Ultrasonographic assessment of growth and estimation of birthweight in late gestation fetal sheep

An Artificial Placenta Experimental System in Sheep: Critical Issues for Successful Transition and Survival up to One Week

Objective: To describe the development of an artificial placenta (AP) system in sheep with learning curve and main bottlenecks to allow survival up to one week. Methods: A total of 28 fetal sheep were transferred to an AP system at 110–115 days of gestation. The survival goal in the AP system was increased progressively in three consecutive study groups: 1–3 h (n = 8), 4–24 h (n = 10) and 48–168 h (n = 10). Duration of cannulation procedure, technical complications, pH, lactate, extracorporeal circulation (EC) circuit flows, fetal heart rate, and outcomes across experiments were compared. Results: There was a progressive reduction in cannulation complications (75%, 50% and 0%, p = 0.004), improvement in initial pH (7.20 ± 0.06, 7.31 ± 0.04 and 7.33 ± 0.02, p = 0.161), and increment in the rate of experiments reaching survival goal (25%, 70% and 80%, p = 0.045). In the first two groups, cannulation accidents, air bubbles in the extracorporeal circuit, and thrombotic complications were the most common cause of AP system failure. Conclusions: Achieving a reproducible experimental setting for an AP system is extremely challenging, time- and effort-consuming, and requires a highly multidisciplinary team. As a result of the learning curve, we achieved reproducible transition and survival up to 7 days. Extended survival requires improving instrumentation with custom-designed devices.

Central and Peripheral Cannulation for Cardiopulmonary Bypass in Fetal Sheep: A Comparative Study

Objective:In-utero correction is an option for treatment of critical congenital heart diseases (CHDs). Fetal cardiac surgery for CHDs is dependent on the reliable use of fetal cardiopulmonary bypass (CPB), but this technology remains experimental. In this study, we established fetal CPB models with central and peripheral cannulation to explore the differences between the two cannulation strategies.

Methods: Ten fetal sheep with 90–110 gestational days were randomized into central cannulation (n = 5) and peripheral cannulation (n = 5) groups. All fetal CPB models were successfully established. At each time point (0, 30, and 60 min after initiation of CPB), echocardiography was performed. Blood samples were also collected for blood gas analysis and tests of myocardial enzymes and liver and kidney function.

Results: In the central cannulation group, right ventricular Tei index significantly increased (p = 0.016) over time. Compared with the peripheral cannulation group, the left ventricular Tei index of the central cannulation group was significantly higher (1.96 ± 0.31 vs. 0.45 ± 0.19, respectively; p = 0.028) and the stroke volume was lower (0.46 ± 0.55 vs. 2.13 ± 0.05, respectively; p = 0.008) at 60 min after CPB. Levels of liver and kidney injury markers and of acid-base balance, including alanine aminotransferase (ALT), aspartate aminotransferase/ALT ratio, blood urea nitrogen (BUN), BUN/creatinine ratio, base excess and bicarbonates, were significantly higher for peripheral than for central cannulation. Other important physiologic parameters, including heart rate, blood pressure, myocardial enzymes, umbilical artery beat index and resistance index, left ventricular Tei index, and left and right ventricular stroke volume, were comparable between the two groups.

Conclusions: Both central and peripheral cannulations can be used to establish fetal CPB models. Central cannulation causes more adverse impacts for cardiac function, whereas peripheral cannulation is more susceptible to complications related to inadequate organ perfusion.

