Detection and prevention of stillbirths
The detection and prevention of fetuses at risk for stillbirth; specifically, those not detected by traditional means using a continuous-wave Doppler ultrasound, an Umbiflow. A pilot study has been established in 9 sites in South Africa. The project has been extended to 5 African countries as Umbiflow international.
The development of Umbiflow was funded by the Council for Scientific Research (CSIR) and The South African Medical Research Council (SAMRC). It is also the result of a successful collaboration between the Gauteng, Western Cape, and National departments of health.
An initial study conducted by SAMRC and the University of Pretoria’s Maternal and Infant Health Care Strategies Unit in Mamelodi, Pretoria, revealed that the device reduced the perinatal mortality rate in the study group by over 50% when compared to the control group.
The UmbiBaby study followed up 91 infants from the Umbiflow International Study, which uses the innovative low-cost Umbiflow device to screen for in utero growth restriction due to placental insufficiency, which is thought to be one of the major causes of stillbirths in low- and middle-income countries.
In the UmbiBaby study, infants were followed up over 8-time points in the first two years of life postpartum. Infants who had been identified within utero growth restriction (abnormal Doppler values) from the Umbiflow International study will be compared to infants who had a normal Doppler in utero from the same study. The main outcomes of the UmbiBaby study are the infant’s growth, body composition and neurological development and it is envisaged that the study will provide valuable information on the management of growth-restricted infants postpartum, who before Umbiflow screening may have been stillbirths.
In the UmbiBaby study, infants who have been identified within utero growth restriction from the Umbiflow International study will be compared with premature and healthy full-term infants from the same study over the first year of life postpartum. The main outcomes of the UmbiBaby study will be the infant’s growth, body composition and neurological development and it is envisaged that the study will provide valuable information on the management of growth-restricted infants postpartum, who before Umbiflow screening may have been stillbirths.
The UmbiGodisa study aims to recruit a total of 300 infants from the Umbiflow International Study at a single time point of 18 months. The main objective of this larger cross-sectional study is to evaluate the dual burden of abnormal Doppler values in utero and maternal HIV infection on infant outcomes, such as infant growth, body composition and neurodevelopment.
Graduates and students
- Umbiflow SA: SAMRC & CSIR
- Umbiflow International: WHO
- Feucht U, Hlongwane T, Vannevel V, Mulol H, Botha T, Pattinson R. Identifying the high-risk fetus in the low-risk mother using fetal Doppler screening. Global Health: Science and Practice 2022;10(3):e2100692. https://doi.org/10.9745/GHSP-D-21-00692.
- Nkosi S, Makin J, Hlongwane T, Pattinson RC. Screening and managing a low-risk pregnant population using continuous-wave Doppler ultrasound in a low-income population: a cohort analytical study. South African Medical Journal 2019;109(5):347-352. https://doi.org/10.7196/SAMJ.2019.v109i5.13611 [Mamelodi study]
- Hlongwane TM, Cronje T, Nkosi BS, Pattinson RC. The prevalence of abnormal Doppler's of the umbilical artery in a low-risk pregnant population in South Africa. EClinicalMedicine 2021;34:100792. https://doi.org/10.1016/j.eclinm.2021.100792 [Umbi-9]
- Hlongwane TMAG, Pattinson RC, Berg A-M. Implementation of continuous-wave Doppler ultrasound to detect the high-risk foetus in the low-risk mother: lessons from South Africa. BMC Pregnancy and Childbirth 2023;23:393. https://doi.org/10.1186/s12884-023-05721-3 [Umbi-9]
