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Open research questions in Maternal and fetal healthcare

68 unresolved questions extracted from the limitations and future-work sections of 974 Maternal and fetal healthcare papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • Despite increasing recognition of CTD‐ILD among women of reproductive age, evidence guiding pregnancy management remains limited, particularly across different levels of disease severity, with persistent gaps in understanding maternal and fetal outcomes, optimal assessment strategies, and therapeutic approaches.

    Pregnancy in CTD‐interstitial lung disease: Current evidence, clinical challenges, and a proposed management algorithm · 2026 · DOI

  • These studies also reported confirming PAS by histopathology but provided no data on the criteria used for this diagnosis. Although a higher rate of placenta previa has been repeatedly demonstrated in IVF conceptions [10-18], conflicting results have been reported on the association between fresh-ET versus FET and the risk of placenta praevia [34,35,68-71].

    In vitro fertilization and the risk of placenta accreta spectrum: a systematic review and meta-analysis · 2026 · DOI

  • The proportion meta-analyses of the incidence of PAS and placenta previa within each group, and the head-to-head meta-analyses, were limited by the availability of raw data, adjusted or unadjusted risk estimates for each outcome (Figures S3 & S4 and Tables S2-7).

    In vitro fertilization and the risk of placenta accreta spectrum: a systematic review and meta-analysis · 2026 · DOI

  • Based on the findings of the present study, the following recommendations are proposed: Strengthening Antenatal Screening and Risk Assessment o Pregnant women with a history of previous cesarean section, particularly those with two or more cesarean scars, should be considered high-risk pregnancies and closely monitored throughout antenatal care. o Early ultrasound screening should be routinely performed to identify placenta previa and possible placenta accreta spectrum disorders, allowing timely referral and management. Copyright Author (s) 2026. Distributed under Creative Commons CC-BY 4.0 Received: 08-05-2026 - Accepted: 07-07-2026 - Published: 14-07-2026 2057 Alqalam Journal of Medical and Applied Sciences.

    Risk Factors and Outcomes of Placenta Previa among Admitted Pregnant Women in Benghazi Medical Centre: A Cross-Sectional study · 2026 · DOI

  • o Prospective multicenter studies are recommended to further outcomes, and neonatal outcomes of placenta previa in Libya. investigate risk factors, maternal o Future research should evaluate the association between placenta previa and placenta accreta spectrum disorders, as well as the effectiveness of preventive and management strategies in improving outcomes.

    Risk Factors and Outcomes of Placenta Previa among Admitted Pregnant Women in Benghazi Medical Centre: A Cross-Sectional study · 2026 · DOI

  • Because clinical guidelines must be applicable across diverse patient populations, this lack of evidence may be insufficient to justify widespread changes in practice [2,20]. Therefore, while noradrenaline may be physiologically advantageous, its clinical superiority remains uncertain [15-17]. Interpretation of available findings is limited as most studies have been conducted in healthy women undergoing elective caesarean delivery.

    Phenylephrine Versus Noradrenaline for the Prevention and Treatment of Spinal-Induced Hypotension During Caesarean Section: A Literature Review · 2026 · DOI

  • Future research should determine whether the haemodynamic advantages of noradrenaline translate into meaningful clinical benefits. Larger multicentre randomised controlled trials are needed to assess maternal morbidity, patient satisfaction, recovery outcomes, and high-risk obstetric populations, where preservation of cardiac output may be particularly relevant. Greater standardisation of dosing protocols and definitions of hypotension would also improve comparison between studies. Although short-term neonatal outcomes appear comparable between phenylephrine and noradrenaline, long-term neonatal follow-up remains limited.

    Phenylephrine Versus Noradrenaline for the Prevention and Treatment of Spinal-Induced Hypotension During Caesarean Section: A Literature Review · 2026 · DOI