Ultrasound monitoring of pregnancy in mini-lop rabbits

Ultrasound plays a considerable role in human and animal reproduction in terms of early detection of pregnancy, prediction of parturition time, and diagnosis of fetal abnormalities. The present study aimed to evaluate the ultrasound implementation for monitoring of gestation in mini-lop rabbits. Fifteen heads of pubertal does were selected and kept in normal conditions of feeding and temperature. Animals were mated with three bucks from the same breed. The pregnancy monitoring was begun from five days post-mating (dpm) to kindling using a 12.5 MHz ultrasonic transducer. The examinations were performed at fixed dpm for all does (5, 7, 12, 16, 20, and 26). Furthermore, randomly selected does (2-3 does per day; one doe was fixed) were subjected to daily ultrasound examination to estimate the relationship between the ultrasound biometrics with the gestational age (GA) and days to parturition. The pregnancy rate was 80%, and the mean number of live kits at birth was 4.2 in the present study. Based on the ultrasound records, the gestation length can be divided into three tertiles of pregnancy (TOP) in rabbits. The first TOP (0-10 dpm) was monitored by detecting and measuring the gestational sac diameter from 6 to 10 dpm. The 2nd TOP (11-12 dpm) was characterized by detection and measurement of Crown Rump Length and Fetal Heart Rate. From 15 to 20 dpm, bi-parietal diameter and head circumference were positively correlated with the GA (p-value < 0.05). Abdominal circumference and femur length were detectable and measurable during the 3rd TOP (21 dpm-kindling). Pregnancy was detected as early as six dpm with acceptable markers in mini-lop rabbits. Highly significant negative correlations were detected between days to parturition and the sonographic biometrics. Three abnormal fetuses were successfully detected and described, too.

B-mode ultrasound and ecobiometric parameters to assess embryonic and fetal development and estimate gestational age in goats

The aim of this study was to monitor maternal-fetal ecobiometric parameters during physiological pregnancy in goats using ultrasound to predict gestational age by establishing mathematical equations. Twenty-five Saanen goats were included in the study. Assessments were performed weekly from the 21^st day of pregnancy until parturition. The abdominal, thoracic, biparietal, and eye socket diameters; distance from the neck to snout; crown-rump, humerus, radius-ulna, metacarpal, femur, tibia, metatarsal, and placentome lengths; kidney height and length; and heart area were measured. Heart rate was obtained using the pulsed Doppler mode. The variables were correlated with gestational age using Spearman's test, and the adjustment of these variables to simple and multiple regression models was done to determine the mathematical formulas for calculating the gestational age. The highest obtained coefficients of determination (R²) were for humerus length (96.2), heart area (95.6), and distance from the neck to the snout (95.3). Only the placentome length and fetal heart rate presented low determination coefficients (R² = 54.3, R² = 45.0). The results indicated significant correlations between measures of maternal-fetal structures and gestational age, and can be used as reference values for detection of abnormalities during fetal development.

Estimation du poids du fœtus zébu peulh à partir de mesures échographiques des paramètres fœtaux

Cette étude vise à estimer le poids du fœtus zébu peulh à partir des mesures échographiques des diamètres de l’abdomen (DA), du bipariétal (DBP), du cordon ombilical (DCO), de la corne utérine (DCU) et des longueurs du fémur (LF), du tibia (LT), et du dos (LD). Elle a concerné soixante et un (n = 61) utérus gravides recueillis après abattage de femelles gestantes. Toutes les gestations étaient simples. Les examens ont été réalisés en bain d’eau au moyen d’une sonde convexe de 3,5 MHz. Les utérus ont été ensuite disséqués afin de rapporté le poids des fœtus au moyen d’une balance. Les données ont été analysées au moyen du système de régression curvilinéaire. Les formules d’estimation du poids à partir des paramètres biométriques ont été de type y = axb, où y est le poids (g), a et b_constantes, et x est le paramètre biomètrique (mm). Toutes les structures morphologiques étudiées ont présenté des corrélations positives et hautement significatives avec le poids du fœtus (p < 0,0001). Toutefois, les DA (R2 = 0,94), DBP (R2 = 0,80), et la LF (R2 = 0,81) semblent être les plus appropriés pour l’estimation du poids du fœtus. À défaut de ces paramètres, les autres structures étudiées peuvent servir de repère dans l’estimation du poids.

