Andrew Breeze

University of Leeds, Leeds Institute of Medical Education, School of Medicine, Honorary senior lecturer

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BChir, MA, MD, University of Cambridge
Subspecialist in maternal & Fetal medicine, RCOG
Supervisors: Christoph Lees and Helen Statham
Address: Leeds Fetal Medicine Unit
A Floor, Clarendon Wing
Belmont Grove
Leeds
LS2 9NS

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Marina Monzani Rocha

Universidade Presbiteriana Mackenzie

Potsdam University

The Open University

Columbia University

University of Oxford

Johns Hopkins University

Giulia Sissa

Ucla

Dr J.W. Owoyele

Tai Solarin University of Education

David M. Kaplan

University of Toronto

Strahil Panayotov

Bulgarian Academy of Sciences

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Papers by Andrew Breeze

Chapter 12 Obstetrics, gynaecology, and breast

Emergencies in Clinical Radiology, 2009

Perinatal palliative care or termination of pregnancy after prenatal diagnosis of lethal fetal abnormality

Early Hum Dev, 2007

or first postnatal blood gas) was found in 41 (49%) infants. Moderate to severe encephalopathy de... more

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Mažo gestacinio amžiaus vaisiaus augimo sulėtėjimo prognozavimas doplerometrijos būdu. DOPPLER IN THE PREDICTION OF THE SMALL FOR GESTATIONAL AGE FETUS

ABSTRACT

Operative delivery rates following induction of labour for obstetric cholestasis

Obstetric Medicine, 2011

Abstract The aim of this study was to determine whether women induced for obstetric cholestasis (... more

Gonadotrophin-releasing hormone analogues for endometriosis: bone mineral density

Reviews, 1996

Gonadotrophin-releasing hormone analogues (GnRHas) are generally well tolerated, and are effectiv... more Gonadotrophin-releasing hormone analogues (GnRHas) are generally well tolerated, and are effective in relieving the symptoms of endometriosis (Prentice 2003). Unfortunately the low oestrogen state that they induce is associated with adverse effects including an acceleration in bone mineral density (BMD) loss. To determine the effect of treatment with gonadotrophin-releasing hormone analogues (GnRHas) on the bone mineral density of women with endometriosis, compared to placebo, no treatment, or other treatments for endometriosis, including GnRHas with add-back therapy. We searched the Cochrane Menstrual Disorders and Subfertility Group&#39;s specialised register of controlled trials (23rd October 2002) and the Cochrane Central Register of Controlled Trials (Cochrane Library, issue 4, 2002). We also carried out electronic searches of MEDLINE (1966 - March Week 2 2003) and EMBASE (1980 - March Week 2 2003). We also searched the reference lists of articles and contacted researchers in the field. Prospective, randomised controlled studies of the use of GnRHas for the treatment of women with endometriosis were considered, where bone density measurements were an end point. The control arm of the studies was either placebo, no treatment, another medical therapy for endometriosis, or GnRHas with add-back therapy. Two reviewers (JF and MS) independently assessed trial quality and extracted data. Study authors were contacted for additional information. Thirty studies involving 2,391 women were included, however only 15, involving 910 women, could be included in the meta-analysis. The meta-analysis showed that danazol and progesterone + oestrogen add-back are protective of BMD at the lumbar spine both during treatment and for up to six and twelve months after treatment, respectively. Between the groups receiving GnRHa and the groups receiving danazol/gestrinone, there was a significant difference in percentage change of BMD after six months of treatment, the GnRH analogue producing a reduction in BMD from baseline and danazol producing an increase in BMD (SMD -3.43, 95 % CI -3.91 to -2.95). Progesterone only add-back is not protective; after six months of treatment absolute value BMD measurements of the lumbar spine did not differ significantly from the group receiving GnRH analogues (SMD 0.15, 95 % CI -0.21 to 0.52). In the comparison of GnRHa versus GnRHa + HRT add-back, that is oestrogen + progesterone or oestrogen only, there was a significantly bigger BMD loss in the GnRHa only group (SMD -0.49, 95 % CI -0.77 to -0.21). These numbers reflect the absolute value measurements at the lumbar spine after six months of treatment. Due to the small number of studies in the comparison we are unable to conclude whether calcium-regulating agents are protective. No difference was found between low and high dose add-back regimes but again only one study was identified for this comparison. Only one study comparing GnRH analogues with placebo was identified, but the study gave no data. No studies comparing GnRH with the oral contraceptive pill (OCP) or progestagens were identified. Both danazol and progesterone + oestrogen add-back have been shown to be protective of BMD, while on treatment and up to six and 12 months later, respectively. However, by 24 months of follow-up there was no difference in BMD in those women who had HRT add-back. Studies of danazol versus GnRHa did not report long-term follow-up. The significant side effects associated with danazol limit its use.

