Use this URL to cite or link to this record in EThOS:
Title: Improving the prevention and outcomes of severe complications of pregnancy through international collaborative and comparative studies
Author: McCall, Stephen J.
ISNI:       0000 0004 7654 5832
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2019
Availability of Full Text:
Access from EThOS:
Full text unavailable from EThOS. Restricted access.
Access from Institution:
Background: International collaborations have been set up to complete combined and comparative studies to improve the evidence to support the prevention and management of severe and rare complications of pregnancy. The utility of such collaborative studies has yet to be tested. This DPhil aims to explore the utility of multinational studies of severe and rare complications of pregnancy. Methods: Secondary analysis and primary data collection through an international collaboration (INOSS) were used to address four clinical research areas; extreme maternal obesity, massive transfusion in major obstetric haemorrhage, abnormally invasive placenta and anaphylaxis in pregnancy. Results: A pooled analysis of two national studies of extreme maternal obesity enabled the examination of a rare exposure group (BMI ≥60 kg/m2). Nevertheless, the combination of two national studies did not allow the examination of the most uncommon outcomes, such as perinatal death or stillbirth. A comparison of five population-based studies of massive transfusion in obstetric haemorrhage showed that haemostatic features varied according to aetiology. It also demonstrated the large variation in blood products used between countries. A binational study on abnormally invasive placenta enabled the examination of the association between outcomes and an uncommon management in a rare complication of pregnancy. A prospective international study of a very rare complication of pregnancy, anaphylaxis, overcame the limitations of comparability and provided a more precise estimate of the causal agents and outcomes associated with this complication. Discussion: Multinational studies are feasible and can be used to address a multitude of clinical questions. They provide the comparison of management across nations, which empowers countries to benchmark their clinical care against that of other countries. The pooling of data creates a unique examination of uncommon modalities of management and a rare exposure group. Prospective studies overcome comparability issues and provide a more robust pooled analysis.
Supervisor: Kurinczuk, Jennifer ; Knight, Marian Sponsor: Medical Research Council
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Epidemiology ; Population Health ; Obstetrics