Tierra Cholestasis Case Study

There are a number of possible types of these births. These include thoracopagus, the most common, affecting 35% of all conjoined twin births, where the chest wall is shared, and often the heart. Pygopagus is another type, occurring in 19% of all cases, where the twins are joined at the buttocks. Two significantly less occurring patterns are ischiopagus, 6%, connected at the tailbone, and craniopagus, 2%, with a fused skull. Some other commonly occuring types include cephalopagus, with the upper torso and back of the cranium fused, and dicephalus, having two heads and necks connected to one body. Cephalopagus and craniopagus twins are rarely operated on, because the brain is such a delicate organ on which to operate, especially when shared brain tissue is involved. Other types include parapagus, a lateral fusion of the lower half of the body, and omphalopagus, joined frontally at the midsection. Finally there is parasitic twinning, where one twin is dependant upon the other for life, and often one is misformed, lacking organs or fully formed parts (www.twinstuff.com).

The notoriety of conjoined twins is furthered by their low birth incidence. Conjoined twinning occurs as often as once in every 40,000 births, but only once in every 200,000 live births (Gilbert, 1998). Even for those vigorous twins who make it past birth alive, only 65% survive past day one. The still bleaker newborn survival rate fluctuates between 5% and 25% (Segal, 1999). Only an estimated 300 conjoined twins in all of recorded history have lived past a few months of age (Grosz, 1996).

All data collection and storage was approved by the institutional review board to ensure proper handling of protected health information under the Health Information Portability and Accountability Act. The diagnosis of TTTS was based on a monochorionic-diamniotic twin pregnancy with a single placenta, thin dividing membrane, and matching gender twins, with polyhydramnios in the recipient (>8 cm deepest vertical pocket of amniotic fluid) and oligohydramnios in the donor (<0.05 was assigned statistical significance.

Ms. Pedroso is a pleasant 36 years old, pregnant females. She became pregnant after a first in-vitro attempted. Currently, the patient is 25 weeks of gestation and has come to the clinic with a chief complaint of recurring heartburn, which she described as a flame-throwing sensation in the epigastric area, abdominal bloating, and a sour taste in the back of her mouth. Ms. Carrillo states noting her symptoms two weeks ago and verbalized the symptoms worsen after eating; particularly after a heavy meal and with certain foods. She describes her pain 8/10 on the pain scale. The patient denies any chest pain or shortness of breath. Ms. Pedroso only known health problem is primary hypertension.

She is without complaints. She has not noted any increase in preterm labor. No signs/symptoms or change in pelvic pressure. She is compliant with bedrest and has help taking care of her son. She is otherwise aware that she should discontinue Motrin next week and is aware of the signs/symptoms that we are monitoring. The placental cord insertion does appear marginal as noted on prior ultrasound and we are following monthly growth. She is aware that after surveillance of cervical length which will the last one we would anticipate would be next week at 32 weeks and after that we would still recommend monthly evaluation of fetal growth. Preterm labor precautions were reviewed. She is scheduled to return in one

Jane is a 45yo, G2 P1001, who was seen for an ultrasound evaluation and consultation. She does have AMA but conceived during embryo transfer with a donor egg that is age 32. The father of the baby is 62. She does smoke vapor nicotine cigarettes. She has not smoked regular cigarettes for the past couple of years. She also does have asthma but is currently asymptomatic. She reportedly has had some seizures in the past but her last one occurred in 2007, about 9-10 years ago and she has not been treated for over 7 years and at this point in time is doing well and therefore medication would not be indicated at this point in time. She does have one previous delivery in 2013 that was by cesarean delivery. Lastly, she does have some issues with chronic back pain following a car accident and injuries in the past. Currently, however, she is only on acetaminophen by report. Overall, on today’s assessment she has no complaints other than she states that she has had some headaches off/on for the past couple of weeks.

Melanie is a 29yo, G5 P2022, who was seen for an ultrasound evaluation and consultation over the development of a rash. Her history is significant for a gastric sleeve that occurred in February 2013. Based on her height and weight at the start of the pregnancy, her BMI was 49. She did have a LEEP procedure on her cervix in 2014 after her last delivery. She does have 2 term deliveries in 2008 and 2014 without complications. Lastly, she developed a rash about 4 weeks ago that began on her abdomen that was reddish and raised and pruritic that has now extended to her arms and legs. She reportedly did receive a corticosteroid injection one week ago and she states that this did improve her symptoms and the rash but again it is still present. This

G: Ms. G appears ill-looking, uncomfortable and clutching her abdomen, as she is experiencing pain, she rated her pain as eight on the scale of 0 to 10 as 10 being the worse pain. The pain of Ms. G is in her upper abdomen and radiating to her upper right back and right scapular tip consistent with Collins sign. The pain initially stated as achy but changed to colicky in nature and became more constant. The pain started after she ate and vomited few times before arrival. Percussion of Ms. G’s abdomen is significant for tenderness to palpation towards her upper right quadrant a positive murphy’s sign, without rebound tenderness. Bowel sounds are normal. Ms. G’s clinical presentation is consistent with Cholecystitis. The pain for Cholecystitis usually starts within an hour post food; it can last from one to five hours and increases steadily over ten to twenty minutes along with Collins sign, and the pain doesn’t relieve after vomiting.

When the twins are in the mother's stomach i noticed that the growth development is very different than other kids if you have a kid than it would be a little different and they would act

Amber is a 22yo, G2 P1001, who is currently 20 weeks 6 days. She is healthy. She was seen earlier in our for a possible blighted ovum versus vanishing twin. At that time, we discussed in detail genetic testing but because of the suspected vanishing twin she did not opt for any further testing. At her anatomic survey, recently there was concern for a persistent right umbilical vein and she was sent for further evaluation.

One type of conjoined twin that differs from most is the parasitic twin, in which one twin is fully developed, but the other is significantly smaller and underdeveloped. Many times, the undeveloped portion is stillborn and must be surgically removed for the wellness of the healthier twin. If the less formed twin does survive, it depends entirely on the larger twin to survive. This abnormality is possible when one embryo overtakes the uterus, forcing the other embryo to stop developing completely, or develop slower. Therefore when the twins are born, there will be an asymmetrical pair. The place where these twins unite varies each case. Sometimes the twins will connect just

By dates, she is 11 ½ weeks and viable twins are identified with good cardiac motion at 12-12 ½ weeks size. The nuchal translucency measurement

Views today demonstrate a viable singleton fetus at 37 weeks 5 days in vertex presentation with posterior placenta. Amniotic fluid volume is measured as normal. BPP 8/8. Doppler studies are normal in value and wave form.

On ultrasound there is a live fetus in cephalic presentation. Fetal biometry is consistent with dates. Amniotic fluid is within normal limits. Umbilical artery Doppler was within normal limits. BPP is 8/8. Transvaginal cervical length was 2.1 cm. It did have a small beak and went

Conjoined twins are the least common type of pregnancies at one birth per 200,000 live births. Not only are they uncommon, but they also don’t always live. Approximately about 40-60 percent of conjoined twins are born stillborn, born dead, and only 35 percent of conjoined twins live past the first day.