  • Based on the findings of this study, the following recommendations are proposed: 1. Strengthening active management of the third stage of labour (AMTSL): Routine and consistent implementation of AMTSL including prophylactic oxytocin, controlled cord traction, and uterine massage should be enforced in all delivery rooms. 2. Availability of essential resources: Continuous supply of uterotonic drugs (particularly oxytocin), intravenous fluids, blood, and blood products must be guaranteed across all maternity units. 3. Early identification and risk assessment: Women with identifiable risk factors (prolonged labour, multiple pregnancy, macrosomia, grand multiparity, prior PPH) should receive heightened surveillance during labour and the immediate postpartum period. 4. Training and capacity building: All maternity- care providers should undertake regular simulation-based training in PPH prevention, recognition, and stepwise management, including emergency drills. 5. Standardised management protocols: Clear, up- to-date PPH management algorithms should be displayed prominently and adhered to across all obstetric units. 6. Rapid response systems: Structured teamwork, clear communication pathways, and rapid- response mechanisms within labour wards are essential to minimise treatment delays. 7. Antenatal anaemia management: Iron deficiency anaemia should be identified and treated during antenatal care to limit the severity of PPH- related haematological complications. 8. Further research: Multicentre prospective studies are needed to evaluate health-system factors, clinical practices, and socio-cultural determinants of PPH outcomes across Sudan.

    Management and Maternal Outcomes of Primary Postpartum Hemorrhage: A Cross-Sectional Study at Wad Medani Maternity Teaching Hospital, Sudan · 2026 · DOI

  • healthy highlight postpartum women, conventional vital signs such as blood pressure and pulse may not change until more than 1000 mL of blood has been lost, making early clinical recognition of PPH particularly challenging and explaining the high prevalence of haemodynamic complications observed in our cohort. [28] depletion. The FIGO that in A review of PPH management in low- and middle- income countries further noted that pre-existing anaemia substantially worsens the outcome of acute haemorrhage, a consideration particularly relevant to the Sudanese context where anaemia in pregnancy remains prevalent. [29] The occurrence, although infrequent, of severe ischaemic complications including occult myocardial ischaemia (1.4%) and anterior pituitary ischaemia Sheehan syndrome (0.9%) underscores the potential for catastrophic end- organ injury when haemorrhage is uncontrolled or treatment is delayed. Collectively, the results indicate that primary PPH at this centre is largely manageable with medical therapy when intervention is timely, but that a material proportion of women require surgical escalation and sustain significant morbidity. The high success rate of medical management, even in a resource-constrained supports investment in uterotonic availability and skills-based training as the primary quality-improvement priorities. The convergence of our findings with those of recent multicentre African studies strengthens the generalisability of these conclusions within the sub- Saharan context. environment, This study is strengthened by its prospective design and comprehensive clinical data collection at a single 42 ©2024 Kordofan Journal Medical & Health sciences. https://www.kujms.org Email: [email protected] KJMHS 2026; Vol. 3 (Issue 2) Online ISSN: 3027-5601 Manuscript ID: KUJMS-V.3.I.2.04 high-volume referral centre. Limitations include the single-site cross-sectional design, which restricts external generalisation, and the use of convenience sampling, which may introduce selection bias. Quantitative blood-loss measurement was not standardised, which may affect the precision of case ascertainment. Future multicentre prospective studies incorporating objective haemorrhage quantification and health-system delay analysis are warranted to generate nationally representative data for Sudan.

    Management and Maternal Outcomes of Primary Postpartum Hemorrhage: A Cross-Sectional Study at Wad Medani Maternity Teaching Hospital, Sudan · 2026 · DOI

  • Despite widespread clinical use, the inter-modality agreement between prenatal ultrasound and MRI and their comparative value for predicting perioperative hemorrhage remain poorly characterized, particularly in low-to-moderate risk populations where placenta accreta predominates.

    Ultrasound as the Primary Predictor of Perioperative Hemorrhage in Low-to-Moderate Risk Placenta Accreta Spectrum: A Prospective Comparison with MRI in Women with Placenta Previa · 2026 · DOI

  • Background Pregnancy alters hematologic state as measured by complete blood count (CBC), but the longitudinal changes in CBC indices that define healthy pregnancies are not well established.

    Associations between hematologic dynamics during pregnancy and obstetric complications: A retrospective observational study · 2026 · DOI