Maternal and fetal ultrasonographic characteristics, vulvar temperature, and vaginal mucous impedance as variables associated with the onset of parturition in term and induced pre-term ewes

The aim of this study was to assess and compare ultrasonographic characteristics of maternal and fetal structures, vulvar temperatures, and vaginal mucous impedance in pregnant ewes in the term parturition group (TPG, n = 15) and induced pre-term parturition group (IPPG; n = 15). All the measurements were taken every 12 h throughout the last gestational week. Maternal and fetal structures and the fetal heart rate (HR) were assessed using ultrasonography. The vulvar temperature and vaginal mucous impedance were determined using a non-contact infrared thermometer, and an electronic estrous detector, respectively. The vulvar temperature was less in the TPG and greater in the IPPG; the end-diastolic velocities (EDVs) of the arteries of the placentome and uterus gradually increased before parturition in the IPPG (P = 0.02, P = 0.02 and P = 0.009, respectively). The placentome shear wave velocity (SWV) was greater in the ewes of the IPPG than TPG 48, 36, and 0 h before parturition (P = 0.001). The following variables were associated with the onset of parturition within the next 12 h in the ewes of the IPPG: resistance index (< 0.54) and EDV (> 0.34 cm/s) of the uterine artery; and vulvar temperature (> 37.3 °C). A fetal kidney SWV of < 1.31 m/s was associated with the onset of parturition in the next 12 h in all the ewes. Results indicate vulvar temperature and certain maternal and fetal factors detected using ultrasonograpy may aid in determining fetal maturity and/or the time of parturition in ewes.

Relationship between fetal biometric assessment by ultrasonography and neonatal lamb vitality, birth weight and growth

Ultrasonographic examination of pregnant ewes can enable the identification of perinatal abnormalities and establish prenatal assistance responsible for minimizing morbidity and perinatal mortality. Therefore, we aimed to evaluate the feasibility of a fetal biometric analysis by ultrasonography to predict neonatal vitality and lamb growth during the first month of life. A longitudinal study was conducted with 13 healthy ewes, subjected to ultrasonographic examination every 15 days from 60^th day of pregnancy until lambing, evaluating thoracic diameter, abdominal diameter, biparietal diameter, humerus, femur and placentome length. At birth, 22 lambs were assessed through Apgar score at 5 minutes and after 1 hour. Measurement of body weight was also carried out immediately at birth and weekly during 30 days after birth. Thoracic diameter showed a significant increase between 91-105 days and 121-135 days. Conversely, abdominal diameter had a progressive growth until 106-120 days, and then, a steady development was observed. Biparietal diameter showed progressive growth only towards days 91 and 105. For the humerus length, we verified a significant increase between 106-120 days and 121-135 days, remaining unaltered onwards; while femur length continued to grow until lambing. The linear regression analysis between birth weight and biparietal diameter at 60-75 days was high (R²=0.96; P<0.0001; coefficient of variability of 3.3%). In conclusion, ultrasonographic analysis of fetal biparietal diameter at mid-pregnancy can be used as a predictor of lamb weight at birth. Moreover, assessment of femur length at final pregnancy can be employed for fetal and neonatal development estimation.

Trans-abdominal in vivo placental vessel occlusion using High Intensity Focused Ultrasound

Pre-clinically, High Intensity Focused Ultrasound (HIFU) has been shown to safely and effectively occlude placental blood vessels in the acute setting, when applied through the uterus. However, further development of the technique to overcome the technical challenges of targeting and occluding blood vessels through intact skin remains essential to translation into human studies. So too does the assessment of fetal wellbeing following this procedure, and demonstration of the persistence of vascular occlusion. At 115 ± 10 d gestational age (term~147 days) 12 pregnant sheep were exposed to HIFU (n = 6), or to a sham (n = 6) therapy through intact abdominal skin (1.66 MHz, 5 s duration, in situ ISPTA 1.3-4.4 kW.cm-2). Treatment success was defined as undetectable colour Doppler signal in the target placental vessel following HIFU exposures. Pregnancies were monitored for 21 days using diagnostic ultrasound from one day before HIFU exposure until term, when post-mortem examination was performed. Placental vessels were examined histologically for evidence of persistent vascular occlusion. HIFU occluded 31/34 (91%) of placental vessels targeted, with persistent vascular occlusion evident on histological examination 20 days after treatment. The mean diameter of occluded vessels was 1.4 mm (range 0.3-3.3 mm). All pregnancies survived until post mortem without evidence of significant maternal or fetal iatrogenic harm, preterm labour, maternal or fetal haemorrhage or infection. Three of six ewes exposed to HIFU experienced abdominal skin burns, which healed without intervention within 21 days. Mean fetal weight, fetal growth velocity and other measures of fetal biometry were not affected by exposure to HIFU. Fetal Doppler studies indicated a transient increase in the umbilical artery pulsatility index (PI) and a decrease in middle cerebral artery PI as a result of general anaesthesia, which was not different between sham and treatment groups. We report the first successful application of fully non-invasive HIFU for occlusion of placental blood flow in a pregnant sheep model, with a low risk of significant complications. This proof of concept study demonstrates the potential of this technique for clinical translation.

