Monochorionic Twin Gestation Case Study Patricia

Patricia is a 38yo, G8 P1061, who is currently 32 weeks 6 days as dated by IVF. Two embryos were implanted but this is thought to be a monochorionic twin gestation based on a 9-week scan. She did have an increased risk of Down syndrome but has had normal anatomic surveys. She was noted to have a complete previa and recently thought to have a vasa previa and was referred for further evaluation. She has had history of infertility and several treatments with IVF and multiple first trimester miscarriages but only 2 D & C’s. She has one prior full-term delivery at 38 weeks without complications. On ultrasound, there is a live twin gestation. It was very difficult to determine chorionicity on our scan today but by history it is monochorionic and this would seem to be accurate. Twin A is on the maternal right and inferior. Twin B is on maternal right and slightly superior. Fetal biometry for both are fairly consistent with dates. Femur length lags on both twins. We did attempt detailed anatomic surveys on both that were unremarkable. There was an anterior/posterior placenta that appears to wrap around the side. Perhaps twin A has more of the anterior portion and twin B has more of the posterior portion but this was difficult to determine for certain. Amniotic fluid was normal for both sacs. On transvaginal imaging vessels can be seen coursing over the cervix and even right at …show more content…
Typically, with vasa previa we place them in the hospital sometime around 32 weeks for daily monitoring and evaluation of contractions. We typically deliver around 35 weeks. In her situation with twins it may be somewhat more difficult to determine when to deliver as well as evaluate based on contractions. For now, I will admit her to our antepartum floor for daily monitoring and twice weekly ultrasounds and we can follow cervical length assessment as

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