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Research in obstetrics

Research output: Chapter in Book/Report/Conference proceedingChapter

Original languageEnglish
Title of host publicationIntroduction to Research Methodology for Specialists and Trainees
PublisherCambridge University Press
Pages201-207
Number of pages7
ISBN (Electronic)9781107585775
ISBN (Print)9781107699472
DOIs
Published1 Jan 2017

King's Authors

Abstract

The obstetric field provides a challenging arena for conducting good-quality research. The labour ward offers a unique environment in which rapid clinical judgement and decision-making skills must be deployed to ensure a safe outcome for baby and mother. More generally, the obstetric environment can be a difficult place for recruiting patients into trials; patients are likely to present around the clock, often with complex medical issues. Within this chapter we describe some of these challenges in more detail, using high-impact case examples to illustrate key learning points. Specifically, we focus on consenting issues in intra-partum trials, the importance of systematic review and meta-analysis in challenging environments, as well as the importance of obtaining long-term outcomes when considering the fetus and the baby. Underpinning our clinical decisions should be the diligent use of up-to-date evidence to make best-practice decisions about care. Indeed, the intra-partum period is a time when good-quality trials are vital, yet evidence is lacking. Are we any closer to facilitating research in this environment? Consenting Issues for Intra-partum Trials The safety and optimal outcome for baby is often linked, but not always directly related to the mother, and hence conflict may arise. The natural desire of a parent to put their baby’s health before their own can be hard for clinicians to ignore - and nor should they - but the anticipated morbidity and mortality for both mother and baby must be carefully weighed and considered in the often urgent actions we undertake at delivery of these infants. Underpinning these decisions should be the conscientious use of current research and evidence to make decisions about care. An Example The optimal mode of delivery of the preterm infant with a breech presentation remains one such unanswered question for obstetricians providing intra-partum care, practice often varying according to clinician and patient preference.

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