Obs - TTTS + PPROM Flashcards
Ms Wong, a 27-year-old lady, G2P1, is currently at 13 weeks of gestation. She had an ultrasound
performed by her private doctor 2 weeks ago and she was told to be carrying a twin pregnancy.
1. What is the diagnosis? How would you counsel the patient?
(USG shows T sign
MC twins
Explain what it is
Twin pregnancy risks
Maternal
Antepartum: PET (aspirin), GDM, Anemia, Hyperemesis gravidarum, PP, Placental insufficiency
Intrapartum: birth canal injury, risk of operative delivery
Postpartum: PPH
Fetus
Antepartum: miscarriage, malformation, iugr, iud
Intapartum: cord prolapse, abruptio, preterm, retained 2nd twin, 2nd twin breech
Postpartum: low birth weight
Risk of MC twins: TTTS, TAPS, TRAPS, sIUGR
Mx
frequent antenatal checkup
IOL at 37 weeks
At 18 weeks of gestation, ultrasound was performed. This is the report. What is the diagnosis and how will you counsel the patient?
USG: poly/oligohydramnios, absent/distended bladder, growth discrepancy, edf normal
Stage II TTTS
Tx Fetoscopic laser devascularisation of placenta
80% one ok, 60% both ok
No treatment: 90% both ded
Risks: PPROM, miscarriage, preterm, hemorrhage, abruptio
Fetoscopic laser devascularisation of the placenta was performed, and twin-twin transfusion resolved. The pregnancy remained uncomplicated until 30 weeks of gestation when patient was admitted for leaking sensation. Speculum examination showed a pool of liquor in the posterior fornix and the os is closed. How would you manage this patient?
This is a case of PPROM.
Complete PE
Vitals for infection/shock
Abd: tenderness
Check liquor for colour/odour
Ix: CBC, CRP, HVS, CTG, USG
Mx
Admit to monitor:
as above + signs of preterm labour, reduced fm, meconium stained liquor
Antibiotics: erythromycin
Dexamethasome
Ensure NICU bed availability and neonatologist to consult
Plan IOL at 36-37 weeks if no sepsis, chorioamnionitis, GBS+
GBS+ IOL at 34 weeks