B-mode ultrasonography and ecobiometric parameters for assessment of embryonic and fetal development in sheep

The aim in this study was to evaluate the maternal-fetal development during physiological gestation in sheep by means of ultrasonography and to predict the gestational age by mathematical formulae. Thirty Santa Inês sheep were included. Evaluations were performed weekly from the 3rd to 21st gestational week. The Shapiro test was used to determine normality of the data, and Spearman test was used for determining correlations of real or transformed measurements as gestation advanced. If there was a significant difference detected, variable adjustments and gestational weeks were tested using regression models. Significance level was set at 5% and the results presented as mean ± SD. Principal components analysis (PCA) was used for data clustering and graphic analysis. The gestational vesicle, abdominal, thoracic, biparietal, ocular orbit, and placentome diameters; and the lengths of crown-to-rump, nuchal to snout, scapula, humerus, radius, metacarpus, femur, tibia, metatarsal, heart length, heart width and kidneys were measured. Using pulsed Doppler ultrasonography, heart rate (HR) was obtained. The greatest coefficients of determination (r²) were obtained for the biparietal diameter (BPD; 96.5%) and metacarpus length (MCAR; 93%), followed by the abdominal diameter (AD; 91.7%) and heart width (HTW; 90.2%). The PCA analysis indicated graphically that at week 8 to 9, there was no significant change related to technique, whereas, at weeks 19, 20, and 21 a decrease in growth was observed, with the greatest data variability at week 19. Ultrasonographic assessments indicated there were significant correlations between developmental stages of all maternal-fetal structures and the gestational age, which can be used as reference values for gestational age assessments and detection of development abnormalities.

An extra-uterine system to physiologically support the extreme premature lamb

In the developed world, extreme prematurity is the leading cause of neonatal mortality and morbidity due to a combination of organ immaturity and iatrogenic injury. Until now, efforts to extend gestation using extracorporeal systems have achieved limited success. Here we report the development of a system that incorporates a pumpless oxygenator circuit connected to the fetus of a lamb via an umbilical cord interface that is maintained within a closed 'amniotic fluid' circuit that closely reproduces the environment of the womb. We show that fetal lambs that are developmentally equivalent to the extreme premature human infant can be physiologically supported in this extra-uterine device for up to 4 weeks. Lambs on support maintain stable haemodynamics, have normal blood gas and oxygenation parameters and maintain patency of the fetal circulation. With appropriate nutritional support, lambs on the system demonstrate normal somatic growth, lung maturation and brain growth and myelination.

Placental vascularity and markers of angiogenesis in relation to prenatal growth status in overnourished adolescent ewes

Introduction

Placental vascularity may be important in the development of fetal growth restriction (FGR). The overnourished adolescent ewe is a robust model of the condition, with ∼50% of offspring demonstrating FGR (birthweight >2 standard deviations below optimally-fed control mean). We studied whether placental vascularity, angiogenesis and glucose transport reflect FGR severity.

Methods

Singleton pregnancies were established in adolescent ewes either overnourished to putatively restrict fetoplacental growth (n = 27) or control-fed (n = 12). At 131d (term = 145d) pregnancies were interrupted and fetuses classified as FGR (n = 17, <4222 g, -2SD below control-fed mean) or non-FGR (n = 10). Placentome capillary area density (CAD), number density (CND), surface density (CSD), and area per capillary (APC) in the fetal cotyledon (COT) and maternal caruncle (CAR) were analysed using immunostaining. COT/CAR mRNA expression of angiogenic ligands/receptors and glucose transporters were measured by qRT-PCR.

