Tierra Cholestasis Case Study

Obstetric Cholestasis (OC) or Intraheptic Cholestasis of pregnancy is a disorder that is unique to pregnancy (Kelly and Nelson-Piercy, 2000).OC classically presents in the third trimester (Royal College of Obstetricians and Gynaecologists [RCOG], 2006), With maternal pruritus and raised bile acids (Geenes and Williamson, 2009).It is one of the few disorders of pregnancy that can affect both maternal well being and fetal outcome. OC usually resolves forty eight hours after delivery (Mays, 2010).

Ultrasound of the fetal biophysical profile dated 06/12/2017 showed a twin intrauterine pregnancy. The placenta was anterior in location, grade III. The fetus was in breech presentation, maternal left. The gestational age by last menstrual period was 36 weeks and 1 day with an estimated due date of 07/09/2017.

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

Tyler was seen in the Neonatal Followup Clinic on January 9, 2014, at 4 months, 12 days corrected age. As you will recall, Tyler was born at 30 + 3 weeks' gestational age with a birth weight of 1300 grams. He is twin A of a monochorionic diamniotic twin set. His neonatal course was complicated by respiratory distress syndrome, apnea of prematurity, jaundice, and anemia of prematurity. He was discharged home mid-August 2013.

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).

Lousie was an induction at 41weeks and three days, her birth was identical to her first resulting in a ventouse delivery after slow progression in her second

What happens chemically in a pregnant woman's body that has conjoined twins is the whole cause of the situation. The two twins will form 8 to 12 days after conception when embryonic layers split. When the two twins are forming they develop specific organs and structures. The separation of the twins will stop around the 13 through 15 day point. There is also a theory for the cause where two separate embryos

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

Twins are at a greater risk to be diagnosed with cerebral palsy than singletons. If one twin dies during infancy or a fetal death, the surviving twin has a higher potential of being diagnosed with cerebral palsy. A survey was conducted in England and Wales to compare birthweight specific cerebral palsy and to analyze was there a connection between cerebral palsy and like-sex and unlike-sex twins, also did the death of a twin sibling increase the chances of the surviving twin having cerebral palsy. The birth weight was a factor in the survey due to a higher occurrence of preterm births in twins. If a child is born pre-mature, he or she is at a higher risk of hypoxic ischaemic cerebral impairment.

Twin-to-twin transfusion syndrome (TTTS) is a rare disease occurring in 10-15% of monochorionic-diamniotic twin gestations in which vascular connections are shared between the fetuses via a common placenta1, 2, 3. A theoretical imbalance in the vascular distribution creates a shift in circulation causing one fetus to receive a surplus in volume, the recipient, and the other to be deficient, the donor4, 5. TTTS can present at any gestational age6 and can progress in severity causing significant morbidity, especially to the recipient, and even demise of one or both twins1, 2, 6. Classic ultrasonic markers of TTTS have been well-described as an amniotic fluid imbalance between the twins2. Several staging systems have been

A 42-year-old male with history of Crohn's colitis as well as symptomatic hidradenitis. He was last seen in 03/2016. Patient last had a colonoscopy in 08/2015 at Duke. Most recently, the patient is undergoing dermatological evaluation at UNC Chapel Hill for his inguinal hidradenitis. He is on IV Remicade. The patient denies any diarrhea or bleeding. Nursing reports to me that he does have an unexplained fever that is being worked up.

Finding out you are expecting twins can be a joyous and yet frightening prospect, most parents immediately think ‘I have to buy 2 of everything?!’. However, multiple foetuses can cause problems most parents haven’t even considered. One of these is twin-to-twin transfusion syndrome.

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

On ultrasound, there is a live fetus in cephalic presentation. Fetal biometry is slightly behind dates with growth at the 9%ile. This is brought down some by the 3-week abdominal circumference lag. Umbilical artery Doppler was within normal limits. There is no shunting of the MCA. AFI is 13 cm. BPP is 8/8. A limited survey did not show the EIF on today’s scan. There were no gross abnormalities seen. We did note an occasional PAC on M-Mode. Transvaginal imaging noted the placental edge to be over 2 cm from the internal os. There was some colorflow noted laterally over the cervix. We tried to Doppler this flow there was no pulsations noted.