Tierra Cholestasis Case Study

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Tierra is a 23yo, G2 P1001, who was seen for a follow-up ultrasound and consultation. As you know, she has a dichorionic/diamniotic twin gestation. She did undergo FTS that returned low-risk. She also has a history of a previous cesarean delivery. She herself reportedly was born with a small cleft palate but it closed on its own. Most recently, the patient has developed cholestasis and is now on ursodiol 300 mg t.i.d. She states that she still periodically itches but the medication has markedly improved her status. She believes that she has had the itching for about 2-3 weeks. On today’s evaluation, she does have good fetal movement and otherwise has no obstetrical complaints. By dates, she is 33 ½ weeks. Both twins are cephalic with twin A on the left, slightly anterior, and twin B more to the right and superior. Both have good amniotic fluid. The dividing membrane is identified. The BPP scores are 8/8 and the Doppler studies are reassuring. An overview fetal anatomy assessment was performed, though limited by the more advanced gestational age in conjunction with twins. No gross malformations were noted but again a detailed assessment was not possible.…show more content…
Normally, the plan with dichorionic/diamniotic twins who are progressing well, delivery would occur at around 38 weeks gestation but with cholestasis this changes the picture somewhat. She states that the plan right now is to deliver at around 36 weeks gestation and we concur with this
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