(Am J Obstet Gynecol 2015;213(5):604–614) This consensus statement describes newborn outcomes after periviable birth (delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation), provides current evidence and recommendations regarding interventions in cases where delivery is anticipated near the limit of viability, and provides an outline for family counseling with the goal of incorporating informed patient preferences. It is reported that approximately 0.5% of all births occur before the third trimester of pregnancy and these very early deliveries result in the majority of neonatal deaths and >40% of infant deaths. The consensus statement intends to provide support and guidance regarding decisions (declining or accepting interventions and therapies) based on individual circumstances and patient values.

Background Recently, the number of prehabilitation trials has increased significantly. The identification of key research priorities is vital in guiding future research directions. Thus, the aim of this collaborative study was to define key research priorities in prehabilitation for patients undergoing cancer surgery. Methods The Delphi methodology was implemented over three rounds of surveys distributed to prehabilitation experts from across multiple specialties, tumour streams and countries via a secure online platform. In the first round, participants were asked to provide baseline demographics and to identify five top prehabilitation research priorities. In successive rounds, participants were asked to rank research priorities on a 5-point Likert scale. Consensus was considered if > 70% of participants indicated agreement on each research priority. Results A total of 165 prehabilitation experts participated, including medical doctors, physiotherapists, dieticians, nurses, and academics across four continents. The first round identified 446 research priorities, collated within 75 unique research questions. Over two successive rounds, a list of 10 research priorities reached international consensus of importance. These included the efficacy of prehabilitation on varied postoperative outcomes, benefit to specific patient groups, ideal programme composition, cost efficacy, enhancing compliance and adherence, effect during neoadjuvant therapies, and modes of delivery. Conclusions This collaborative international study identified the top 10 research priorities in prehabilitation for patients undergoing cancer surgery. The identified priorities inform research strategies, provide future directions for prehabilitation research, support resource allocation and enhance the prehabilitation evidence base in cancer patients undergoing surgery.

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Background Current guidelines recommend that resolution of a complete molar pregnancy (CMP) can only be confirmed once a negative β‐human chorionic gonadotropin (β‐hCG) has been maintained for six months following uterine surgical evacuation. However, multiple studies have found that the risk of developing gestational trophoblastic neoplasia (GTN) once a negative β‐hCG had been obtained is negligible, which suggests that a shorter follow‐up may be reasonable. Aim To determine the trend in β‐hCG following diagnosis of a CMP and the incidence of GTN, in a single unit. Materials and Methods All patients presenting to the tertiary hospital, Royal Prince Alfred Hospital Early Pregnancy Assessment Service (RPAH EPAS), with a histopathological diagnosis of a CMP between 2010 and 2017 were included. Data collected included age, parity, β‐hCG at diagnosis, subsequent β‐hCG levels, incidence of GTN and treatment required. Results Sixty‐seven patients were diagnosed with CMP between January 2010 and July 2017 through RPAH EPAS. The mean age of women diagnosed with a CMP was 33 years. None of the 40 patients who spontaneously achieved a negative β‐hCG and completed their six months follow‐up had a subsequent rise in β‐hCG. The median number of days from surgical evacuation to normalisation of β‐hCG was 55.5 days. Sixteen out of 67 patients who had a CMP required further management for persistent GTN. None of these patients achieved a negative β‐hCG prior to further management. Conclusions Consideration could be made to decreasing the period of β‐hCG monitoring for women who achieve a spontaneous negative β‐hCG following surgical evacuation of a CMP.

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