Table 19 Research gaps
From: Reducing stillbirths: screening and monitoring during pregnancy and labour
| Pilot/cohort studies of interventions |
|---|
| • Alternative imaging or diagnostic technologies (alternatives to X-ray pelvimetry) to predict cephalopelvic disproportion in the antepartum period |
| • Pathophysiology of impaired placentation and identification of clinical markers of poor placentation/perfusion to develop tests of stillbirth risk |
| • Development of optimal methodologies for vibroacoustic stimulation (frequency, placement, amplitude, etc), and studies of efficacy and predictive reliability |
| • Safety of vibroacoustic stimulation (auditory function, cognitive development) and pulse oximetry (cognitive development) |
| • Interventions to prevent and treat oligohydramnios, particularly in cases of intact membranes |
| • Non-interventional sensitivity, specificity, and predictive value testing of untested screening techniques in unselected populations (low- and high-risk pregnant women) |
| • Development of predictive variables for stillbirth at term |
| • Low-tech strategies, such as the partograph, for identifying high-risk pregnancies in low-resource settings |
| • New adjunctive techniques to improve the positive predictive value of fetal distress and hypoxia of cardiotocography |
| Well-designed RCTs of interventions powered to detect stillbirth rates |
| • Community-based pregnancy risk screening schemes |
| • Formal fetal movement monitoring in high-risk pregnancies |
| ◦ Comparisons of different methods |
| ◦ Impact of timing from monitoring-to-intervention on perinatal mortality |
| • Optimal combinations of tests to screen for fetal growth restriction |
| • Optimal management of fetal growth restriction and timing of delivery |
| • Ultrasound assessment of placental appearance (lesions and calcifications) in high-risk pregnancy |
| • Ability of uterine artery Doppler ultrasound in combination with other testing for pre-eclampsia prediction and subsequent development of prevention measures for women at highest risk |
| • Optimising glycaemic control in managing diabetes mellitus in pregnancy |
| • Assessment of stillbirth risk in instances of gestational diabetes and impaired glucose tolerance (little data compared to pre-existing diabetes mellitus) |
| • Usefulness of BPP in identifying fetal compromise |
| • Vibroacoustic stimulation studies in labour |
| • Impact of in-hospital fetal surveillance units on stillbirth outcomes |
| • Partograph versus no partograph use |
| Effectiveness and cost-effectiveness trials in large populations/at scale |
| • Cost-benefit analyses of routine ultrasound for gestational age dating and multiple pregnancy detection in resource-poor settings |
| • Cost-effectiveness studies of fetal surveillance units in hospitals |
| • Safety of out-of-hospital bed rest and outpatient fetal surveillance in high-risk pregnancies in resource-poor settings (including economic analyses) |