Velayutham Thangaratinam, Shakila Selvambigai (2011)
Ph.D. thesis, University of Birmingham.
Objective To undertake Health Technology Assessment (HTA) in maternal and perinatal medicine for tests and treatment in the areas of pre eclampsia, preterm labour, epilepsy and congenital heart disease (CHD) in newborn. Methods The work undertaken in the thesis is divided into 4 sections: Delphi survey of practice; Systematic review of reviews; Systematic reviews of therapeutic effectiveness; Systematic reviews of test accuracy Results The Delphi survey identified blood pressure to be the best predictor of complications. A significant benefit of progestational agents was observed in reducing preterm delivery before 37 weeks (OR 0.42, 95% CI 0.31 to 0.57). The combined rate of seizure deterioration was 0.40 (95% CI 0.26 to 0.55) in pregnant women with epilepsy on lamotrigine dosage based on serum levels compared to 0.73 (95% CI 0.56 to 0.86) in those managed by clinical features only. The abstracts of 19,500 citations were reviewed to identify the studies of accuracy of tests in pre eclampsia including proteinuria, uric acid, liver function tests, symptoms and blood pressure. The sensitivity and specificity were 0.63 (95% CI 0.39, 83) and 0.998% (95% CI, 0.99, 100) respectively for detecting CHD in the newborn by pulse oximetry. Conclusion Through the HTA of tests and treatment in priority areas of maternal and perinatal medicine, the thesis has led to the generation of clinical recommendation where there was clear evidence of benefit and for further research where there were gaps in evidence.
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