Results

Fetal weight was reduced in FGR vs. Non-FGR/Control groups. Total placentome weight was Control > Non-FGR > FGR and fetal:placental weight ratios were higher in overnourished versus Control groups. COT vascular indices were Non-FGR > FGR > Control. COT-CAD, CSD and APC were significantly greater in Non-FGR overnourished versus Control and intermediate in FGR groups. CAR vascularity did not differ. CAR-VEGFA/FLT1/KDR/ANGPT1/ANGPT2/SLC2A1/SLC2A3 mRNA was lower and COT-ANGPT2 higher in overnourished versus Control groups.

Discussion

Relative to control-intake pregnancy, overnourished pregnancies are characterised by higher COT vascularity, potentially a compensatory response to reduced nutrient supply, reflected by higher fetal:placental weight ratios. Compared with overnourished pregnancies where fetal growth is relatively preserved, overnourished pregnancies culminating in marked FGR have less placental vascularity, suggesting incomplete adaptation to the prenatal insult.

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Overnourishment of adolescent sheep dams produces FGR in approximately 50% of cases.

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Cotyledonary vascularity is increased in overnourished vs. control-intake pregnancy.

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Cotyledonary vascularity is highest in non-FGR cases, suggesting greater adaptation.

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Changes in cotyledonary vascularity are mirrored by angiopoietin-2 mRNA expression.

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Caruncular angiogenic ligands are reduced in FGR without any changes in vascularity.

Peri- and Postnatal Effects of Prenatal Adenoviral VEGF Gene Therapy in Growth-Restricted Sheep

Uterine artery (UtA) adenovirus (Ad) vector-mediated overexpression of vascular endothelial growth factor (VEGF) enhances uterine blood flow in normal sheep pregnancy and increases fetal growth in the overnourished adolescent sheep model of fetal growth restriction (FGR). Herein, we examined its impact on gestation length, neonatal survival, early postnatal growth and metabolism. Singleton-bearing ewes were evenly allocated to receive Ad.VEGF-A165 (5 × 10(10) particles/ml, 10 ml, n = 17) or saline (10 ml, n = 16) injected into each UtA at laparotomy (0.6 gestation). Fetal growth was serially monitored (blind) by ultrasound until delivery. Lambs were weighed and blood was sampled weekly and a glucose tolerance test performed (68-day postnatal age). Hepatic DNA/RNA was extracted at necropsy (83-day postnatal age) to examine methylation status of eight somatotropic axis genes. IGF1 mRNA and protein expression were measured by RT-PCR and radioimmunoassay, respectively. All pregnancies remained viable following Ad.VEGF-A165 treatment. Fetal abdominal circumference and renal volume were greater in the Ad.VEGF-A165 group compared with the saline group at 21/28 days (P ≤ 0.04) postinjection. At delivery, gestation length (P = 0.07), lamb birthweight (P = 0.08), umbilical girth (P = 0.06), and plasma glucose (P = 0.09) tended to be greater in Ad.VEGF-A165-treated lambs. Levels of neonatal intervention required to ensure survival was equivalent between groups. Absolute postnatal growth rate (P = 0.02), insulin area under the curve (P = 0.04) and carcass weight at necropsy (P = 0.04) were increased by Ad.VEGF-A165 treatment. There was no impact on markers of insulin sensitivity or methylation/expression of key genes involved in somatic growth. Ad.VEGF-A165 gene therapy increased fetal growth in a sheep FGR model, and lambs continued to thrive during the neonatal and early postnatal period.

VEGF Gene Transfer to the Utero-Placental Circulation of Pregnant Sheep to Enhance Fetal Growth

In this chapter, we describe a safe and effective approach to achieve local VEGF gene transfer to the uterine arteries in pregnant sheep using direct injection of viral vectors into the uterine arteries. This approach resulted in improved fetal growth in growth-restricted pregnancies. Adenoviral vectors encoding VEGF-A165 or a reporter gene β-galactosidase were dissolved in 10 mL normal saline shortly before administration. A midline laparotomy was performed and the course of the uterine artery identified. The main trunk (just prior to the first bifurcation) was mobilized by dissection and a vessel loop placed beneath it in order to elevate the artery, which was then occluded digitally just proximal to the planned injection site. The adenoviral solution was slowly injected over 1 min, and the occlusion was maintained for a further 4 min to maximize transduction of the downstream endothelium. After ensuring hemostasis, the abdomen was closed in layers.

