Views today demonstrate a viable twin gestation at 16 weeks 2 days.
Twin A: Maternal left, inferior, vertex presentation with posterior placenta. Fetal biometry appears symmetric and corresponds with stated EDD. Due to early gestational age detailed fetal anatomy was not assessed but is notable for symmetric choroids, intact ventral wall, visualization of stomach, bladder, and male genitalia. Amniotic fluid volume measures normally by MVP.
Twin B: Maternal right, superior, transverse, anterior placenta. fetal biometry appears symmetric and corresponds with stated EDD. Due to early gestational age detailed fetal anatomy was not assessed but is notable for the presence of stomach, bladder, kidneys, symmetric choroids, male genitalia. …show more content…
We reviewed today’s reassuring study with the twins and recommend serial anatomy. I would also consider an additional 1 mg of folic acid to give each fetus 1 mg of folic acid. She plans repeat cesarean delivery. Understands that with a twin gestation she would be at increased risk for diabetes, hypertensive complications, risk of operative vaginal delivery, and indicted preterm birth.
More relevant to her rash I did see and now the vesicles are primarily crusted in various stages of healing. It is very close on her perineum. It does not spread along a dermatome. I am suspicious that it appears most consistent to me at this point as HSV. We talked about the difference and the importance of a primary serial conversion during pregnancy versus a recurrence of HSV and that the risk of transmission to her fetus is significantly less with a recurrence and almost negligible versus with a primary serial conversion transmission risk depends upon trimester. Certainly, transmission is the lowers in the first trimester, highest in the third trimester, but has the greatest impact on the fetus earlier in gestation. I called Women’s Wellness and put her in the conference room to try to see if serologies were back yet. She waited 30 minutes. We received records and there is no appearance of titers in the labs that were faxed to us today. Given our inability to draw any conclusions today, we laid out the plan and her risks and I asked her to come back in 3 weeks for a follow-up discussion. all questions were answered to her satisfaction. Thank you very much. She will continue on Valtrex treatment dose at this
Twin A: Maternal left, inferior, vertex presentation with posterior placenta. Fetal biometry appears symmetric and corresponds with stated EDD. Due to early gestational age detailed fetal anatomy was not assessed but is notable for symmetric choroids, intact ventral wall, visualization of stomach, bladder, and male genitalia. Amniotic fluid volume measures normally by MVP.
Twin B: Maternal right, superior, transverse, anterior placenta. fetal biometry appears symmetric and corresponds with stated EDD. Due to early gestational age detailed fetal anatomy was not assessed but is notable for the presence of stomach, bladder, kidneys, symmetric choroids, male genitalia. …show more content…
We reviewed today’s reassuring study with the twins and recommend serial anatomy. I would also consider an additional 1 mg of folic acid to give each fetus 1 mg of folic acid. She plans repeat cesarean delivery. Understands that with a twin gestation she would be at increased risk for diabetes, hypertensive complications, risk of operative vaginal delivery, and indicted preterm birth.
More relevant to her rash I did see and now the vesicles are primarily crusted in various stages of healing. It is very close on her perineum. It does not spread along a dermatome. I am suspicious that it appears most consistent to me at this point as HSV. We talked about the difference and the importance of a primary serial conversion during pregnancy versus a recurrence of HSV and that the risk of transmission to her fetus is significantly less with a recurrence and almost negligible versus with a primary serial conversion transmission risk depends upon trimester. Certainly, transmission is the lowers in the first trimester, highest in the third trimester, but has the greatest impact on the fetus earlier in gestation. I called Women’s Wellness and put her in the conference room to try to see if serologies were back yet. She waited 30 minutes. We received records and there is no appearance of titers in the labs that were faxed to us today. Given our inability to draw any conclusions today, we laid out the plan and her risks and I asked her to come back in 3 weeks for a follow-up discussion. all questions were answered to her satisfaction. Thank you very much. She will continue on Valtrex treatment dose at this