OP03.02: Diagnostic sensitivity and clinical value of prenatal ultrasound, post-mortem magnetic resonance imaging and conventional autopsy in structural fetal abnormality

Ultrasound in Obstetrics and Gynecology, 2009

Down syndrome risk. Of the 56 cases of trisomy 21 (1,2%), 25 were males and 31 females (P = 0,74)... more Down syndrome risk. Of the 56 cases of trisomy 21 (1,2%), 25 were males and 31 females (P = 0,74). Detection rate for trisomy 21 was 84% in males and 87% in females (P=0,8). Free beta HCGMoM, NTMoM and PAPPAMoM were not significantly different between male and female trisomy 21 fetuses. Conclusions: There is a trend towards female fetuses having a higher chance of increased risk at the combined test. There are no gender differences in the detection rate of trisomy 21. Whether risk assessment protocols need to become gender specific needs further investigation.

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OP03.03: Diagnostic sensitivity and clinical value of prenatal ultrasound, post-mortem magnetic resonance imaging and conventional autopsy for late miscarriage and stillbirth

Ultrasound in Obstetrics and Gynecology, 2009

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P09.03: What is the value of MRI post-mortem in pregnancy loss? Results from a pilot study

by Andrew Breeze and Christoph Lees

Ultrasound in Obstetrics and Gynecology, 2004

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Poor Obstetric Outcome in Subsequent Pregnancies in Women With Prior Fetal Death

Obstetrics & Gynecology, 2005

Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more

Is Perinatal Post-Mortem Mri Ready for Routine Clinical Practice?

Fetal and Maternal Medicine Review, 2013

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Perinatal palliative care or termination of pregnancy after prenatal diagnosis of lethal fetal abnormality

Early Human Development, 2007

or first postnatal blood gas) was found in 41 (49%) infants. Moderate to severe encephalopathy de... more

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OC50: Use of a confidence scale in reporting normal and abnormal fetal anatomy on postmortem MRI

by Andrew Breeze and Christoph Lees

Ultrasound in Obstetrics and Gynecology, 2006

Objectives Postmortem magnetic resonance imaging (MRI) may be an alternative to conventional auto... more Objectives Postmortem magnetic resonance imaging (MRI) may be an alternative to conventional autopsy. However, it is unclear how confident radiologists are in reporting such studies. We sought to determine the confidence with which radiologists report on various fetal organs by developing a scale to express their confidence of normality and abnormality, and to place this in the context of a pathological diagnosis of whether the organ was in fact normal or abnormal.

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OP06.04: Postmortem fetal lung volumetry using MRI and comparison to lung weights at autopsy

by Andrew Breeze, Christoph Lees, and Ilse Joubert

Ultrasound in Obstetrics and Gynecology, 2006

Objectives Following perinatal death, organ weights at autopsy may provide evidence of growth res... more Objectives Following perinatal death, organ weights at autopsy may provide evidence of growth restriction and pulmonary hypoplasia. Whilst postmortem magnetic resonance imaging (MRI) may provide comparable information to autopsy about structural abnormalities, its ability to provide reproducible data about organ size has yet to be determined. We examined the feasibility of using postmortem MRI to provide estimates of organ size and weight.

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OC099: How well is normal fetal anatomy visualised at post-mortem MRI?

by Andrew Breeze and Christoph Lees

Ultrasound in Obstetrics and Gynecology, 2004

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Prospective audit of a one-centre combined nuchal translucency and triple test programme for the detection of trisomy 21