  • Usability of the model in the context of current care 20c 21 22 23a 23b 24 25 26 27a 27b 27c E D;E D D;E D;E E D;E D;E D D D;E Version: 11-January-2024 Identify any differences between the development and evaluation data in healthcare setting, eligibility criteria, outcome, and predictors Name the institutional research board or ethics committee that approved the study and describe the participant-informed consent or the ethics committee waiver of informed consent Give the source of funding and the role of the funders for the present study Declare any conflicts of interest and financial disclosures for all authors Indicate where the study protocol can be accessed or state that a protocol was not prepared Provide registration information for the study, including register name and registration number, or state that the study was not registered Provide details of the availability of the study data Provide details of the availability of the analytical code4 Provide details of any patient and public involvement during the design, conduct, reporting, interpretation, or dissemination of the study or state no involvement. Describe the flow of participants through the study, including the number of participants with and without the outcome and, if applicable, a summary of the follow-up time. A diagram may be helpful. Report the characteristics overall and, where applicable, for each data source or setting, including the key dates, key predictors (including demographics), treatments received, sample size, number of outcome events, follow-up time, and amount of missing data. A table may be helpful. Report any differences across key demographic groups. For model evaluation, show a comparison with the development data of the distribution of important predictors (demographics, predictors, and outcome). Specify the number of participants and outcome events in each analysis (e.g., for model development, hyperparameter tuning, model evaluation) Provide details of the full prediction model (e.g., formula, code, object, application programming interface) to allow predictions in new individuals and to enable third-party evaluation and implementation, including any restrictions to access or re-use (e.g., freely available, proprietary)5 Report model performance estimates with confidence intervals, including for any key subgroups (e.g., sociodemographic). Consider plots to aid presentation. If examined, report results of any heterogeneity in model performance across clusters. See TRIPOD Cluster for additional details3.

    Evaluating Postpartum Hemorrhage Transfusion Risk With a Machine Learning Model for Informed Consent: Retrospective Cohort Study · 2026 · DOI

  • Our analysis provides the largest study yet to document trends in maternal mortality in India. We use robust nationally representative survey data paired with geospatial analyses to show the marked variation in maternal death risk across the country. We demonstrate that the poorer states need to accelerate their rates of progress in reducing maternal mortality if the whole of India is to achieve the UN SDGs. Our analyses have some limitations, however. Maternal deaths remain a reasonably uncommon cause of death. Reliable measurement of trends requires large sam- ple sizes. Indeed, NFHS surveys prior to 1997 showed increases in maternal mortality, but this was with fewer than 50 maternal deaths being available for analyses.4 Hence, some of the state-level estimates relying on small numbers of recorded deaths may be similarly unreliable. If the SRS had undercounted the overall number of female deaths at 15–49 years of age, we might have also under- counted the absolute maternal deaths (but less likely the MMR). However, independent demographic assessments find that the SRS has a high coverage of expected births,37 but undercounts deaths in females older than 5 years by 8– 11%.38-40 We correct for this possible undercounting in ª 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd. 555 Meh et al. Figure 3. Spatial distribution of risk-adjusted maternal mortality ratios (MMRs) in rural areas of India in 2008–2011. The risk of maternal death is adjusted for female literacy, rural/urban status, smoking prevalence, language and spatial clustering effects. States/union territories in India: AP, Andhra Pradesh; AR, Arunachal Pradesh; AS, Assam; BR, Bihar; CH, Chandigarh; CT, Chhattisgarh; DL, Delhi; GA, Goa; GJ, Gujarat; HR, Haryana; HP, Himachal Pradesh; JH, Jharkhand; JK, Jammu and Kashmir; KA, Karnataka; KL, Kerala; MP, Madhya Pradesh; MH, Maharashtra; MN, Manipur; ML, Meghalaya; MZ, Mizoram; NL, Nagaland; OR, Orissa; PB, Punjab; RJ, Rajasthan; SK, Sikkim; TN, Tamil Nadu; TR, Tripura; UL, Uttarakhand; UP, Uttar Pradesh; WB, West Bengal. absolute deaths by using the UN totals of deaths at 15– 49 years of age, to which we apply the SRS proportions of deaths. The causes of death based on verbal autopsy are subject to misclassification.25 However, we minimised such misclassification by having a central panel with at least two skilled obstetrical experts re-review all maternal deaths. Overall, our analyses provide useful evidence to inform health policies and strategies for tackling maternal mortal- ity in India.

    Clinical profile and outcomes of critically ill obstetric patients in the intensive care unit of a tertiary care center · 2026 · DOI

  • The majority of primary studies are conducted at single tertiary referral centers with potential selection bias toward clinically suspected cases. Population-based incidence data for placenta accreta stratified by prior CS number and previa status are sparse in low- and middle-income countries where CS rates are rising rapidly.

    The Relationship between a History of Cesarean Section and The Incidence of Placenta Accreta : A Systematic Review · 2026 · DOI

  • The temporal increase in PAS incidence beyond what CS rate increases alone can explain has been observed but not mechanistically dissected. Studies are needed to distinguish whether this rise is driven by accumulation of women with multiple prior CS across successive cohorts, improved PAS recognition and conservative management enabling recurrence, or other healthcare system changes.

