Predictive value of cardiovascular parameters in stages 1 and 2 of twin-to-twin transfusion syndrome.

OBJECTIVE: The Quintero staging of twin-to-twin transfusion syndrome (TTTS) does not include a comprehensive cardiovascular assessment. The aim of this study is to assess the predictive value of the myocardial performance index (MPI) and the Children's Hospital of Philadelphia (CHOP) score on recipient survival in Quintero stages 1 and 2 TTTS. METHODS: The cohort study was based on prospectively collected data between May 2008 and February 2013 in a population of stages 1 and 2 TTTS. Comparisons between groups were carried out using Student's t-test and χ(2)-test. A stepwise ascending multivariate logistic regression model was then built. RESULTS: A total of 73 pregnancies in stages 1 and 2 of Quintero's classification were treated with laser. Rates of recipient fetal losses were higher when MPI was above 0.43 ms (71.4% vs 28.6%, p = 0.022). Rate of CHOP score above 5 was higher in the fetal loss group (28.6% vs 5.1%, p = 0.022). After adjustment for Quintero stages 1 or 2, the risk of recipient loss rate is higher according to CHOP score [OR 7.6; 95% confidence interval (CI) 1.3-43.5] or MPI value (OR 3.7; 95% CI 1.0-13.9). CONCLUSION: The CHOP score and MPI are correlated with the recipient survival in stages 1 and 2 TTTS.

Equipment failure: causes and consequences in endoscopic gynecologic surgery.

STUDY OBJECTIVE: To determine the incidence of equipment failure in gynecologic endoscopy and investigate causes and consequences. DESIGN: A prospective observational single-center study between January and April 2006. SETTING: Gynecologic surgery department of a university hospital. INTERVENTIONS: In all, 116 endoscopic interventions were included: 62 laparoscopies, 51 operative hysteroscopies, and 3 fertiloscopies. Emergency and equipment testing procedures were excluded. MEASUREMENTS AND MAIN RESULTS: Equipment malfunctions were divided into 4 categories with regard to imaging, transmission of fluids and light, the electric circuit, and surgical instruments. We also found cases with faulty connections between elements. Factors including human error, loss of time, and actual or potential consequences were analyzed. At least 1 equipment failure was noted in 38.8% of operative procedures, 41.9% of laparoscopies, and 37.3% of hysteroscopies. Fluid, gas, and light transmission was faulty in 36.2%, surgical instruments in 29.3%, the electric circuit in 22.4%, and imaging in 12.1%. Of malfunctions, 46.6% were a result of faulty connection between 2 elements. The most common cause for concern was bipolar forceps and cables in laparoscopy (42.3%) and the assembly of small parts in hysteroscopy (47.4%). Personnel were implicated in 43% of cases (nurses in 72%, surgeons in 12%, both in 16%). One equipment failure increased the total duration of laparoscopy by 7% and of hysteroscopy by 20%. The mean delay was 5.6+/-4.0minutes by equipment failure. Of the incidences, 19% could have led to serious complications for the patient; however, no morbidity or mortality actually occurred in this series. CONCLUSION: Equipment malfunction is common in endoscopic surgery and concerns both laparoscopy and hysteroscopy. Consequences are potentially serious. It is mandatory to identify and rectify causes of equipment failure so as to optimize the daily use of endoscopic instruments and improve patient safety. The implementation of systematic checklists is currently under evaluation.

Assessment of STAN S21 fetal heart monitor by medical staff.

OBJECTIVE: To compare the responses of medical staff using the STAN S21 fetal heart monitor versus standard cardiotocography (CTG) to monitor abnormal fetal heart rate in labor. METHOD: Questionnaires were completed by medical staff involved in a randomized controlled trial to compare STAN surveillance with traditional surveillance before the trial had finished. Respondents were questioned about their experience and confidence using the STAN system. RESULTS: The response rate was 82% (89/109). Overall, 71% of respondents preferred using STAN surveillance, while 5% preferred standard CTG. Reasons given for preference over CTG alone were the continuous nature of surveillance (47%), the need for fewer scalp pH tests (39%), and its capacity to screen for severe fetal distress (30%). CONCLUSION: Most of the medical staff surveyed preferred using STAN versus standard surveillance techniques to monitor abnormal fetal heart rate during labor.