Objective To develop, using a Delphi procedure and a nominal group technique, a core outcome set (COS) for studies evaluating treatments for twin-twin transfusion syndrome (TTTS), which should assist in standardizing outcome selection, collection and reporting in future research studies.Methods An international steering group comprising healthcare professionals, researchers and patients with experience of TTTS guided the development of this COS. Potential core outcomes, identified through a comprehensive literature review and supplemented by outcomes suggested by the steering group, were entered into a three-round Delphi survey. Healthcare professionals, researchers, and patients or relatives of patients who had experienced TTTS were invited to participate. Consensus was defined a priori using the 15%/70% definition of the Core Outcome Measures in Effectiveness Trials (COMET) initiative. The modified nominal group technique was used to evaluate the consensus outcomes in a face-to-face consultation meeting and identify the final COS.Results One hundred and three participants, from 29 countries, participated in the three-round Delphi survey. Of those, 88 completed all three rounds. Twenty-two consensus outcomes were identified through the Delphi procedure and entered into the modified nominal group technique. The consensus meeting was attended by 11Conclusions Implementing the COS for TTTS within future research studies could make a substantial contribution to advancing the usefulness of research in TTTS. Standardized definitions and measurement instruments are now required for individual core outcomes. Copyright
What are the novel findings of this work? Implementation of the NICE twin guideline was associated with > 70% reduction in the rate of stillbirth in twins without a concomitant increase in neonatal mortality, rate of admission to the neonatal intensive care unit or rate of emergency Cesarean section. The reduction observed in monochorionic twins was higher than that in dichorionic twins. What are the clinical implications of this work? Reduction in stillbirth in twins can be achieved through implementation of guidelines. The reduction in stillbirth in twins represents a promising step towards achieving the UK national target of reducing stillbirths by 50% by 2025. National mortality reports should provide twin data separately for dichorionic and monochorionic pregnancies.
Implementation of NICE twin guideline was associated with >70% reduction in stillbirth without a concomitant increase in neonatal mortality, admission to the neonatal unit or emergency Caesarean section. The reduction observed in monochorionionic twins was higher than that in dichorionic twins. What are the clinical implications of this work? Reduction in stillbirth in twins can be achieved through implementation of guidelines The reduction in stillbirth in twins represents a promising step towards achieving the UK national target of reducing stillbirths by 50% by 2025 National mortality reports should report the twin data separately in dichorionic and monochorionic pregnancies.
Oral communication abstractsObjectives: We assessed the feasibility of fetal sheep cardiac magnetic resonance (CMR) measurements of ventricular volume for chamber sizes and cardiac output against gold standard cine phase-contrast (PC) measurements made in the ascending aorta (AAo) and main pulmonary artery (MPA). Methods: 5 ewes with singleton pregnancies underwent surgery at 112-120d (term = 150d) to catheterise the fetal femoral artery. At 139-140d, ewes were anesthetised to undergo fetal CMR using the femoral arterial pressure waveform for cardiac gating. Short-axis cine imaging of the fetal hearts was acquired and the right (RV) and left (LV) ventricles were segmented to measure ejection fraction (EF), stroke volume (SV), right and left ventricular output (CO) and combined ventricular output (CVO). LV-CO and RV-CO were also measured by cine PC acquisitions of AAo and MPA flow respectively. All cardiac measurements were indexed to fetal weight. The ventricular output by ventricular volumetry and PC were compared by linear regression and Bland-Altman analysis. Results: Our results are in keeping with previously reported microsphere measurements and we found good agreement between LV-CO and RV-CO by ventricular volumetry versus PC but with underestimation of output of approximately 10% by ventricular volumetry, which we attributed to incomplete coverage of the entire ventricular volume (figure 1). Conclusions: This data suggests that following appropriate modification of the field of view, this technique represents a valid approach to assessing cardiac function, chamber sizes, and cardiac output in the fetal sheep.
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