Table 19

Research gaps

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)

Haws et al. BMC Pregnancy and Childbirth 2009 9(Suppl 1):S5   doi:10.1186/1471-2393-9-S1-S5

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