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Zambuto SG, Scott AK, Oyen ML. Beyond 2D: Novel biomaterial approaches for modeling the placenta. Placenta 2024:S0143-4004(24)00073-0. [PMID: 38514278 DOI: 10.1016/j.placenta.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/09/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
This review considers fully three-dimensional biomaterial environments of varying complexity as these pertain to research on the placenta. The developments in placental cell sources are first considered, along with the corresponding maternal cells with which the trophoblast interact. We consider biomaterial sources, including hybrid and composite biomaterials. Properties and characterization of biomaterials are discussed in the context of material design for specific placental applications. The development of increasingly complicated three-dimensional structures includes examples of advanced fabrication methods such as microfluidic device fabrication and 3D bioprinting, as utilized in a placenta context. The review finishes with a discussion of the potential for in vitro, three-dimensional placenta research to address health disparities and sexual dimorphism, especially in light of the exciting recent changes in the regulatory environment for in vitro devices.
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Affiliation(s)
- Samantha G Zambuto
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA; Center for Women's Health Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Adrienne K Scott
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA; Center for Women's Health Engineering, Washington University in St. Louis, St. Louis, MO, USA; Center for Regenerative Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Michelle L Oyen
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA; Center for Women's Health Engineering, Washington University in St. Louis, St. Louis, MO, USA; Center for Regenerative Medicine, Washington University in St. Louis, St. Louis, MO, USA.
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Sayres L, Flockton AR, Ji S, Rey Diaz C, Gumina DL, Su EJ. Angiogenic Function of Human Placental Endothelial Cells in Severe Fetal Growth Restriction Is Not Rescued by Individual Extracellular Matrix Proteins. Cells 2023; 12:2339. [PMID: 37830553 PMCID: PMC10572031 DOI: 10.3390/cells12192339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/14/2023] Open
Abstract
Severe fetal growth restriction (FGR) is characterized by increased placental vascular resistance resulting from aberrant angiogenesis. Interactions between endothelial cells (ECs) and the extracellular matrix (ECM) are critical to the complex process of angiogenesis. We have previously found that placental stromal abnormalities contribute to impaired angiogenesis in severe FGR. The objective of this research is to better characterize the effect of individual ECM proteins on placental angiogenic properties in the setting of severe FGR. ECs were isolated from human placentae, either control or affected by severe FGR, and subjected to a series of experiments to interrogate the role of ECM proteins on adhesion, proliferation, migration, and apoptosis. We found impaired proliferation and migration of growth-restricted ECs. Although individual substrates did not substantially impact migratory capacity, collagens I, III, and IV partially mitigated proliferative defects seen in FGR ECs. Differences in adhesion and apoptosis between control and FGR ECs were not evident. Our findings demonstrate that placental angiogenic defects that characterize severe FGR cannot be explained by a singular ECM protein, but rather, the placental stroma as a whole. Further investigation of the effects of stromal composition, architecture, stiffness, growth factor sequestration, and capacity for remodeling is essential to better understand the role of ECM in impaired angiogenesis in severe FGR.
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Affiliation(s)
- Lauren Sayres
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Amanda R. Flockton
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Shuhan Ji
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Carla Rey Diaz
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Diane L. Gumina
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Emily J. Su
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
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Edwards C, Cavanagh E, Kumar S, Clifton VL, Borg DJ, Priddle J, Wille ML, Drovandi C, Fontanarosa D. Shear wave velocity measurement of the placenta is not limited by placental location. Placenta 2023; 131:23-27. [PMID: 36469959 DOI: 10.1016/j.placenta.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/22/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Ultrasound elastography shows diagnostic promise via the non-invasive determination of placental elastic properties. A limitation is a potential for inadequate measurements from posterior placentae. This study aimed to analyse placental position's influence on measures of shear wave elastography (SWV). METHODS SWV elastography measurements were obtained via ultrasound at 24, 28 and 36 weeks gestation from 238 pregnancies. . The placental position was labelled as either anterior, posterior or fundal/lateral. Average SWV measurements (m/s) and the corresponding standard deviations (SD) were used for data analysis. RESULTS There was a statistically significant difference between SWV recorded from anterior (1.33 ± 0.19)m/s and posterior (1.39 ± 0.18)m/s placentae (p < 0.001). However, the average sampling depth between these groups was significantly different (3.98 cm vs. 5.38 cm, p < 0.001). There was no statistically significant difference between SWV when measurements were compared at similar depths, regardless of placental location. The addition of placental position to a previously developed mixed-effects model confirmed placental position did not result in improved SWV measurements. In this model, sampling depth remained the best predictor for SWV. CONCLUSIONS This study showed that placental position does not influence the accuracy or reliability of SWV.
