Tiffany is a 37yo, primigravida, who is currently 24 weeks 4 days. She is known to our office for her monochorionic twin gestation. She has had a somewhat shortened cervix and has been followed very closely. The cervix has decreased down to around 2.5 cm but there has been no evidence of a funnel. She also has a notable history of gastric bypass as well as partial gastrectomy due to a ruptured ulcer. During that hospital admission for the ruptured ulcer she had a cardiomyopathy and Afib. She has followed with cardiology this pregnancy and is doing very well. The echocardiogram was normal and a Holter monitor was performed but the result is pending. She has been followed closely for twin-to-twin transfusion syndrome as well as cervical shortening.
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She was concerned about the weight drop on twin A; hence, specifically the small head measurements. I explained to her that twin A is overall somewhat smaller than twin B and that the small head measurements were likely to be a reflection of a smaller baby. We did discuss other random possibilities in terms of infections and genetic problems but these would be unlikely given no other abnormal findings. Perhaps more likely would be the fact that there could be unequal placental sharing and perhaps twin A has less share than twin B and we will need to continue to follow for signs of placental insufficiency, We also discussed her cervical length evaluation and we will need to obtain a transvaginal cervical length at next week’s visit. Finally, perhaps more concerning on today’s scan is the development of polyhydramnios on twin B with an MVP over 8 cm. Some practices would use an MVP of 10 cm to count as polyhydramnios; however, because twin A does not have oligohydramnios at < 2 cm at this time I am not significantly concerned. If we follow-up in one week and there is any evidence of poly/oli or absent bladders we will need to consider further evaluation at Cincinnati. For now, she is scheduled to return here in one week for vaginal cervical length as well as twin-to-twin transfusion syndrome
She was concerned about the weight drop on twin A; hence, specifically the small head measurements. I explained to her that twin A is overall somewhat smaller than twin B and that the small head measurements were likely to be a reflection of a smaller baby. We did discuss other random possibilities in terms of infections and genetic problems but these would be unlikely given no other abnormal findings. Perhaps more likely would be the fact that there could be unequal placental sharing and perhaps twin A has less share than twin B and we will need to continue to follow for signs of placental insufficiency, We also discussed her cervical length evaluation and we will need to obtain a transvaginal cervical length at next week’s visit. Finally, perhaps more concerning on today’s scan is the development of polyhydramnios on twin B with an MVP over 8 cm. Some practices would use an MVP of 10 cm to count as polyhydramnios; however, because twin A does not have oligohydramnios at < 2 cm at this time I am not significantly concerned. If we follow-up in one week and there is any evidence of poly/oli or absent bladders we will need to consider further evaluation at Cincinnati. For now, she is scheduled to return here in one week for vaginal cervical length as well as twin-to-twin transfusion syndrome