Maternal mental health: a key area for future research among women with congenital heart disease.

In this viewpoint, we respond to the recently published national priorities for research in congenital heart disease (CHD) among adults, established through the James Lind Alliance Priority Setting Partnership, with specific attention to priority 3 (mental health) and priority 5 (maternal health). Our recent policy impact project explored how maternal mental health is currently addressed in adult congenital heart disease (ACHD) services in the National Health Service, identified gaps and discussed possible ways forward. Our multidisciplinary discussion groups, which included women with lived experience of CHD and pregnancy, cardiology and obstetrics clinicians and medical anthropologists, found that while pregnancy and the postnatal period increase the mental health challenges faced by women with CHD, current services are not yet equipped to address them.

Carbohydrate and fatty acid perturbations in the amniotic fluid of the recipient twin of pregnancies complicated by twin-twin transfusion syndrome in relation to treatment and fetal cardiovascular risk.

Introduction: Twin-twin transfusion syndrome (TTTS) complicates 15% of monochorionic twin pregnancies, often being associated with recipient cardiac dysfunction. Untreated, it has a fetal mortality rate of at least 90%; although treatment by fetoscopic laser coagulation significantly improves prognosis. Measurement of recipient amniotic fluid metabolites, such as cardiac Troponin T and atrial natriuretic polypeptide, correlate with cardiac function in this fetus.

Maternal plasma and amniotic fluid cytokines in monochorionic, diamniotic twin pregnancies complicated by twin-to-twin transfusion syndrome.

Introduction: Cytokine imbalance has been implicated in placental-related pathologies, i.e. recurrent miscarriage and pre-eclampsia.

Maternal cell-free messenger RNA in twin pregnancies: the effects of chorionicity and severe twin to twin transfusion syndrome (TTTS).

Objective: To investigate the effects of chorionicity and severe twin to twin transfusion (TTTS) on maternal circulating cell-free messenger RNA (cf-mRNA).

Design: Prospective cohort study.

Setting: A UK tertiary referral Fetal Medicine Center.

Assimilating evidence quality at a glance using graphic display: research synthesis on labor induction.

Evidence profiled in the World Health Organization induction of labor guideline extended to 84 tables and 116 pages, which is hard to assimilate. Summarizing this evidence graphically can present information on key outcomes succinctly, illustrating where the gaps, strengths and weaknesses lie. For induction of labor, graphic representation clearly showed that evidence was lacking on maternal complications when comparing oxytocin with other agents, evidence was strong on birth within 24 h when comparing vaginal prostaglandins with placebo or no treatment, but again it was weak on uterine hyperstimulation when comparing oxytocin with vaginal prostaglandins.

Systematic reviews to evaluate causation: an overview of methods and application.

Currently systematic reviews focus on diagnosis or effectiveness of treatment. It is the understanding of disease aetiology that underpins medical education, practice and research. Whether an association meets causal criteria is usually assessed qualitatively.

Reversed twin-to-twin transfusion syndrome following successful laser therapy.

We report a case of severe twin-to-twin transfusion syndrome (TTTS) in which fetoscopic laser ablation was successfully performed at 21 weeks' gestation. Despite successful resolution of signs on ultrasound examination after a period of 7 weeks, the donor developed polyhydramnios whereas the 'initial' recipient maintained normal liquor volume, features suggestive of 'reversed TTTS'. Two live babies were delivered at 31 weeks' gestation with good neonatal outcome.