Helen Perry

Twin–Twin Transfusion Syndrome: study protocol for developing, disseminating, and implementing a core outcome set

BackgroundTwin–Twin Transfusion Syndrome (TTTS) is associated with an increased risk of perinatal mortality and morbidity. Several treatment interventions have been described for TTTS, including fetoscopic laser surgery, amnioreduction, septostomy, expectant management, and pregnancy termination. Over the last decade, fetoscopic laser surgery has become the primary treatment. The literature to date reports on many different outcomes, making it difficult to compare results or combine data from individual studies, limiting the value of research to guide clinical practice. With the advent and ongoing development of new therapeutic techniques, this is more important than ever. The development and use of a core outcome set has been proposed to address these issues, prioritising outcomes important to the key stakeholders, including patients. We aim to produce, disseminate, and implement a core outcome set for TTTS.MethodsAn international steering group has been established to oversee the development of this core outcome set. This group includes healthcare professionals, researchers and patients. A systematic review is planned to identify previously reported outcomes following treatment for TTTS. Following completion, the identified outcomes will be evaluated by stakeholders using an international, multi-perspective online modified Delphi method to build consensus on core outcomes. This method encourages the participants towards consensus ‘core’ outcomes. All key stakeholders will be invited to participate. The steering group will then hold a consensus meeting to discuss results and form a core outcome set to be introduced and measured. Once core outcomes have been agreed, the next step will be to determine how they should be measured, disseminated, and implemented within an international context.DiscussionThe development, dissemination, and implementation of a core outcome set in TTTS will enable its use in future clinical trials, systematic reviews and clinical practice guidelines. This is likely to advance the quality of research studies and their effective use in order to guide clinical practice and improve patient care, maternal, short-term perinatal outcomes and long-term neurodevelopmental outcomes.Trial registrationCore Outcome Measures in Effectiveness Trials (COMET), 921 Registered on July 2016.International Prospective Register of Systematic Reviews (PROSPERO), CRD42016043999. Registered on 2 August 2016.

Outcome reporting across randomized trials and observational studies evaluating treatments for twin–twin transfusion syndrome: systematic review

Twin–twin transfusion syndrome (TTTS) is associated with significant mortality and morbidity. Potential treatments for the condition require robust evaluation. The aim of this study was to evaluate outcome reporting across observational studies and randomized controlled trials assessing treatments for TTTS.

Home blood‐pressure monitoring in a hypertensive pregnant population: cost minimisation study

Traditional blood‐pressure monitoring in hypertensive pregnant women requires frequent visits to the maternity outpatient services. Home blood‐pressure monitoring (HBPM) could offer a cost‐saving alternative that is acceptable to patients. The aim of this study was to undertake a health economic analysis of HBPM compared with traditional monitoring in hypertensive pregnant women.

Home blood‐pressure monitoring in a hypertensive pregnant population

The majority of patients with chronic or gestational hypertension do not develop pre‐eclampsia. Home blood‐pressure monitoring (HBPM) has the potential to offer a more accurate and acceptable means of monitoring hypertensive patients during pregnancy compared with traditional pathways of frequent outpatient monitoring. The aim of this study was to determine whether HBPM reduces visits to antenatal services and is safe in pregnancy.

Correlation between central and uterine haemodynamics in hypertensive disorders of pregnancy: Central and uterine haemodynamics in HDP

Pregnancies affected by a hypertensive disorder (HDP) have increased uterine artery pulsatility index (UtA‐PI) compared with that in healthy pregnancies. Women with HDP are also known to have lower cardiac output and increased systemic vascular resistance. The aim of this study was to investigate the relationship between central and uterine hemodynamics in HDP and uncomplicated pregnancy.

OC24.05: The interaction between the maternal systemic and uteroplacental circulations in pregnancies resulting in small-for-gestational-age newborns

Objectives: Umbilical artery (UA) Doppler Pulsatility Index, Resistance Index and Systolic/Diastolic Ratio are measured in clinical practice to assess fetal wellbeing. Different normal values are used for decision-making and there is a need for uniform UA Doppler criteria. Methods: Prospective study of healthy women with singleton pregnancies, recruited <14 weeks’ gestational age (GA), from study sites in Brazil, Kenya, Pakistan and the UK between 2012-2015. Women were included if they met the INTERGROWTH-21st Fetal Growth Longitudinal Study criteria. UA measurements were serially taken at 5±1 week intervals, according to a standardised protocol by dedicated research staff, using identical equipment. The UA measures were modelled as functions of GA in a multilevel framework, following established methodology. Results: A total of 539 women contributed 1563 Doppler measures; 75% of women had ≥3 measures. Low rates of adverse events confirmed the low-risk status of the population: preterm birth (6.5%), pre-eclampsia (0.8%), neonatal mortality (0.6%), and birthweight for GA z-score of 0.1. From 24-40 weeks GA, there were between 21 and 134 individual observations per week. All three Doppler indices decreased with advancing GA (p<0.001). The figure below presents the individual values for the three Doppler indices and the corresponding 5th, 50th and 95th smoothed centile curves. Conclusions: These normative data should help to standardise the evaluation of the UA circulation worldwide.

Cardiac output measurements during high-risk caesarean section using electrical bioreactance or arterial wave form analysis: an assessment of agreement: Cardiac Output Monitoring in High-Risk Caesarean Section.

Maternal hemodynamics change significantly during Cesarean section complicated by massive hemorrhage or severe hypertensive disease. Cardiac output (CO) monitoring aids early, goal‐directed hemodynamic therapy. The aim of this study was to record hemodynamic changes observed during Cesarean section in pregnancies at high risk of hemodynamic instability, using invasive (LiDCOrapid™) and non‐invasive (NICOM®) devices, and to assess agreement between the two devices in measuring CO.