Polyhydramniotic Twin Gestation Case Studies

At this stage she is experiencing swelling of the legs, along with iron deficiency and a possibility of gestational diabetes, in order to maintain a heathy full term pregnancy at twenty weeks with additional calorie requirement of protein, vitamins and minerals like iron, zinc, folate and vitamin D (Grosvenor & Smolin, 2015, p. 373). She will need to decrease her salt and sugar intake, eat more lean protein, drink water only three liters per day while eliminating sweet tea, In addition to incorporating

There is no lower extremity swelling. There is perhaps just some fullness to the left calf, though no tenderness, no obvious sign of mass and she reports that her swelling is significantly better than previous.

Lynn K. is a 31-year-old Caucasian female G1P0 presents at 25 wga for a prenatal visit. She does not take her prenatal vitamins every day because they make her feel very nauseous and has experienced morning sickness throughout her pregnancy. She states that she feels fatigued very easily and describes feeling short of breath when carrying out simple tasks around the house. She began feeling this way approximately four weeks ago, and attributed it to “normal pregnancy symptoms.” Recently, she began noticing occasional lightheadedness and dizziness. The patient’s history indicates that she has suffered heavy periods prior to her pregnancy.

We discussed the findings of today’s scan and the potential implications. I explained to them that neurologic abnormalities are a very difficult counseling sessions because it is impossible to determine outcomes. Even mildly dilated ventricles with no other associated findings can have significant delay. We discussed longterm consequences of both agenesis as well as Dandy-Walker given the findings on the ultrasound. We discussed their wishes in terms of continuation of pregnancy and to give us more information I opted to order a fetal MRI. This would likely be able to help us to determine the findings in the third and fourth ventricles and possibly even agenesis of the corpus callosum. We discussed the possibility of invasive testing with amniocentesis but they had previously done preimplantation genetic diagnosis and did not desire any further testing at this time. Finally, I spoke with Krystal about the implications of non-continuation of pregnancy and how the procedure is typically performed using laminaria in a 2-day process. For now, we will proceed with ordering the MRI and we will see her back in 4 weeks if she continues the pregnancy; otherwise, we will give her information for

Paige is a 25yo, G3 P1011, who is currently 30 weeks 6 days. She is followed in our office after being admitted to the hospital for abruption with a positive KB and decreasing fibrinogen. Her fibrinogen stabilized around 200. She had no more vaginal bleeding and she was discharged home. When she came in she was also contracting and noted to be 2 cm and have a shortened cervical length at 1.9 cm that decreased down to 1.2 cm with pressure. She was ultimately discharged home and has been home for about one week. She is here today for follow-up.

Patient was on normal diet but was placed Nothing by mouth by the end of the day due to patient’s physician Dr. Lee stating that X.L was about to give birth and that she needed to be place NPO in case if X.L would need to have an caesarean section (C-section). Patient had normal breath sound, heart sounds, and bowel sounds heard throughout all quadrants. Patient had limited movement. Patient stated that she was fatigue, anxiety level of 6/10 and pain level of 7/10. Patient had a temperature of 97.8 F, heart rate 74 respiration rate 18, Pulse O2 99%, Blood Pressure 125/78, pain level 7/10. All vital signs are in normal ranges and pain medication will be given to decrease X.L pain level (D 'Amico & Barbarito, 2012).

In addition, the plan will be to perform a repeat cesarean delivery at term. We have scheduled her to follow-up with us in 4 weeks for interval growth and to complete the fetal cardiac anatomy assessment. If we are unable to do that at the next visit we might consider getting a Pediatric Cardiology evaluation to clear the

Sofia is a 30yo, G4 P2012, who was seen for a follow-up ultrasound assessment. She has GDM and is on metformin 500 mg t.i.d. She also does have some issues with depression and is on trazadone. Currently at this time she overall has no complaints and has positive fetal movement.

