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Table 11 Research gaps investigating interventions to prevent intrapartum stillbirths

From: Reducing stillbirths: interventions during labour

Biodynamics and descriptive studies
   • Frequency of uterine rupture in pregnancies subsequent to Caesarean section in rural settings
   • Dynamics of maternal hyperoxygenation in placental perfusion and feto-placental circulation (risk or benefit to fetus?)
   • Drug safety studies (fetal/neonatal outcomes): magnesium sulphate
   • Safety of misoprostol for induction of labour
     ◦ Vaginal misoprostol optimal dosing and dose-range studies
Pilot/clinical/cohort studies of interventions
   • Trials/comparisons of lesser-studied induction methods
     ◦ Extra-amniotic prostaglandins
     ◦ IV prostaglandins
   • Feasibility and effectiveness of oral misoprostol administration in low-resource settings
   • Foley catheter insertion for pre-induction cervical ripening
   • Transabdominal amnioinfusion, especially in cases of intact membranes
   • Effective interventions for pre-term labour
   • Acceptability and utility of inexpensive manual vacuum extractors compared to forceps for assisted vaginal delivery
Rigorously designed large RCTs powered to detect impact on stillbirth
   • Induction vs. expectant management for macrosomia and mild pre-eclampsia
   • Comparison of first attempting assisted vaginal delivery in operating theatre vs. immediate Caesarean for obstructed labour in low-/middle-income countries
   • Distress-to-decision-to-incision studies for Caesarean in low-/middle-income country settings
   • Planned Caesarean vs. vaginal breech trials to confirm or refute recommendation of Term Breech Trial for routine policy of planned Caesarean for breech
   • Impact of hyperoxygenation on stillbirth rate
   • Impact of amnioinfusion on stillbirth rate
Large effectiveness trials at scale or population level
   • Unmet obstetric need studies reporting stillbirth outcomes (in addition to maternal impact)
   • Association of facility quality improvement in comprehensive EOC/EmOC services with perinatal outcomes