    The Relationship between a History of Cesarean Section and The Incidence of Placenta Accreta : A Systematic Review · 2026 · DOI

  • The Moradan et al. Iranian study found no significant differences in accreta between second versus more than two cesarean sections, contradicting most other literature. This discordance may reflect population-specific factors (surgical techniques, infection rates, tissue healing characteristics) in Iranian tertiary settings. Replication of this comparison using larger sample sizes and multicenter cohorts in both high-income and lower-income healthcare systems is needed.

    The Relationship between a History of Cesarean Section and The Incidence of Placenta Accreta : A Systematic Review · 2026 · DOI

  • Serum amyloid A (SAA) was found elevated in both placenta previa and accreta groups but could not distinguish previa from accreta alone. Additional biomarker studies combining SAA with other inflammatory or decidualization markers (e.g., endometrial thickness, vascular markers) in prospective cohorts are needed to develop a diagnostic panel for PAS risk stratification.

    The Relationship between a History of Cesarean Section and The Incidence of Placenta Accreta : A Systematic Review · 2026 · DOI

  • Recurrent placenta accreta risk was identified in only nine focal-occult PAS patients with subsequent pregnancies (Larish et al.), with three showing recurrence. A larger prospective cohort tracking women with prior PAS through subsequent pregnancies is needed to quantify recurrence rates, identify predictors of recurrence, and determine whether intervening pregnancy intervals or timing affects risk.

    The Relationship between a History of Cesarean Section and The Incidence of Placenta Accreta : A Systematic Review · 2026 · DOI

  • Isthmocele presence on ultrasound appears to correlate with disproportionately higher PAS risk, but this relationship has only been characterized in a single case series (Marbin et al.). Prospective studies measuring isthmocele dimensions, depth, and morphology against accreta incidence across multiple centers are required to establish whether scar niche parameters can serve as direct predictors independent of CS number.

    The Relationship between a History of Cesarean Section and The Incidence of Placenta Accreta : A Systematic Review · 2026 · DOI

  • The dose-response relationship between multiple cesarean sections and placenta accreta risk has been established, but the specific influence of CS closure technique, suture material, infection status, and individual tissue healing characteristics on scar quality and subsequent PAS expression remains uninvestigated. Research directly comparing accreta incidence across different surgical closure methods in prospective cohorts is needed.

    The Relationship between a History of Cesarean Section and The Incidence of Placenta Accreta : A Systematic Review · 2026 · DOI

  • The most common type of occlusion is internal iliac artery balloon occlusion, only a few studies have focused on intraoperative aortic balloon occlusion This retrospective case-control study included relatively large number of cases and the result shown this technique can effectively reduce intraoperative haemorrhage in patients with placenta accreta, without causing any obvious adverse maternal or neonatal outcomes.

    Prophylactic use of an infrarenal abdominal aorta balloon catheter in pregnancies complicated by placenta accreta · 2017 · DOI

  • Uterine balloon tamponade (UBT) has been shown to be an effective technique to treat PPH in developed countries, but has not been examined in resource-poor settings.

    Uterine balloon tamponade for the treatment of postpartum haemorrhage in resource‐poor settings: a systematic review · 2012 · DOI

  • Despite its prevalence and its well-described clinical manifestations, the ultimate causes of PPH are not known and have not been investigated through an evolutionary lens.

    Framing Postpartum Hemorrhage as a Consequence of Human Placental Biology: An Evolutionary and Comparative Perspective · 2011 · DOI

  • In developing countries where the incidence of HIV is high, delaying amniotomy in labour reduces vertical transmission rates and hence the use of oxytocin with intact membranes warrants further investigation.

    Intravenous Oxytocin Alone for Cervical Ripening and Induction of Labour · 2001 · DOI

  • Some publications focus in detail on the assessment of pathological changes in the umbilical cord, but the relationship between macromorphological changes in the umbilical cord and fetal growth restriction remains controversial and unresolved.

    CLINICAL AND MORPHOLOGICAL FEATURES OF THE UMBILICAL CORD IN LATE MANIFESTATION OF FETAL GROWTH RESTRICTION · 2025 · DOI

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68 open questions have been extracted from the limitations and future-work passages of 974 Maternal and fetal healthcare papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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