Uteroplacental adenovirus vascular endothelial growth factor gene therapy increases fetal growth velocity in growth-restricted sheep pregnancies

Fetal growth restriction (FGR) occurs in ∼8% of pregnancies and is a major cause of perinatal mortality and morbidity. There is no effective treatment. FGR is characterized by reduced uterine blood flow (UBF). In normal sheep pregnancies, local uterine artery (UtA) adenovirus (Ad)-mediated overexpression of vascular endothelial growth factor (VEGF) increases UBF. Herein we evaluated Ad.VEGF therapy in the overnourished adolescent ewe, an experimental paradigm in which reduced UBF from midgestation correlates with reduced lamb birthweight near term. Singleton pregnancies were established using embryo transfer in adolescent ewes subsequently offered a high intake (n=45) or control intake (n=12) of a complete diet to generate FGR or normal fetoplacental growth, respectively. High-intake ewes were randomized midgestation to receive bilateral UtA injections of 5×10¹¹ particles Ad.VEGF-A165 (n=18), control vector Ad.LacZ (n=14), or control saline (n=13). Fetal growth/well-being were evaluated using serial ultrasound. UBF was monitored using indwelling flowprobes until necropsy at 0.9 gestation. Vasorelaxation, neovascularization within the perivascular adventitia, and placental mRNA expression of angiogenic factors/receptors were examined using organ bath analysis, anti-vWF immunohistochemistry, and qRT-PCR, respectively. Ad.VEGF significantly increased ultrasonographic fetal growth velocity at 3-4 weeks postinjection (p=0.016-0.047). At 0.9 gestation fewer fetuses were markedly growth-restricted (birthweight >2SD below contemporaneous control-intake mean) after Ad.VEGF therapy. There was also evidence of mitigated fetal brain sparing (lower biparietal diameter-to-abdominal circumference and brain-to-liver weight ratios). No effects were observed on UBF or neovascularization; however, Ad.VEGF-transduced vessels demonstrated strikingly enhanced vasorelaxation. Placental efficiency (fetal-to-placental weight ratio) and FLT1/KDR mRNA expression were increased in the maternal but not fetal placental compartments, suggesting downstream effects on placental function. Ad.VEGF gene therapy improves fetal growth in a sheep model of FGR, although the precise mechanism of action remains unclear.

Factors affecting the accuracy of pregnancy scanning in ewes

The objective was to evaluate the accuracy of pregnancy scanning by transabdominal ultrasonography and affecting factors. Altogether 44,783 ewes were registered (2008-2010), 39,724 diagnosed as pregnant and subsequently lambed. The ewes, 0.5-14 years old, were divided into 4 age and 6 breed groups and analysed. The accuracy (per cent; number of scanned fetuses/number of born lambs) decreased with increasing number of fetuses (P < 0.001). Overall accuracy was 90.3 per cent, highest (93.7 per cent) in ewes carrying one fetus, 91.9 per cent, 82.4 per cent, and 74.9 per cent in ewes with 2, 3 and ≥4 fetuses at scanning, respectively. Finnsheep ewes with highest number of lambs showed lowest accuracy (P < 0.001). Analyses of a more complete sub set of data (n = 23,396), showed that number of fetuses diagnosed, breed, age of ewe, operator and time in gestation, significantly affected the accuracy. Accuracy decreased with age of ewe (P < 0.001) and was 71.8 per cent, 91.6 per cent and 89.3 per cent for scanning at <40, 40-80 and 81-100 days of gestation, respectively (P < 0.001). In general, the numbers of fetuses were overestimated at scanning and increased gradually with number of fetuses diagnosed. In conclusion, the accuracy was affected by several factors, which should be considered when interpreting/implementing the results, especially in breeds with high fecundity.