- Hlongwane TM, Botha T, Nkosi BS, Pattinson RC. Preventing antenatal stillbirths: an innovative approach for primary health care. S Afr Fam Pract 2022;64(1):15487. https://doi.org/10.4102/safp.v64i1.5487 [Umbi-9]
- Vannevel V, Vogel JP, Pattinson RC, Adanu R, Charantimath U, Goudar SS, Gwako G, Kavi A, Maya E, Osoti A, Pujar Y. Antenatal Doppler screening for fetuses at risk of adverse outcomes: a multicountry cohort study of the prevalence of abnormal resistance index in low-risk pregnant women. BMJ Open 2022;12(3):e053622. https://doi.org/10.1136/bmjopen-2021-053622 [Umbi-International]
- Vogel JP, Vannevel V, Robbers G, Gwako G, Lavin T, Adanikin A, Hlongwane T, Pattinson RC, Qureshi ZP, Oladapo OT. Prevalence of abnormal umbilical arterial flow on Doppler ultrasound in low-risk and unselected pregnant women: a systematic review. Reproductive Health 2021;18:38. https://doi.org/10.1186/s12978-021-01088-w
- Bonell A, Vannevel V, Sonko B et al. A feasibility study of the use of Umbiflow to assess the impact of heat stress on fetoplacental blood flow in field studies. International Journal of Gynaecology and Obstetrics 2023;160(2):430-436. https://doi.org/10.1002/ijgo.14480
In utero growth restriction and the impact thereof on childhood growth:
- Dornan JC, Feucht U, Dornan SS, Mulol H, Vannevel V, Hlongwane T, Pattinson R. Continuous-wave Doppler, fetal growth restriction and small for gestational age babies. BJOG 2021;128(5):940. https://doi.org/10.1111/1471-0528.16643
- Feucht U, Mulol H, Vannevel V, Pattinson R. The ability of continuous-wave Doppler ultrasound to detect fetal growth restriction. PLOS One 2021;16(8):1-14. https://doi.org/10.1371/journal.pone.0255960 [Umbi-Baby]
- Nel S, Feucht UD, Mulol H, Wenhold FAM. Association of prenatal placental function with anthropometry and body composition through 2 years of age in South African infants: The UmbiBaby study. The Journal of Nutrition. 2023;153:958-969. https://doi.org/10.1016/j.tjnut.2023.02.007 [UmbiBaby]
- Nyofane M, Hoffman M, Mulol H, Botha T, Vannevel V, Pattinson R, Feucht U. Early childhood growth parameters in South African children with exposure to maternal HIV infection and placental insufficiency. Viruses 2022;14(12):2745. https://doi.org/10.3390/v14122745 [UmbiGodisa]
- Hlongwane TM, Bozkurt B, Barreix MC, Pattinson R, Gülmezoglu M, Vannevel V, Tunçalp Ö. Implementing antenatal care recommendations, South Africa. Bull World Health Organ. 2021;99(3):220-227. https://doi.org/10.2471/BLT.20.278945
- Pattinson RC, Hlongwane TMAG; Vannevel V. Challenges to improve antenatal and intrapartum care in South Africa. South African Medical Journal 2019;109(11b):15-19. https://doi.org/10.7196/SAMJ.2019.v109i11b.14248.
- Odendaal H, Pattinson R, Schubert P, Mason D, Brink L, Gebhardt S, Groenewald C, Wright C. The key role of examining the placenta in establishing a probable cause for stillbirth. Placenta 2022;129:77-83. https://doi.org/10.1016/j.placenta.2022.10.001
- Vannevel V, Hlongwane T, Wright C, Feucht U, Soma-Pillay P, Adam S, Mulol H, Fosu-Amoah D, Van Deventer H, Venter M, Mendes A, Coetzee M, Cloete J, Mbowane T, Chasela C, Pattinson R. Placental histology and umbilical artery Doppler in pregnant women with severe COVID-19. Published abstract (no.1577). BJOG 2021;128:203. https://doi.org/10.1111/1471-0528.15_16715
- Mueller D, Pattinson RC, Hlongwane TM, Busse R, Panteli D. Portable continuous wave Doppler ultrasound for primary healthcare in South Africa: can the EUnetHTA Core Model guide evaluation before technology adoption? https://doi.org/10.1186/s12962-021-00261-z
- Nel S, Pattinson R, Vannevel V, Feucht U, Mulol H, Wenhold FAM. Integrated growth assessment in the first 1000 days of life: an interdisciplinary conceptual framework. Public Health Nutrition 2023;26(8):1523-1538. https://doi.org/10.1017/S1368980023000940