Morris, Rachel Katherine (2011)
Ph.D. thesis, University of Birmingham.
Restriction of fetal growth and compromise of its wellbeing remain significant causes of perinatal death and childhood disability. There is a lack of scientific consensus about the best strategies for predicting these conditions before birth and thus there is uncertainty about the best management of pregnant women who might have a growth-restricted baby. This health technology assessment thesis used state of the art methods to review 337 studies including 472,544 women. It determined : 1. The accuracy of available tests for predicting small for gestational age infants (SGA) and 2. Compromise of fetal wellbeing and 3. Summarised the effectiveness of available treatments for these conditions. To allow translation of these results into patient care, the diagnostic and therapeutic information was integrated in a model based economic evaluation. This thesis has demonstrated that the tests reviewed have a limited use in screening/diagnosis for SGA/compromise of fetal and neonatal wellbeing when used in isolation. The quality of primary research was variable with recommendations being made particularly for the use of standardised and relevant outcome measures. The decision model and economic analysis identified that an effective, affordable and safe intervention applied to all mothers without prior testing is likely to be the most cost-effective strategy in the prevention of these conditions.
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