Associate ProfessorBrad de Vries

I can offer a number of PhD or Masters projects which are flexible depending on the candidate's abilities and interests.

(1) Oxytocin and induction of labour.

Background: Caesarean section and induction of labour rates are rising. Completely ceasing oxytocin in the active phase of induced labours reduce rates of uterine hyperstimulation and abnormal fetal heart rate patterns, and in recent meta-analyses, reduces caesarean section rates. However, the length of labour is prolonged.

Project: We are planning a pilot double-blinded randomised controlled trial of halving the rate of oxytocin in the active phase of induced labours compared with the usual protocol for preventing caesarean section overall and caesarean section for fetal distress. The candidate will lead research that would lead to a large adequately funded multicentre randomized controlled trial of reducing oxytocin infusion rates once labour is established.

Significance: Methods to prevent fetal distress in labour are expected to reduce serious adverse outcomes such as stillbirth and ischaemic hypoxic encephalopathy, and to prevent caesarean sections and their complications.

Desirable attributes: Would suit a candidate with clinical experience in obstetrics or midwifery (eg an obstetric registrar or consultant or clinical midwife) with a working knowledge of epidemiological methods.

(2a) Describing normal labour

Background: Methods of describing the progress of normal labour have changed, leading to changes in clinical guidelines. However, newer methods suffer from major bias (de Vries BS et al. Impact of analysis technique on our understanding of the natural history of labour: a simulation study. BJOG. 2021;128(11):1833-42).

Project: Data are available from the 1950's to 1970's, a time when caesarean section rates were much lower, including some of the original data used by Professor Emmanual Friedman; as well as local contemporary data. The candidate will develop regression methods to analyse longitudinal labour data of cervical dilatation over time, test the methods using simulation studies, and then apply the methods to existing datasets.

Significance: The methods will allow normal labour to be described and will impact on international clinical guidelines for managing labour. Regression methods will allow differences in normal labour to be described in subgroups of women (eg different age groups and body mass index) leading to individualized management of labour, with the aim of preventing maternal and perinatal adverse outcomes, and reducing interventions such as caesarean section.

Desirable attributes: Would suit a candidate with a biostatistics background or a clinical (obstetrics or midwifery) or epidemiology background and strong grounding in biostatistics methods.

(2b) Describing normal labour (alternative)

Project: The candidate will examine a smaller groups of women in labour in detail and describe labour progress. This may involve frequent ultrasound examinations or development and use of alternative devices.

Desirable attributes: Would potentially suit a sonographer or biomedical engineering student.