Stillbirth

What is the value of undertaking a study to determine the clinical and cost effectiveness of late pregnancy ultrasound to prevent adverse perinatal outcome in nulliparous women?

Addressing priority 2: NIHR Research published.

Currently, women are offered a scan at 20 weeks, but are not offered any scans after that unless a problem is identified. It is currently known that some babies with problems are not picked up by the usual abdominal examinations during antenatal check-ups. As babies that are small, large or not head first prior at birth are more likely to be sick at birth or not survive, it is thought an extra scan in late pregnancy may be helpful and improve outcomes for babies. The trial will evaluate existing evidence, consider and determine the level of appropriate support for women for whom a late scan identifies a problem, evaluate financial costs vs benefit of a screening programme and finally, taking into account all the evidence, design a study of scanning in late pregnancy. HTA will then be able to judge whether or a not a trial of scanning in late pregnancy for all women should go ahead.

Care and support for bereaved parents

Addressing priority 7: Commissioning brief advertised to researchers by the NIHR HTA Programme.

WILL (When to Induce Labour to Limit risk in pregnancy hypertension) - a multicentre, randomised controlled trial

Addressing priority 8: NIHR Research in progress.

This trial tests whether planned delivery at 38 weeks is better than monitoring women and babies until at least 40 weeks. The WILL trial will run for 3 years in about 30 UK hospitals. We will ask women to take part if they have reached 36 or 37 weeks of pregnancy and have high blood pressure and no other current problems. This trial started in June 2018.

Perinatal and 2 year neurodevelopmental outcome in late preterm fetal compromise: the TRUFFLE 2 Randomised Trial

Addressing 3 of the priorities: NIHR Research in progress.

In the last months of pregnancy, babies who are smaller or who grow more slowly than expected are at higher risk of dying in the mother's womb. Some of these smaller babies who survive may have developmental problems later in infancy. Doctors have many ways to monitor such babies in the womb but, until the baby is born, the only treatment available is to deliver the baby. If the pregnancy has reached its full term, induction of labour is the usual option. If the baby is preterm (before 37 weeks of pregnancy) the right course of action is less clear. Delivering the baby early, as soon as there are signs of problems, will minimise any damage due to lack of oxygen in the womb, but the baby may suffer harm as a result of being born prematurely. This research team is looking at the balance of risks linked with continuing the pregnancy a little longer or delivering the baby early.