Category: Case presentation of twin pregnancy ppt

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Case presentation of twin pregnancy ppt

17.01.2021 Case presentation of twin pregnancy ppt

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Title: Ectopic Pregnancy. Description: Case 2: Note that the ectopic is separate from the ovarian cyst Tags: ectopic fundus pregnancy. Latest Highest Rated. We presume the prior appearance was due to a bowel loop 35 Case 13?

Scans 2 days apart show IUP on follow-up. Why was a gestational sac not visualized on the original scan? Managed expectantly, and no surgery or intervention was needed. Presumed ruptured hemorrhagic cyst 41 Case 17 continued 42? Whether your application is business, how-to, education, medicine, school, church, sales, marketing, online training or just for fun, PowerShow. And, best of all, most of its cool features are free and easy to use. You can use PowerShow. Or use it to find and download high-quality how-to PowerPoint ppt presentations with illustrated or animated slides that will teach you how to do something new, also for free.

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Here at Slidesgo, Clinical cases are an important reference in the medical community, since they are a trustworthy source of information for doctors.Abdominal pregnancy, a rare diagnosis, belongs to the ectopic pregnancy group, the leading cause of pregnancy related exitus.

The positive diagnosis is very difficult to establish most often in an acute setting, leading to a staggering percent of feto-maternal morbidity and mortality. Case report. We present the case of weeks-old abdominal pregnancy with partial feto-placental detachment in a patient, after hysteroscopy and in vitro fertilization, which until the acute symptoms that led to emergency laparotomy went unrecognized.

The patient recovered completely and satisfactorily after surgery and, due to the high risk of uterine rupture with regard to a second pregnancy, opted for a surrogate mother.

Abdominal pregnancy can be regarded as a difficult to establish diagnosis, with a greater chance in case of increased awareness. It is compulsory to be well informed in order not to be surprised by the diagnosis and to apply the correct treatment immediately as the morbidity and mortality rate is elevated.

An ectopic pregnancy can be defined as a pregnancy implantation anywhere else than in the endometrial lining of the uterine cavity [ 1 ]. For each ectopic pregnancies, about 9,2 abdominal ones occur [ 4 ]. The case of a secondary abdominal pregnancy after hysteroscopy and in vitro fertilization is described. A week-old primigravida patient was admitted in the emergency room of the University Emergency Hospital Bucharest for acute pelvic-abdominal pain and lipothymia.

Following the immediate stabilization of the vital functions, all the necessary diagnostic steps were taken in order to establish the initial cause.

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According to her general history, after a normal hysteroscopic evaluation, in vitro fertilization was successfully attained, all prior routine examinations revealing normal results and being uneventful. The emergency ward general and genital examination established a distended painful acute abdomen with a fundal uterine height of approximately 23 weeks without any associated vaginal bleeding or cervical modification.

case presentation of twin pregnancy ppt

The emergency sonographic evaluation rendered with high suspicion an extrauterine abdominal pregnancy corresponding to the gestational age mentioned - about 23 weeks - without any fetal cardiac activity, an empty uterine cavity and a considerable amount of fluid located in the rectovaginal sac and around the uterus.

Upon establishing the final diagnosis — acute abdomen, suspicion of 23 weeks old abdominal pregnancy with no fetal cardiac activity, transient lipothymia state - an emergency laparotomy was decided. The following intraoperatory findings were discovered: ml of blood associated with clots and a week-old abdominal pregnancy with a partially detached fundal uterine placental implantation site Fig.

Intraoperatory findings: ml of blood associated with clots and a week-old abdominal pregnancy. A fundal uterine wedge resection successfully eliminated the residual placental villi, which were until the middle third, macroscopically visualized Fig. Mattress sutures were used in order to safely close the excised fundal myometrium Fig. No other abdominal findings were observed upon a very thorough examination. The patient recovered without any other complications being released from hospital in 7 days and registering uneventful and satisfactory follow-ups.

In order to avoid a premature uterine rupture, a decision regarding a surrogate mother was elected. The general rate of abdominal pregnancy is of about Their number is declining despite a rising trend for ectopic pregnancies; the explanation is lying in the increasing awareness and improved care as the vast majority of abdominal pregnancies are due to ruptured tubal ones [ 4 ]. Numerous implantation sites have been encountered, among which: uterine, omental, vital organs, large vessels, cul de sac, bowel, appendix, broad ligament, pelvic sidewall, peritoneum, spleen, etc.