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Affiliation(s)
- Christopher Edwards
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Mater Research Institute-University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia.
| | - Erika Cavanagh
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Mater Research Institute-University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Sailesh Kumar
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Mater Research Institute-University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4000, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia.
| | - Vicki L Clifton
- Mater Research Institute-University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4000, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
| | - Danielle J Borg
- Mater Research Institute-University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4000, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
| | - Jacob Priddle
- School of Mathematical Sciences, Faculty of Science, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Centre for Data Science, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Marie-Luise Wille
- School of Mechanical, Medical, and Process Engineering, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD, 4000, Australia; ARC Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Christopher Drovandi
- School of Mathematical Sciences, Faculty of Science, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Centre for Data Science, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Davide Fontanarosa
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, 4000, Australia
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Gupta A, Immanuel J, Ho V, Dalal R, Symons P, Simmons D. Placental abnormalities in type 1 and type 2 diabetes mellitus: a systematic review and metaanalysis of shear wave elastography. Am J Obstet Gynecol MFM 2022; 4:100736. [PMID: 36049626 DOI: 10.1016/j.ajogmf.2022.100736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to describe the placental changes occurring in women with preexisting diabetes mellitus and to determine if elastography can detect placental changes in vivo. DATA SOURCES PubMed, Embase, Medline, and Cochrane were searched to identify English language studies published until July 2020. STUDY ELIGIBILITY CRITERIA 1) For key question 1, studies that described histopathologic changes in placentas from women with known diabetes mellitus and 2) for key question 2, those that described structural-placental changes detectable by elastography in high-risk pregnancies (eg, those complicated by preeclampsia and/or fetal growth restriction), were included. METHODS For key question 1, we grouped placental pathologies using the Amsterdam International Consensus Group definitions. For key question 2, we conducted a metaanalysis including all data from studies reporting placental stiffness in meters per second (m/s) or kilopascals (kPa). The mean difference (95% confidence interval) was calculated using a random effects model. RESULTS Data were extracted from 14 studies of placental histopathology in women with known diabetes. In this group, a wide variety of placental histopathologic changes are described, though none are considered pathognomonic. The histopathologic changes including maternal vascular malperfusion, fetal vascular malperfusion, and/or infectious/inflammatory/other changes were divided into 3 broad categories on the basis of presumed etiology. A total of 15 studies reported the placental stiffness scores in women with a high-risk pregnancy vs those with a normal pregnancy. Only 1 reported stiffness scores for placentas in women with preexisting diabetes mellitus (N<10 women). Pooled analysis of 14 studies with available data included 478 "high-risk pregnancies" and 828 control or healthy pregnancies. Maternal-derived pathologies resulted in higher placental stiffness (mean difference 4.5 kPa [95% confidence interval, 3.16-5.87]) compared with control or healthy pregnancies. Fetal-derived pathologies also resulted in higher placental stiffness (mean difference of 6.5 kPa [95% confidence interval, 1.08-11.86]) compared with control or healthy pregnancies. CONCLUSION Shear wave elastography may provide an in vivo approximation of placental histopathology in women with certain kinds of high-risk pregnancies. A high-risk pregnancy may involve maternal- and fetal-derived pathologies. Further studies, particularly in women with preexisting diabetes, are needed to confirm this observation.
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Affiliation(s)
- Akhil Gupta
- Macarthur Clinical School of Medicine, Western Sydney University, New South Wales, Australia (Drs Gupta, Immanuel, Ho, Dalal, and Simmons); Department of Medicine, Campbelltown Hospital, Sydney, New South Wales, Australia (Drs Gupta, Ho, and Simmons); Department of Diabetes and Endocrinology, Blacktown Hospital, Sydney, New South Wales, Australia (Dr Gupta).