by Andrew Breeze and Christoph Lees

Prenatal Diagnosis, 2005

To determine detection and false-positive rates for trisomy 21 using two-stage combined nuchal tr... more To determine detection and false-positive rates for trisomy 21 using two-stage combined nuchal translucency (NT) and triple testing, whilst disclosing abnormal nuchal measurements at the scan. A prospective audit in a UK women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s hospital, of 3188 women with singleton pregnancies, requesting screening for trisomy 21. Median age was 37 years (range 19-46). Women were offered NT screening at 11 to 14 weeks. Those with NT &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =3 mm were offered chorionic villus sampling. Those declining CVS, and those with NT &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;3 mm, were offered early triple tests. Women with a term combined risk of trisomy 21 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 1:250, based on age, NT, and triple test results were offered amniocentesis. Using a 3-mm NT &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;cut-off&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; identified 16/25 cases of trisomy 21 (64%; 95% CI 38.8, 78.9). Of 2725 women who had a combined nuchal plus triple test assessment, 79 (2.6%) had a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 1:250 term risk of trisomy 21. Forty (1.3%) had amniocentesis identifying 6/9 remaining cases (67%:95% CI:27.9, 92.5). Overall, the detection rate was 88% (95% CI:68.8, 97.5) for a 4.8% FPR. For the screened population, to achieve an 88% detection rate using the triple test alone, the predicted FPR would be 20%. Conversely, for an FPR of 4.8% using the triple test alone, the detection rate would be only 60%. In a high-risk group, the combination of NT with triple test offers detection of trisomy 21 at least equivalent to either test, while allowing disclosure of an abnormal NT at the scan and reducing the FPR. Importantly, the FPR is less than 5%, considerably lower than expected for triple test alone for this population.

Obstetric and neonatal outcomes in severe fetal ventriculomegaly

by Andrew Breeze, Christoph Lees, and Peta Alexander

Prenatal Diagnosis, 2007

ObjectiveTo determine the early outcome and the incidence of associated structural anomalies in p... more ObjectiveTo determine the early outcome and the incidence of associated structural anomalies in pregnancies complicated by severe fetal ventriculomegaly (VM).To determine the early outcome and the incidence of associated structural anomalies in pregnancies complicated by severe fetal ventriculomegaly (VM).MethodsA review of cases of severe fetal VM (posterior horn of lateral ventricle > 15 mm at referral or during prenatal follow-up) referred to a fetal medicine centre in Eastern England over 4 years from 2001 was made. Results of specialist prenatal investigations including ultrasound (US), karyotype, antiplatelet antibodies and congenital infection screen were noted. Neonatal clinical and cranial US findings, autopsy findings and neurodevelopmental follow-up at 4 months were obtained.A review of cases of severe fetal VM (posterior horn of lateral ventricle > 15 mm at referral or during prenatal follow-up) referred to a fetal medicine centre in Eastern England over 4 years from 2001 was made. Results of specialist prenatal investigations including ultrasound (US), karyotype, antiplatelet antibodies and congenital infection screen were noted. Neonatal clinical and cranial US findings, autopsy findings and neurodevelopmental follow-up at 4 months were obtained.ResultsTwenty cases of severe VM were identified, including 3 with spina bifida. Median gestation at diagnosis was 28 weeks (range 16–36 weeks). Twelve cases had additional intra-cranial abnormalities and two had abnormalities outside the central nervous system. One case was complicated by toxoplasmosis. There was one case of trisomy 21. Ten pregnancies were terminated. Ten babies were live born, all of whom had VM confirmed, and two of these babies died within 4 months. Of the remaining eight, seven have abnormal neurodevelopment.Twenty cases of severe VM were identified, including 3 with spina bifida. Median gestation at diagnosis was 28 weeks (range 16–36 weeks). Twelve cases had additional intra-cranial abnormalities and two had abnormalities outside the central nervous system. One case was complicated by toxoplasmosis. There was one case of trisomy 21. Ten pregnancies were terminated. Ten babies were live born, all of whom had VM confirmed, and two of these babies died within 4 months. Of the remaining eight, seven have abnormal neurodevelopment.ConclusionsSevere VM is often diagnosed after the threshold of viability. Termination of pregnancy was requested in about half the cases owing to the risk of long-term neurodisability, and in all cases diagnosed before 24 weeks. In those live born, there was abnormal outcome in all but one. Copyright © 2006 John Wiley & Sons, Ltd.Severe VM is often diagnosed after the threshold of viability. Termination of pregnancy was requested in about half the cases owing to the risk of long-term neurodisability, and in all cases diagnosed before 24 weeks. In those live born, there was abnormal outcome in all but one. Copyright © 2006 John Wiley & Sons, Ltd.