In our case, a fundal uterine implantation site occurred with up to the middle third myometrial invasion. An abdominal pregnancy can go undetected until an advanced gestational age, at which most abdominal pregnancies are discovered, complicating the further management [ 7 ].

Multiple Pregnancy - Obstetrics

Unfortunately our patient did not experience any of the above-mentioned symptoms, which could have led at least to a more scrupulous and frequent examination with a chance of discovery; the only symptoms experienced being the acute ones due to the bleeding, such as lipothymia and pelvic pain attributed to peritoneal irritation by blood. Laboratory tests do not have a diagnostic value, among the altered ones, being a positive pregnancy test, elevated human chorionic gonadotropin level or an elevated alpha-fetoprotein with added suspicion [ 1617 ].

Abdominal tenderness was also positive upon palpation, the other signs being unable to be discovered as the pregnancy in our case was not as advanced despite the fact that the gestational sac was in direct contact with the anterior wall Fig.

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The final diagnosis, which in our case, is often ultrasonographically obtained with a greater ease at the end of the first trimester or early in the second one, was obtained due to better pelvic organs visualisation [ 18 ]. Some of the suspicion signs described in literature are listed as it follows: the classic finding represents an empty uterine cavity which can be associated with no sign of ectopic tubal pregnancy, with an abdominal mass representing the fetus without any myometrium surrounding it or with the absence of myometrial tissue between the bladder and the gestational sac and sometimes without any surrounding amniotic fluid; other suggestive ultrasound findings describe the fetal parts being very close to the abdominal wall, an abnormal lie, no amniotic fluid between the placenta and fetus, free intraabdominal fluid or even abnormal doppler velocimetry in the umbilical artery waveform [ 6111416171920 ].

Upon the ultrasonographic evaluation, some of the suspicious signs mentioned above, were found, which led to the correct diagnosis such as the empty uterine cavity and the gestational sac without any myometrium surrounding it located above and anterior to the uterus associated with an increased amount of free fluid — most probably blood.

Our patient had regular ultrasound follow-ups, all the images revealing a normal pregnancy. We believe this was due to the addition of the 2 separate masses, the empty uterus and the gestational sac with a fundal implantation as one due to the bidimensional image rendered by sonography.

Abdominal pregnancy - Case presentation

Similar facts were presented according to [ 14 ], a broad ligament pregnancy and empty uterus having been mistaken with a bicornuate uterus pregnancy, the empty uterine cavity was thought to be the empty horn [ 14 ]. Being difficult to diagnose despite the modern echographic techniques listed above, magnetic resonance imaging was used in order to add value, thus lowering the age of identification and locating the fetus and placenta [ 71920 ].

Whenever in doubt, diagnostic laparoscopy is also recommended [ 19 ]. As in our condition, the vast majority of cases unfortunately appear in the emergency ward because of the acute symptoms due to premature rupture of the placental implantation site, so, most frequently, the final diagnosis is obtained upon laparotomy [ 719 ].A 38 year-old woman presented with a dichorionic diamniotic twin pregnancy at gestational age of 32 weeks concerning for an abdominal wall mass in one of the twins.

Initial ultrasound evaluation was suspicious for an omphalocele, but the affected twin was found to have bladder exstrophy at birth.

This illustrates the difficulties of accurate prenatal diagnosis of bladder exstrophy in a twin pregnancy at a late gestation. Bladder exstrophy is a rare congenital malformation which occurs as a result of incomplete closure of the lower anterior abdominal wall.

The incidence ranges from 1 : 10, to 50, live births with a male to female ratio of 2 : 1 [ 12 ]. The embryologic defect is failed mesenchymal cell migration between the cloaca and abdominal wall ectoderm. This leads to an absence of anterior abdominal connective tissue and muscles. Prenatal diagnosis involves differentiating this defect from other common anterior abdominal wall defects including omphalocele and gastroschisis.

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Ultrasonography has been the standard diagnostic modality but may be limited in twin pregnancies and late gestational presentations. Proper identification is important for prenatal counseling and preparing surgical teams for expectant management. We describe the sonographic findings and management in an unusual case of bladder exstrophy.

