TWINSTopic Conference

LU VI Block 10

Tindoc.Tugano.Urquiza.Uy.Velasco.Ventigan.Ventura.Verdolaga.

VillanuevaM.VillanuevaR.Visperas.Yabut.Yambot.YapB.YapJ

EV, 33 YEAR OLD G2P1(0010), SINGLE

• Labor painsChief Complaint

• (+) HPN, 2005• (+) goiter, Sept. 2011• (-) PTB, BA, CA

Past Medical History

EV, 33 YEAR OLD G2P1(0010), SINGLE

• (+) HPN, parents• (-) DM, BA, PTB, CA

Family Medical History

• HS graduate, secretary• (-) smoking, alcohol, drugs• First coitus at 23 y.o. with1

nonpromiscuous sexual partner• (-) OCP, IUD

Personal/Social History

EV, 33 YEAR OLD G2P1(0010), SINGLE

• Menarche at 10 y.o.• Interval of 30-33 days• 4 days duration• 4 pads per day• LNMP: Jan 21, 2011, unsure• PMP: Dec 2010• EDC: Oct 28, 2011• AOG: 36 4/7 weeks by early

UTZ

Menstrual History

EV, 33 YEAR OLD G2P1(0010), SINGLE

Obstetric History

G Date AOG Mode of Delivery

1 2007 2 mos. Spontaneous Abortion

2 2011 Present pregnancy

HISTORY OF PRESENT ILLNESS

OBAS

Labor pains

Watery vaginal discharg

e Good fetal

movement

REVIEW OF SYSTEMS

abdominal painfluid leakage

feverheadacheBOVvomitingdec fetal movementvaginal bleedingdysuriaedema

EV, 33 YEAR OLD G2P1(0010), SINGLE

Antenatal visits

• Lying-in clinic

• >10x c/o PGH High Risk

Primary antenatal condition

• (+) gestational Diabetes Mellitus

Quickening

• 24 weeks AOG

PHYSICAL EXAM

General

• Awake• Cohere

nt• Stretch

er-borne

• NICRD

Vitals• 170/110• HR 92• RR 44• T 36.0• Ht 155

cm• Wt 107.2

kg

HEENT

• Pink conjunctivae

• Anicteric sclerae

• (-) CLAD• (-) TPC• (-) ANM

Lungs• Equal

chest expansion

• Clear breath sounds

• (-) rales, wheezes

PHYSICAL EXAM

Heart• Adynamic

precordium• Distinct heart

sounds• Normal rate• Regular

rhythm• (-) murmurs

Abdomen

• Globular• FH 36 cm• EFW 3.4-3.6

kg• FHT 130s RLQ,

140s LPU• Cephalic-

transverse

IE• Normal external

genitalia• Nulliparous

vagina• Cervix open• Uterus enlarged

to AOG• (-) AMT• Adequate

pelvimetry

BPP/BIOMETRY/DOPPLER STUDIES

• Twin live intauterine pregnancies, both with good cardiac and somatic activites

Impression

• Cephalic in presentation, 34 weeks by BPD and 33 weeks by FL. Adequate amniotic fluid volume. EFW is AGA. BPP 10/10. Doppler flow studies show normal values

Twin A

BPP/BIOMETRY/DOPPLER STUDIES

• In transverse presentation, 33 weeks by BPD and 33 weeks by FL. Adequate amniotic fluid. EFW is AGA. BPP 10/10. Doppler flow studies of the umbilical artery show normal values

Twin B

Placenta is anterior, high-lying, grade II. Placentation appears monochorionic, diamnionic. Doppler flow

studies of the uterin contractions show normal values

EV, 33 YEAR OLD G2P1(0010), SINGLE • Pregnancy uterine, 36 4/7

weeks AOG by early UTZ, twin gestation, cephalic-transverse in preterm labor; gestational diabetes mellitus, chronic hypertension with superimposed preeclampsia, sublinical hypothyroidism, G2P1 (0010)

Assessment

• Primary low segment cesarian section secondary to malpresentation of 2nd twin

Plan