthcare system, the non-technical issues raised would need to be carefully and sensitively addressed.

Preterm birth (PTB), defined as the birth of an infant before 37 weeks of gestation, poses significant health risks, including increased mortality

Pregnancy complications such as preeclampsia (PE) and adverse pregnancy outcomes (APOs) such as preterm birth (PTB), small for gestational age (SGA), and stillbirth (SB) pose a serious global health challenge and collectively contribute to high rates of maternal and infant mortality and morbidity. Close to 2 million stillbirths were reported in 2020 [1,2] while […]

Background Preterm birth (PTB), defined as the birth of infants before 37 weeks of gestation, poses significant health risks, including increased mortality and long-term disabilities. India stands as a major contributor to global PTB-related mortality, primarily due to its substantial prevalence. The complex temporal relationship among multiple etiological factors makes predicting PTB occurrence challenging. This is further complicated by the diverse PTB phenotypic categories, namely maternal, foetal, placental, parturition, and pathway-to-delivery features affecting birth outcomes. Methods Our study focused on PTB in the Indian population using a comprehensive dataset from the GARBH-Ini cohort. We analysed 21 variables across maternal, foetal, placental, parturition-related, and other phenotypic categories in the context of Phenotype I (PTB/Non-PTB) and Phenotype II, which classifies PTB based on the pathway to delivery as either Spontaneous Onset of Labour (SOL) or Caregiver-Initiated (CGI). We assessed the prevalence of these phenotypic variables using the complete dataset and applied hierarchical clustering to identify key PTB-associated phenotypic patterns and their impact on neonatal outcomes, including NICU admissions and early neonatal mortality. Additionally, we used one-year follow-up data to examine infant-related phenotypic variables and their distribution across PTB and non-PTB cases. Results We identified key phenotypic variables across maternal, foetal, placental, and parturition categories that significantly influenced PTB outcomes. In SOL cases, foetal (perinatal sepsis, polyhydramnios) and parturition-related (PROM, short cervix, peripartum bleeding) features were significantly associated. In contrast, CGI cases were predominantly associated with maternal complications like pre-eclampsia. Placental abnormalities, such as placenta previa, in combination with PROM and short cervix, were notably prevalent in PTB cases, impacting neonatal mortality, NICU admissions, and infant health. Conclusions The study underscores the complexity of PTB as a time-based, multifaceted syndrome driven by diverse etiological factors. India’s prominence in global PTB-related mortality necessitates tailored preventive strategies. Our findings emphasise the significance of monitoring specific phenotype class and their associated features, facilitating the development of targeted interventions to reduce PTB occurrences in the Indian population. These relationships among features could assist in prioritising cases for personalised care and improve understanding of how PTB phenotypes affect infant health.

Preterm birth (PTB) is defined as a live-born baby delivered before 37 completed weeks of gestation [1,2]. It is one of the major global pregnancy complications with more than 60% of PTB occurring in lower-middle-income countries (LMICs) [3,4]. Preterm birth, small for gestational age (SGA) and low birth weight (LBW) newborns have been categorised as […]