| | - Jincy Immanuel
- Macarthur Clinical School of Medicine, Western Sydney University, New South Wales, Australia (Drs Gupta, Immanuel, Ho, Dalal, and Simmons)
| | - Vincent Ho
- Macarthur Clinical School of Medicine, Western Sydney University, New South Wales, Australia (Drs Gupta, Immanuel, Ho, Dalal, and Simmons)
| | - Raiyomand Dalal
- Macarthur Clinical School of Medicine, Western Sydney University, New South Wales, Australia (Drs Gupta, Immanuel, Ho, Dalal, and Simmons)
| | - Patricia Symons
- South Western Sydney Clinical School, UNSW Medicine, Warwick Farm, Australia (Dr Symons)
| | - David Simmons
- Macarthur Clinical School of Medicine, Western Sydney University, New South Wales, Australia (Drs Gupta, Immanuel, Ho, Dalal, and Simmons); Department of Medicine, Campbelltown Hospital, Sydney, New South Wales, Australia (Drs Gupta, Ho, and Simmons); Department of Anatomical Pathology, Liverpool Hospital, Sydney, New South Wales, Australia (Dr Symons).
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Saw SN, Dai Y, Yap CH. A Review of Biomechanics Analysis of the Umbilical-Placenta System With Regards to Diseases. Front Physiol 2021; 12:587635. [PMID: 34475826 PMCID: PMC8406807 DOI: 10.3389/fphys.2021.587635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Placenta is an important organ that is crucial for both fetal and maternal health. Abnormalities of the placenta, such as during intrauterine growth restriction (IUGR) and pre-eclampsia (PE) are common, and an improved understanding of these diseases is needed to improve medical care. Biomechanics analysis of the placenta is an under-explored area of investigation, which has demonstrated usefulness in contributing to our understanding of the placenta physiology. In this review, we introduce fundamental biomechanics concepts and discuss the findings of biomechanical analysis of the placenta and umbilical cord, including both tissue biomechanics and biofluid mechanics. The biomechanics of placenta ultrasound elastography and its potential in improving clinical detection of placenta diseases are also discussed. Finally, potential future work is listed.
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Affiliation(s)
- Shier Nee Saw
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Yichen Dai
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Choon Hwai Yap
- Department of Bioengineering, Imperial College London, London, United Kingdom
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Hefeda MM, Zakaria A. Shear wave velocity by quantitative acoustic radiation force impulse in the placenta of normal and high-risk pregnancy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00246-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Abstract
Background
Traditionally, the placental functional integrity is suggested by indirect ultrasound measurements like fetal growth, amniotic fluid index, and uterine and umbilical artery Doppler indices. Only recently the elasticity of the placenta is studied as a measure of placental consistency and biomechanical prosperities and may reflect the placental function. Shear wave velocity is the quantitative parameter of the shear wave elastography. A high-risk pregnancy is a situation which puts the mother, the fetus, or both at greater risk than a normal pregnancy.
Results
The shear wave velocity (SWV) showed no significant difference between the placenta of normal pregnancies in the second and third trimesters (0.85 ± 0.43 m/s and 0.89 ± 0.57 m/s, respectively). The placenta of patients with preeclampsia/eclampsia had high SWV in the second and third trimesters (2.13 ± 1.48 m/s and 2.23 ± 1.48 m/s) with a highly significant difference from the normal placenta (P < 0.001). The placentas with abnormal location (placenta previa) and penetration (placenta accreta) had higher SWV than the placenta of normal pregnancies. The mean SWV for placenta previa was 1.1 ± 0.74 m/s and 1.3 ± 0.81 m/s in the second and third trimesters, respectively, with a mildly significant difference with the normal placenta. The placenta accreta shows high mean SWV in the second and third trimesters (1.6 ± 0.65 m/s and 1.961.6 ± 0.65, respectively) which differed significantly (P < 0.001) from SWV in the normal placenta in the second and third trimesters.
Conclusion
Shear wave velocity measurement as the quantitative parameter of acoustic radiation force impulse (ARFI) elastography reflects the placental elasticity in normal and high-risk pregnancies. The SWV increases in conditions like hypertension, preeclampsia, maternal renal disease, and diabetes and reflects the structural and biomechanical abnormalities in such diseases. High shear wave velocity correlates with the incidence of growth restriction and abnormal Doppler parameters especially in the hypertensive disease. The virtual touch quantification (VTQ) can be used as a complementary diagnostic and prognostic tool in high-risk pregnancy.
