Table 11

Research gaps investigating interventions to prevent intrapartum stillbirths

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

Darmstadt et al. BMC Pregnancy and Childbirth 2009 9(Suppl 1):S6   doi:10.1186/1471-2393-9-S1-S6

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