No abstract

Nursing: Concepts of Practice, 2nd ed. Dorothea E Orem. McGraw‐Hill, 1221 Avenue of the Americas, New York, NY 10020, 1980, 232 pp, $10.95 paperback.

Objectives: Several entry techniques are used at laser coagulation for TTTS. Little is known about how access diameter may affect outcomes following surgery. We assessed the effect of access diameter on the rate of preterm rupture of the membranes (PPROM < 32) and preterm birth before 32 weeks (PTB < 32). Methods: Retrospective study of 277 consecutive fetoscopic laser procedures performed at 2 centres using different access diameters for a given entry technique. We collected clinical data regarding maternal, TTTS disease and procedural characteristics, and pregnancy outcomes. Univariate and multivariate logistic regression analysis was performed. Repeat invasive procedures (n = 3) and termination of pregnancy/double IUFD (n = 15) were excluded. Results: The fetoscopic entry techniques and access diameters assessed were: cannula (diameters: 3.5 mm or 3.8 mm) or sheath (diameters: 3.0 mm or 3.8 mm). Access diameter did not affect the rate of PPROM < 32 or PTB < 32 wks. Larger access diameter did not affect the PPROM < 32 rate but was associated with lower GA at birth (2 centres; P < 0.05) and a shorter laser-birth interval (1 centre; P = 0.048). Conclusions: Access diameter does not influence PPROM < 32 rate but may shorten pregnancy duration following laser photocoagulation. OP06.04Fetoscopic entry technique at laser therapy for twin-twin transfusion syndrome affects rates of amniorrhexis and preterm birth before 32 weeks Objectives: To assess if percutaneous entry technique at laser therapy for TTTS affects the rate of preterm prelabour rupture of membranes (pPROM) and preterm birth (PTB) before 32 weeks. Methods: Retrospective study of 629 consecutive fetoscopic laser procedures performed at 5 centres using various fetoscopic techniques. Databases were searched for maternal, TTTS disease and procedural characteristics, and pregnancy outcomes. Univariate and multivariate logistic regression analysis was performed. Repeat invasive procedures (n = 65), termination of pregnancy or double IUFD (n = 51) after laser were excluded. Results: 3 Fetoscopic percutaneous entry techniques were assessed: Seldinger technique; cannula; direct entry. Access diameter and criteria indicating surgery differed between centres. PTB < 32 weeks occurred in 247 cases (39.3%), with pPROM in 119 of these cases (48.2%). Following amniorrhexis, the median latency to delivery was 2 days (IQR 0-8). The use of a cannula entry technique was significantly associated with pPROM < 32 (P = 0.006) and PTB < 32 (P = 0.028). No difference between the use of the Seldinger technique and direct sheath entry was demonstrated. Conclusions: Fetoscopic entry technique may independently affect rates of pPROM and PTB < 32 rates following laser coagulation.

AJ Walt, Early Care of the Injured Patient, 3rd ed., 1982, W B Saunders Co, West Washington Sq, Philadelphia, Pa 19105, 413, Committee on Trauma, American College of Surgeons $22.50.