ABSTRACT
OBJECTIVE: The selectivity index (SI) has been proposed as a measure of technical success in laser surgery for twin-twin transfusion syndrome. Surgeries with an index >-0.25 have been considered highly selective. The purpose of this study was to evaluate the applicability of this index in our patient population. STUDY DESIGN: The SI was assessed in 314 consecutive laser surgeries and correlated with perinatal survival. RESULTS: A total of 310 patients (98.7%) underwent a completely selective procedure. The SI was 0.8 in the selective laser photocoagulation of communicating vessels group vs 0.3 in the nonselective laser photocoagulation of communicating vessels group (P = .001). In the selective group perinatal survival of at least 1 twin (92.6% vs 50%) and survival of the donor (75.4% vs 0%) was significantly better (P = .05). CONCLUSION: The SI as originally proposed is misleading and of limited use as it does not differentiate selective from nonselective procedures. We propose instead using a ratio of selective/nonselective procedures, and selectively coagulated/total number of coagulated vessels to appraise center-specific and patient-specific surgical performance of laser surgery for twin-twin transfusion syndrome.
Subject(s)
Fetofetal Transfusion/surgery , Laser Coagulation/methods , Cohort Studies , Female , Fetofetal Transfusion/diagnostic imaging , Fetofetal Transfusion/mortality , Humans , Pregnancy , UltrasonographyABSTRACT
BACKGROUND: Pancreatitis in pregnancy remains a rare event and is most often associated with gallstone disease. Hyperlipidemic gestational pancreatitis usually occurs in women with a preexisting abnormality of the lipid metabolism and poses particular problems in diagnosis and clinical management. CASES: We describe 5 patients with acute episodes of pancreatitis during pregnancy caused by hyperlipidemia. CONCLUSION: Acute pancreatitis in pregnancy causes significant morbidity. Even though it is often associated with gallstones, we describe 5 cases in which the etiology of the pancreatitis was maternal hyperlipidemia. Etiology, diagnosis, and management will be discussed.
Subject(s)
Hyperlipidemias/complications , Pancreatitis/etiology , Pregnancy Complications/etiology , Acute Disease , Adult , Female , Gallstones/complications , Humans , Hyperlipoproteinemia Type V/complications , Pregnancy , Pregnancy Complications/physiopathology , Retrospective StudiesABSTRACT
BACKGROUND: Expeditionary military facilities care for deployed military personnel. They deploy with limited equipment and personnel to austere environments. Female military personnel are deployed forward in a support capacity. Under these conditions, ectopic pregnancy continues to be a potential catastrophe leading to maternal death. CASES: We report three cases of ectopic pregnancy in forward-deployed personnel. The random occurrence and different clinical presentations emphasize the importance of early diagnosis and management. CONCLUSION: During austere remote deployments, early diagnosis and evacuation of patients with ectopic pregnancy may make the difference between excellent outcomes and maternal death.
