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Maryam Al-Shabibi OMSB Resident Obstetrics & Gynaecology

Maryam Al-Shabibi OMSB Resident Obstetrics & Gynaecology. History . 7/9/2009 Mrs. A, 23 years old lady Primigravida at 23 weeks of gestation Referred from Private clinic Monochorionic monoamniotic spontaneous twin pregnancy with one twin fetal demise. Blood group A negative

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Maryam Al-Shabibi OMSB Resident Obstetrics & Gynaecology

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  1. Maryam Al-Shabibi OMSB Resident Obstetrics & Gynaecology

  2. History 7/9/2009 • Mrs. A, 23 years old lady • Primigravida at 23 weeks of gestation • Referred from Private clinic • Monochorionicmonoamniotic spontaneous twin pregnancy • with one twin fetal demise. • Blood group A negative • Antenatal period uneventful

  3. History….cont • 2 weeks history of low back and abdominal pain and vaginal discharge. • Appreciating good fetal movements. • No history of vaginal bleeding or draining liqour. • No past medical or surgical history.

  4. Physical Examination • Comfortable • Not in pain • Vitals normal, afebrile • Abdominal examination: uterus relaxed 36 weeks size

  5. Physical Examination ….cont • Speculom: minimal vaginal discharge seen cervix and vagina look healthy • Vaginal exam: cervix 2 cm long, os 1 cm dilated membranes present.

  6. Trans abdominal scan done: • Monochorionicdiamniotic twin pregnancy • Twin I : cephalic presentation , no cardiac activity seen, polyhydramnios. • Twin II: breech presentation, stuck to the right uterine wall, no cardiac activity seen . Impression: • Monochorionicdiamniotic twin pregnancy. • Both fetal demise. • Twin – To – Twin Transfusion Syndrome.

  7. Investigations • Full blood count • Coagulation profile • Indirect Coomb Test ( ICT ) : negative

  8. Management • Explained to the patient . • Counseled regarding the need for induction. • Booked for induction of labour • Readmitted on 12/9/2009 • labour induced with 2 doses of prostin .

  9. Delivered on 14/9/2009 • Outcome: **Twin I : macerated , girl, 520 g with fronto – parietal swelling ** Twin II: macerated, girl, 510 g

  10. Received anti D immunoglobulin • Uneventful post natal stay • Discharged on 15/9/2009

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