What is involved?

MRI:

Magnetic resonance imaging (MRI) is a method of obtaining pictures of the inside of the body. While ultrasound is excellent for showing the anatomy of the normal fetus (baby) it gives us less information about the placenta. Similarly, echocardiography gives excellent information on the heart, but MRI gives more details on the blood flow and anatomical structure. We are interested in developing MR techniques to improve our abilities to assess both the heart and the placenta during pregnancy. The aim is to help us understand the causes, onset and risks of pre-eclampsia – a serious pregnancy complication which affects both the mother and the baby. The images from your heart and placenta on the same day will allow us to understand the effects of pregnancy on your heart as well as changes in the activity of the heart on the placenta. Images from your baby will allow us to understand how the development of your baby is related to the maturation of the placenta. We are interested both in short term and long term effects.

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We are therefore asking your permission to image you up to three times prior to delivery. We would like to take images of both your heart and your placenta within the same scan. We also take images of your baby to be able to assess baby’s growth. We also seek your permission to study your placenta after delivery with MR imaging and/or standard pathology. Where possible we also seek your permission to contact you after delivery to invite you to take part in other ethically approved studies.

The MR technique uses a large magnet and radio waves. It does not involve the use of either X-rays or radiation. It is not believed to have any hazard associated with it, although care is necessary to keep certain metallic objects away from the magnet and, at the present time, we exclude women who are in the first three months of an uncomplicated pregnancy. This is only a precaution as there are no reports of any side effects even in the very young fetus. MR can also be used to obtain information about the way a tissue is functioning. Therefore, techniques called “Diffusion MRI”, and “Perfusion MRI” are used. These allow to look at the movement of blood and water in the tissue. MRI scanners differ in the strength of the magnetic field, we will use scanners with clinically routinely employed strength.

You can find a short video explaining the procedure for a fetal MRI in more detail and what you can expect when you come for your scan. While this video describes specifically a fetal MRI for acquiring images of the brain of the baby, the procedure used for this study is very similar.

Optional parts:

We offer you to take part in other elements of this study, these are however completely optional.

Blood: We would also like to collect small samples of your blood to look at markers of placental and cardiac function around the time of your MR scans. Where ever possible we will use blood that is taken as part of your routine clinical care. The samples will be anonymized and transferred by a member of the research team to dedicated laboratory space in the hospital where they will be analysed.

Histopathology: After birth we seek your permission to collect your placenta and to assess it with MR imaging and/or placental pathology. The latter will be undertaken initially here at St Thomas pathology department as part of the normal clinical services and then potentially by a placental pathology expert in one of the study’s collaborating centres. We will compare this information to the data we acquired from your placenta prior to delivery using MRI and your blood samples.

Fetal ECG: We would also like to collect some information about your baby using a portable fetal electrocardiograph (ECG) monitor. A series of electrode pads will be attached to your abdomen and connected to a small monitor attached to you, which will allow us to record your baby’s heart trace.

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