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Edwards C, Cavanagh E, Kumar S, Clifton V, Fontanarosa D. The use of elastography in placental research - A literature review. Placenta 2020; 99:78-88. [PMID: 32763616 DOI: 10.1016/j.placenta.2020.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/15/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Ultrasound elastography is a technique used to quantify biomechanical changes that occur in parenchymal tissue with disease. Recent research has applied the technique to the placenta in order to investigate changes associated with uteroplacental dysfunction. We performed a literature review to summarise the current available information regarding this novel technique. METHODS Pubmed, CINAHL and Embase were searched using the terms "placenta", "ultrasound" and "elastography". Only full text studies written in English and limited to placental sonoelastography were included. RESULTS Twenty-eight studies met the inclusion criteria and were included in this review. Publications were divided into in vivo and ex vivo groups, and further categorised into four subgroups: normal pregnancy, pregnancy-induced hypertension and pre-eclampsia, fetal growth restriction and other pregnancy complications. CONCLUSION Ultrasound elastography can quantitatively assess biomechanical properties of the placenta in conditions where placental function is compromised.
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Affiliation(s)
- Christopher Edwards
- Queensland University of Technology (QUT), Faculty of Health, School of Clinical Sciences, Institute of Health and Biomedical Innovation, Brisbane, QLD, 4000, Australia; Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4101, Australia
| | - Erika Cavanagh
- Queensland University of Technology (QUT), Faculty of Health, School of Clinical Sciences, Institute of Health and Biomedical Innovation, Brisbane, QLD, 4000, Australia; Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4101, Australia
| | - Sailesh Kumar
- Queensland University of Technology (QUT), Faculty of Health, School of Clinical Sciences, Institute of Health and Biomedical Innovation, Brisbane, QLD, 4000, Australia; Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4101, Australia; University of Queensland, Faculty of Medicine, Herston, QLD, 4006, Australia.
| | - Vicki Clifton
- Mater Research Institute, University of Queensland, Level 3, Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4101, Australia; University of Queensland, Faculty of Medicine, Herston, QLD, 4006, Australia
| | - Davide Fontanarosa
- Queensland University of Technology (QUT), Faculty of Health, School of Clinical Sciences, Institute of Health and Biomedical Innovation, Brisbane, QLD, 4000, Australia.
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Saw SN, Tay JJH, Poh YW, Yang L, Tan WC, Tan LK, Clark A, Biswas A, Mattar CNZ, Yap CH. Altered Placental Chorionic Arterial Biomechanical Properties During Intrauterine Growth Restriction. Sci Rep 2018; 8:16526. [PMID: 30409992 PMCID: PMC6224524 DOI: 10.1038/s41598-018-34834-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/24/2018] [Indexed: 12/16/2022] Open
Abstract
Intrauterine growth restriction (IUGR) is a pregnancy complication due to placental dysfunction that prevents the fetus from obtaining enough oxygen and nutrients, leading to serious mortality and morbidity risks. There is no treatment for IUGR despite having a prevalence of 3% in developed countries, giving rise to an urgency to improve our understanding of the disease. Applying biomechanics investigation on IUGR placental tissues can give important new insights. We performed pressure-diameter mechanical testing of placental chorionic arteries and found that in severe IUGR cases (RI > 90th centile) but not in IUGR cases (RI < 90th centile), vascular distensibility was significantly increased from normal. Constitutive modeling demonstrated that a simplified Fung-type hyperelastic model was able to describe the mechanical properties well, and histology showed that severe IUGR had the lowest collagen to elastin ratio. To demonstrate that the increased distensibility in the severe IUGR group was related to their elevated umbilical resistance and pulsatility indices, we modelled the placental circulation using a Windkessel model, and demonstrated that vascular compliance (and not just vascular resistance) directly affected blood flow pulsatility, suggesting that it is an important parameter for the disease. Our study showed that biomechanics study on placenta could extend our understanding on placenta physiology.
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Affiliation(s)
- Shier Nee Saw
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Jess Jia Hwee Tay
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Yu Wei Poh
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Liying Yang
- Department of Obstetrics & Gynecology, Singapore General Hospital, Singapore, Singapore
| | - Wei Ching Tan
- Department of Obstetrics & Gynecology, Singapore General Hospital, Singapore, Singapore
| | - Lay Kok Tan
- Department of Obstetrics & Gynecology, Singapore General Hospital, Singapore, Singapore
| | - Alys Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Arijit Biswas
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health Systems, Singapore, Singapore
| | - Citra Nurfarah Zaini Mattar
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health Systems, Singapore, Singapore
| | - Choon Hwai Yap
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore.
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