Perinatal Postmortems: What Is Important to Parents and How Do They Decide

by Andrew Breeze and Christoph Lees

Abstract: Background: Falling consent rates for postmortems, regardless of age of death, have b... more Abstract: Background: Falling consent rates for postmortems, regardless of age of death, have been widely reported in recent years. The aim of this study was to explore parental attitudes to, and decision-making about, a perinatal postmortem after termination for fetal abnormality, late miscarriage, or stillbirth.Methods: A prospective self-completion questionnaire was given to 35 women and their partners. The participants had experienced second or third trimester pregnancy loss in a single fetal medicine and delivery unit in the United Kingdom and were making decisions about having a postmortem. They were asked to complete a questionnaire about their attitudes to, and expectations of, a perinatal postmortem.Results: Thirty-one questionnaires were received from parents of 17 babies (49% of those asked; 16 from mothers, 15 from fathers). Parents of nine babies (53%) said they would agree to a full postmortem, of three babies to a limited postmortem, and of four babies to an external examination only; one couple were undecided. The most important issues for the parents in this study that related to their decisions about a postmortem centered on the need for information, both for future planning and about what had happened. Moderately important issues related to altruism, which is, improving medical knowledge and helping other parents experiencing similar bereavement. Among the lowest scoring issues were potential barriers, such as concerns about cultural or religious acceptability of a postmortem, funeral delays, and what would happen to the baby’s body.Conclusions: Bereaved parents who participated in this study, where postmortem consent rates were relatively high, thought that their need for knowledge eclipsed assumed barriers when deciding whether or not to have a postmortem for their baby. (BIRTH 39:1 March 2012)

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Attitudes to perinatal postmortem: parental views about research participation

To study parental attitudes to participating in questionnaire research about perinatal postmortem... more To study parental attitudes to participating in questionnaire research about perinatal postmortem immediately after late miscarriage, stillbirth and termination for fetal abnormality. Prospective self-completion questionnaire. UK fetal medicine and delivery unit. 35 women and their partners after second or third trimester pregnancy loss, making decisions about having a postmortem. Participants were asked to complete a questionnaire about postmortem decision-making which included questions about their attitudes to taking part in research. Prior to giving full approval for the study, the Research Ethics Committee (REC) requested feedback after 10 questionnaires had been returned. Responses from the first 10 participants were positive about the research and the REC allowed the study to continue. 31 questionnaires were received from parents of 17 babies (49% of those asked; 16 from mothers, 15 from fathers). Of the 22 participants who answered a question about the impact of participating in this research, 73% stated that completing the questionnaire had helped them feel better about the decision whether or not to consent to postmortem and none reported any adverse effect of completing the questionnaire. Additional comments made by 19 participants supported this finding. Research into this sensitive area of perinatal medicine where there is a poor outcome is possible and is indeed well received by many parents. RECs should not automatically take a negative stance towards studies of this type.

Prediction and perinatal outcomes of fetal growth restriction

Seminars in Fetal & Neonatal Medicine, 2007

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Feasibility of percutaneous organ biopsy as part of a minimally invasive perinatal autopsy

by Andrew Breeze and Christoph Lees

Virchows Archiv : an international journal of pathology, 2008

To determine the feasibility of percutaneous fetal organ biopsies in the context of a ‘minimally ... more To determine the feasibility of percutaneous fetal organ biopsies in the context of a ‘minimally invasive’ perinatal autopsy after stillbirth and termination for abnormality is the aim of this study. We assessed successful biopsy rate and the proportion adequate for histological examination in 30 fetuses undergoing organ sampling before autopsy. The relationship between gestational age, body weight, death–biopsy interval, operator experience and successful biopsy rate was investigated. Significant findings from conventional block histology were compared with corresponding percutaneous biopsies. Of 210 organ biopsies attempted from seven target organs, 107 were obtained, of which 94 were adequate for pathological comment. The median delivery–autopsy interval was 4 (range 2–11) days. Adequate samples were obtained from the lung in 86% cases (95% CI 68, 96%), liver 76% (95% CI 56, 90%) and less frequently for the myocardium, kidney, adrenal, thymus and spleen. There was no relationship between biopsy success and time to biopsy, gestational age, body weight and user experience. No histological abnormalities found at autopsy were diagnosed from needle biopsies. Although targeted percutaneous biopsies appear feasible for some organs, fewer than 50% of all biopsies are adequate for histological examination. This technique cannot be considered to provide useful clinical information as part of a ‘minimally invasive’ perinatal autopsy.

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Chapter 12 Obstetrics, gynaecology, and breast

Emergencies in Clinical Radiology, 2009

Perinatal palliative care or termination of pregnancy after prenatal diagnosis of lethal fetal abnormality

Early Hum Dev, 2007

or first postnatal blood gas) was found in 41 (49%) infants. Moderate to severe encephalopathy de... more

Download

Mažo gestacinio amžiaus vaisiaus augimo sulėtėjimo prognozavimas doplerometrijos būdu. DOPPLER IN THE PREDICTION OF THE SMALL FOR GESTATIONAL AGE FETUS

ABSTRACT

Operative delivery rates following induction of labour for obstetric cholestasis

Obstetric Medicine, 2011

Abstract The aim of this study was to determine whether women induced for obstetric cholestasis (... more