Appraisal of the selectivity index in a cohort of patients treated with laser surgery for twin-twin transfusion syndrome.

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.

Acute hyperlipidemic pancreatitis in pregnancy.

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.

Management of ectopic pregnancy in the military during deployment to Southwest Asia.

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.