I gave them the name, persistent right umbilical vein, as this may elicit more information. This is more of a fetal finding and generally has favorable outcomes when found in isolation. Because there were no other gross abnormalities seen on today’s scan I am very reassured. We also discussed her due date. Per your office using LMP dating, the due date is 08/18/17. Using ultrasound dating that was 6 days different the due date would be 08/24/17. Some people change due dates within the first trimester using a week and some use 5 days. In our office using a 5-day rule, we would have changed her due date to 08/24/17, which makes her appropriate percentile. I explained to them using 08/18/17 which is within one week of the 1st ultrasound was not inappropriate but the baby did look small. You may consider changing her due date to the 08/24/17 based on the 1st scan or perhaps wait until the next growth scan in your office at which time if there is appropriate growth you may consider changing then versus if the baby continues to fall off then there would be more concern for IUGR. We would be happy to see her back at any time in the future but assuming this is an appropriately growing fetus, we have not scheduled her to return at this time. Please do not hesitate to contact me for any further

Regarding the chronic HTN, we did have a discussion with her and how this can affect the pregnancy. We did perform impedance cardiography. Her BP when she arrived was upper-normal at 132/84 but on the impedance cardiography it was normal at 117/78. Her heart rate when she arrived was 99 and for the test was 91. Impedance cardiography demonstrated that her cardiac output was normal at this time for her gestational age at about 5 ½ L/min. In addition, the TPR was normal at about 1300. Therefore, labetalol is a good choice. She states that in the late afternoon early evening she feels that her BP is going up and labetalol is better as a twice a day medication. Therefore, based on the fact that she is on a low-dose and her BP when she arrived was upper-normal we recommended that she take 100 mg b.i.d. In addition, based on the current

Antonia is a 42yo, G6 P5005, who was seen for a follow-up ultrasound assessment and fetal anatomy evaluation. She does have AMA and underwent full genetic counseling and elected to have noninvasive prenatal testing (NIPT). This was done and returned low-risk female. She does have 5 previous term vaginal deliveries and therefore she is grand multiparous. Lastly, she has had GDM that has required medication in her last 2 pregnancies. She states that she was told to evaluate her sugars but has not been doing so on a routine basis. With this history, we would recommend early Glucola testing. Currently at this time the patient overall has no complaints and has positive fetal movement.

Her past medical history is negative for major medical disorders by her report. She denies a history of chronic HTN but her BP when she was first seen by us today was 160/102. On completion of our evaluation her BP was 124/83. She denies any allergies to medications and

These twins are also called sternopagus twins and make up only a mere 3% of all cases.

Maria arrived at Alice Springs maternity unit complaining of headache; her blood pressure was 160/120mmhg measured manually. She had peripheral pitting oedema in her legs, proteinuria 4+, oliguria and elevated uric acid. Lisonkova and Joseph (2013) make a strong case that late-onset preeclampsia is associated with younger maternal age and nulliparity which correlated with the background of the woman under my care. While pre-eclampsia is generally diagnosed on the basis of hypertension and proteinuria (Pettit & Brown, 2012), Lewis (2011) classify these parameters as inaccurate and non specific markers. The reasons come from two directions. First they are only present in 15-20% of all pregnant women (Lewis, 2011). Second, they are just two signs of progressive circulatory malfunction and inflammation of the placenta (Lewis, 2011).

There are various ways with which a fetus can present at birth. These include cephalic, breech, face and brow presentation. Normally, at term, the fetus assumes a longitudinal lie with its head as the presenting part. This is the normal cephalic presentation. A breech presentation is when the fetal bottom is the presenting part. With advancing gestational age, the incidence of breech presentation decreases. It constitutes 25% of births before 28 weeks, 7% of births at 32 weeks and only 3% persists as breech at term deliveries. [1] Currently, external cephalic version (ECV) is the treatment of choice for pregnant women with early detected breech pregnancies. In the event of a successful ECV, the pregnant woman can have a normal