Prenatal diagnosis of birth defects is important as it has a direct impact on how a newborn is managed, enabling medical practitioners to make any necessary preparations, such as arranging to deliver a baby in a specialist unit with the equipment and expertise needed to treat its condition. It also allows parents to receive counselling and meet appropriate specialists, in order to make informed choices and to prepare themselves mentally and emotionally for a potentially difficult period after birth.
Currently, screening for fetal abnormalities by ultrasound takes place at 12 weeks and 18-20 weeks. Although anatomical structures are developed by the time of the later scan, it can be difficult to obtain clear images, particularly in obese mothers or in cases with an unfavourable fetal position.
While ultrasound is a powerful tool – it is inexpensive, safe and portable, and images are acquired in real-time – its diagnostic accuracy and sensitivity are limited. To use and interpret a scan requires extensive training, and despite substantial investment in training those that use ultrasound, many abnormalities remain undetected; for example, the national screening programme only detects around a third of serious cardiac abnormalities, and the detection rate for hernias of the diaphragm is around 60 per cent. In addition, there is substantial regional and hospital-specific variation in prenatal detection rates of birth defects, so that in some areas detection rates are substantially worse than in others.
Professor Reza Razavi and colleagues at King’s College London, as part of King’s Health Partners Academic Health Sciences Centre, have been awarded funding under the joint Wellcome Trust and EPSRC Innovative Engineering for Health scheme to develop a fully automated and computer-guided ultrasound system, which will allow midwives to acquire three-dimensional images of a whole baby in a much higher resolution than is currently possible. The team are also aiming to develop computer software that will be able to automatically analyse the images acquired. These techniques should substantially improve detection rates of congenital abnormalities.
Professor Razavi, who is Head of Imaging Sciences at King’s College London and Director of Research at King’s Health Partners, said: “Identifying birth defects at an early stage is essential both for medical professionals and for the parents themselves. Current ultrasound scans are relatively crude and many serious abnormalities are not detected, leading to these babies becoming very ill soon after birth, and substantial delay before a diagnosis is made and they can be transferred to a specialist centre for appropriate treatment.
“We are developing a radically new approach to fetal screening, largely removing the need for experts to acquire and interpret the images. It will allow the initial screening scans to be done in a few minutes, and provide a consistently higher detection rate for major abnormalities.”
In addition, the research team believe that the high-quality 3D images produced of the placenta, amniotic fluid and fetus could be used across large population studies focusing on genetic and environmental factors. This should greatly help the understanding of fetal and maternal health in conditions such as intra-uterine growth restriction and pre-eclampsia, as well as the study of some chronic diseases that have origins in fetal life.
Dr Ted Bianco, Director of Technology Transfer at the Wellcome Trust, said: “This is an ambitious research project at the cutting edge of engineering in its application to health. If successful, it would greatly enhance the value of ultrasound for the care of mothers and their babies.”
Professor David Delpy, Chief Executive of EPSRC, said: “The role of innovative engineering and the physical sciences in providing new ways to diagnose and treat medical conditions is often underappreciated. EPSRC is proud to be working with the Wellcome Trust to support this research, which will hopefully improve the detection of serious conditions in unborn children, enhance treatment and increase their chances of survival. This project is an example of how engineering developments can improve and save lives: what could be more important?”
Image credit: Wellcome Images