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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)