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The challenges managing pregnancies with suspected fetal macrosomia : a mixed methods evaluation
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Ewington, Lauren J. (2023) The challenges managing pregnancies with suspected fetal macrosomia : a mixed methods evaluation. PhD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b3941066
Abstract
Objectives
Macrosomic and large for gestational age (LGA) fetuses are at increased risk of shoulder dystocia and associated complications. The aim of this thesis was to explore the specific challenges when managing these pregnancies. The objectives were to investigate the predictive value of diagnostic tools, explore decision-making for birth interventions, investigate the quality of information available, synthesise the findings and make recommendations for practice.
Methods
A mixed methods approach was taken mirroring a woman’s journey from diagnosis to birth. The accuracy of ultrasound to detect LGA using a customised standard was investigated in a retrospective cohort study. A systematic review of multivariable prediction models for macrosomia / LGA was conducted to assess if they improved detection. Qualitative interviews with obstetricians were undertaken to explore how they made decisions about birth in pregnancies with suspected macrosomia / LGA. Finally, a systematic review of the online health information on induction of labour was performed. The results from the thesis were synthesised using the extended Pillar Integration Process.
Results
Three key themes were identified which make managing pregnancies with suspected macrosomia / LGA challenging. 1. Variation in practice due to varying definitions of macrosomia / LGA, conflicting national guidance and reports, organisational culture, personal experience, and defensive medical practice. 2. Diagnostic and therapeutic uncertainty making obstetricians balance unknown risks when recommending birth options for women. 3. Challenges communicating risk and facilitating shared decision-making in the context of uncertainty when there is a finite time resource available and the health information available to women varies in quality.
Conclusions
The findings highlight the need for standardisation of care, the need for better diagnostic testing, and the need to start a process to provide standardised information about risk to women to facilitate shared decision-making when managing pregnancies with suspected fetal macrosomia / LGA.
Item Type: | Thesis (PhD) | ||||
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Subjects: | R Medicine > RG Gynecology and obstetrics | ||||
Library of Congress Subject Headings (LCSH): | Fetal growth disorders -- Diagnosis, Fetal presentation, Fetus -- Growth, Birth weight -- Complications, Pregnancy -- Complications, Labor (Obstetrics) -- Complications -- Research | ||||
Official Date: | January 2023 | ||||
Dates: |
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Institution: | University of Warwick | ||||
Theses Department: | Warwick Medical School | ||||
Thesis Type: | PhD | ||||
Publication Status: | Unpublished | ||||
Supervisor(s)/Advisor: | Quenby, Siobhan ; Slowther, Anne | ||||
Format of File: | |||||
Extent: | xx, 393 pages : illustrations | ||||
Language: | eng |
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