A core outcome set for pre‐eclampsia research: an international consensus development study

Objective To develop a core outcome set for pre‐eclampsia. Design Consensus development study. Setting International. Population Two hundred and eight‐one healthcare professionals, 41 researchers and 110 patients, representing 56 countries, participated. Methods Modified Delphi method and Modified Nominal Group Technique. Results A long‐list of 116 potential core outcomes was developed by combining the outcomes reported in 79 pre‐eclampsia trials with those derived from thematic analysis of 30 in‐depth interviews of women with lived experience of pre‐eclampsia. Forty‐seven consensus outcomes were identified from the Delphi process following which 14 maternal and eight offspring core outcomes were agreed at the consensus development meeting. Maternal core outcomes: death, eclampsia, stroke, cortical blindness, retinal detachment, pulmonary oedema, acute kidney injury, liver haematoma or rupture, abruption, postpartum haemorrhage, raised liver enzymes, low platelets, admission to intensive care required, and intubation and ventilation. Offspring core outcomes: stillbirth, gestational age at delivery, birthweight, small‐for‐gestational‐age, neonatal mortality, seizures, admission to neonatal unit required and respiratory support. Conclusions The core outcome set for pre‐eclampsia should underpin future randomised trials and systematic reviews. Such implementation should ensure that future research holds the necessary reach and relevance to inform clinical practice, enhance women's care and improve the outcomes of pregnant women and their babies

Trauma- und Gewaltfolgen – psychische Auswirkungen

This paper addresses consequences of exposure to violence and trauma. Traumata are defined as events with an extraordinary threat or catastrophic extent. Beside Posttraumatic Stress Disorder (PTSD), affected people may develop Complex PTSD, Prolonged Grief Disorder or Adjustment Disorder as direct consequences of exposure with extreme stress. Indirect trauma-related disorders are amongst others Major Depression, Substance Dependency and Personality Disorders. These disorders develop often comorbid to PTSD. The likelihood to develop a PTSD at one point during the life course is 1-4 % in Germany. A PTSD is diagnosed if for any length of time the traumatic situation is re-experienced (e.g. in pictures or nightmares), potential triggers are avoided, emotional reactivity is numb and a permanent hyperarousal is experienced. The intensity, the duration and the frequency of traumatic experiences as well as the lack of social support after the trauma are important risk factors for the development of a PTSD. In the last two decades successful treatment approaches for PTSD have been developed. The main focus of all evidence-based treatment approaches is the exposure in sensu of the traumatic experiences. Behavioral therapy approaches have shown to be most effective in the treatment of PTSD. A better understanding of the consequences of exposure to violence and trauma may help us to identify people at risk for developing trauma-related disorders already at an early stage