A case of successful pregnancy in a ewe with uterus didelphys

Uterus didelphys is a rare congenital abnormality of the reproductive tract. Although it occurs in various species, there are no published reports describing pregnancy outcome in association with this abnormality. Herein we describe a case of successful unilateral singleton pregnancy in a ewe incidentally found to have uterus didelphys during the course of a biomedical research study. The pregnancy was established using assisted reproductive techniques and interrupted in late gestation, at which point the abnormality was identified. Serial ultrasound assessment of foetal biometry revealed a normal foetal growth trajectory. Despite a 45% reduction in placentome number, total placentome weight was near normal secondary to compensatory placentome growth and development. To our knowledge, this is the first detailed report of normal foetal growth in an animal with uterus didelphys and illustrates the ability of the ovine placenta to adapt to a reduced number of placentomes and maintain foetal nutrient supply.

Monitoring for potential adverse effects of prenatal gene therapy: use of large animal models with relevance to human application

Safety is an absolute prerequisite for introducing any new therapy, and the need to monitor the consequences of administration of both vector and transgene to the fetus is particularly important. The unique features of fetal development that make it an attractive target for gene therapy, such as its immature immune system and rapidly dividing populations of stem cells, also mean that small perturbations in pregnancy can have significant short- and long-term consequences. Certain features of the viral vectors used, the product of the delivered gene, and sometimes the invasive techniques necessary to deliver the construct to the fetus in utero have the potential to do harm. An important goal of prenatal gene therapy research is to develop clinically relevant techniques that could be applied to cure or ameliorate human disease in utero on large animal models such as sheep or nonhuman primates. Equally important is the use of these models to monitor for potential adverse effects of such interventions. These large animal models provide good representation of individual patient-based investigations. However, analyses that require defined genetic backgrounds, high throughput, defined variability and statistical analyses, e.g. for initial studies on teratogenic and oncogenic effects, are best performed on larger groups of small animals, in particular mice. This chapter gives an overview of the potential adverse effects in relation to prenatal gene therapy and describes the techniques that can be used experimentally in a large animal model to monitor the potential adverse consequences of prenatal gene therapy, with relevance to clinical application. The sheep model is particularly useful to allow serial monitoring of fetal growth and well-being after delivery of prenatal gene therapy. It is also amenable to serially sampling using minimally invasive and clinically relevant techniques such as ultrasound-guided blood sampling. For more invasive long-term monitoring, we describe telemetric techniques to measure the haemodynamics of the mother or fetus, for example, that interferes minimally with normal animal behaviour. Implanted catheters can also be used for serial fetal blood sampling during gestation. Finally, we describe methods to monitor events around birth and long-term neonatal follow-up that are important when considering human translation of this therapy.

Fetoplacental biometry and umbilical artery Doppler velocimetry in the overnourished adolescent model of fetal growth restriction

OBJECTIVE

The purpose of this study was to evaluate ultrasonographically fetal growth trajectories, placental biometry, and umbilical artery (UA) Doppler indices in growth-restricted pregnancies of overnourished adolescent ewes and normally developing pregnancies of control-fed ewes.

STUDY DESIGN

Singleton pregnancies were established using embryo transfer in 42 adolescent ewes that were overnourished (n = 27) or control-fed (n = 15) and were scanned at weekly intervals from 83-126 days' gestation and necropsied at 131 days' gestation (term = 145 days).

RESULTS

Ultrasonographic placental measurements were reduced and UA Doppler indices were increased from 83 days' gestation; measurements of fetal abdominal circumference and femur length, renal volume and tibia length, and biparietal diameter were reduced from 98, 105, and 112 days' gestation, respectively, in overnourished vs control-intake pregnancies.

CONCLUSION

Overnourishment of adolescent sheep dams produced late-onset asymmetric fetal growth restriction that was commensurate with brain sparing. Ultrasonographic placental biometry was already reduced and UA Doppler indices increased by mid gestation in overnourished pregnancies, preceding reduced fetal growth velocity and indicating an early nutritionally mediated insult on placental development.