Case Presentation

Maryam Al-ShabibiOMSB Resident

Obstetrics & Gynaecology

History 7/9/2009Mrs. A, 23 years old ladyPrimigravida at 23 weeks of gestationReferred from Private clinicMonochorionic monoamniotic spontaneous

twin pregnancywith one twin fetal demise.Blood group A negativeAntenatal period uneventful

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.

Physical ExaminationComfortableNot in painVitals normal, afebrile

Abdominal examination: uterus relaxed 36 weeks size

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.

Trans abdominal scan done: Monochorionic diamniotic twin pregnancyTwin I : cephalic presentation , no cardiac

activity seen, polyhydramnios.Twin II: breech presentation, stuck to the

right uterine wall, no cardiac activity seen .

Impression: Monochorionic diamniotic twin pregnancy. Both fetal demise.Twin – To – Twin Transfusion Syndrome.

Investigations

Full blood count

Coagulation profile

Indirect Coomb Test ( ICT ) : negative

ManagementExplained 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 .

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

** Twin II: macerated, girl, 510 g

Received anti D immunoglobulin

Uneventful post natal stay

Discharged on 15/9/2009