A year-old, gravida 8, parawoman presented with a dichorionic diamniotic twin intrauterine pregnancy with discordant growth. Amniocentesis at 18 weeks gestation showed both twins with karyotype 46 XY.

Management of Multiple Pregnancy

Fetal echocardiogram at 28 weeks on twin B was concerning for possible ventriculoseptal defect and coarctation of the aorta. Ultrasound at a late gestational age of 32 weeks on twin B showed normal amniotic fluid and renal development. However, a filling urinary bladder was not clearly visualized in twin B compared to twin A. A cm diameter lower abdominal mass and extracorporeal liver with an entering vessel suspicious for omphalocele was seen on twin B Figure 1.

ANEMIA IN PREGNANCY - PowerPoint PPT Presentation

The patient was referred to pediatric surgery for counseling on abdominal wall defects, specifically omphalocele and gastroschisis. Examination of newborn B showed a low set umbilicus, pubic bone diastasis, and epispadias. The anterior abdominal wall mass was infraumbilical with a large, everted mucosalized surface and identifiable ureteral orificies consistent with bladder exstrophy Figure 2.Family history Excessive fetal movement Exaggerated pregnancy symptoms.

Adequate analgesia epidural anaesthesia. Continuous fetal monitoring of both twins. Conduct labour and delivery of first twin normally as in singleton. No ergometrine after delivery of anterior shoulder of the first twin.

case presentation of twin pregnancy ppt

If abnormal, correct to a longitudinal lie and preferably cephalic presentation by ECV. If unsuccessful do internal podalic version success rate is higher but require anaesthesia An assistant stabilizes the fetal head at the pelvic brim await uterine contractions for about 10 minutes, if none then use oxytocin infusion. Rupture fetal membranes when contractions are established and deliver. Active management of 3rd stage of labour to prevent PPH -give ergometrine at delivery of anterior shoulder -early cord clamping and controlled cord traction -maintain oxytocin infusion for about 2 hours post partum.

Delayed Delivery of Second Twin. In the circumstances where one of the fetuses has been expelled very preterm and uterine activity then ceased, The pregnancy has occasionally been allowed to continue With delivery of another fetus days to even many weeks later.

Preterm labour. Duration of Gestation. Decresses with number of fetuses. Unequal size of twin fetuses. With vaginal delivery, the first infant is usually born spontaneously or with little manipulation.

Subsequent infants are delivered according to the presention. This may require complicated obstetrical maneuvers, internal podalic version breech extraction, cesarean delivery.

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Toggle navigation. Help Preferences Sign up Log in. To view this presentation, you'll need to allow Flash. Click to allow Flash After you enable Flash, refresh this page and the presentation should play. View by Category Toggle navigation. Products Sold on our sister site CrystalGraphics. Description: Breastfeeding: advantages for infant. Conception: Necessary Tags: pregnancy breastfeed can husband my. Latest Highest Rated. Perinatal period from beginning of labour to 72 hrs. Whether your application is business, how-to, education, medicine, school, church, sales, marketing, online training or just for fun, PowerShow.

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Help Preferences Sign up Log in. View by Category Toggle navigation. Products Sold on our sister site CrystalGraphics. Anemia is the most common medical disorder during pregnancy.

Provided by: pramilabehera. Latest Highest Rated. Maternal Hb. Mass expansion mg? Fetus Placenta mg? Shed through gut.

case presentation of twin pregnancy ppt

Mildly anemic progresses to marked Anaemia Pt. Reduced stored iron e.

case presentation of twin pregnancy ppt

Reduced stored and transport iron Increased erythrocyte protoporphyrin concentration Detected by a routine check of the transferrin saturation.

Stage of deficiency of stored, transport and functional iron Reduction of hemoglobin and serum ferritin Low serum transferrin saturation Increased erythrocyte protoporphyrin concentration Iron deficiency attracts medical attention most commonly at this stage. Reticulocyte hemoglobin conc. Hb increases 0.

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Drawbacks - Intolerance - Unpredictable absorption rate. Ferric gluconate Skin discoloration Local abscess Allergic reaction Fe over load. Treatment Stop infusion.


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