Friday, 6 November 2015

management cor IUD of one fetus in twin pregnancies

Dr shaiful: Assalamualaikum, 5th month of pregnancy...so it would be after age of viability...which means more than 24 weeks gestations...which we called intrauterine death (IUD) or fetal demise...
For fetal demise of one fetus in twin pregnancy, mx depends on type of chorionicity, gestation and causes of fetal demise...

Dr. Shaiful: But for monochorionic twins (shared placenta) the risk of IUD of the paired twin is there...can be as high as 20%...even if survive...there is still risk of neurological damage to the surviving fetus...
I have encounter certain hospital giving MgSo4 (not for PE) but for cerebral protection in potential severe prem baby (eg htaa) which can be applied as well in this case of reducing risk of morbidity of surviving 2nd fetus...
Time of delivery is basically still grey area in monochorionic twins...and opinions from fetomaternal specialist (eg Dr Anna) is really required...
If conservative is choosed, some suggest delivery as early as 28 weeks for MCMA, and up to 34 weeks for MCDA...

Dr. Shaiful: Lets begin with DCDA twin (2 sacs 2 placentas = 2 different sets of rooms). If one fetus IUD, and the causes is not related to systemic or uteroplacental insufficieny, and most likely not gonna cause another IUD to the surviving fetus...conservative managememt can be done and wait for delivery at least till 34 weeks (most studies showed that 90% of preterm baby salvageable at 34 weeks)

Dr. Shaiful: Im forwarding my answers to ur fren in other posting asking about management cor IUD of one fetus in twin pregnancies....
Above are the answers...
Hope its useful...

Dr. Shaiful:My homework for u guys are events occur at 34 weeks...
Tq.

Faiz Roslan: Dr, one of the events occur during 34 weeks is that the amniotic fluid is at its max. Betul ke dr?

6oct2015

No comments:

Post a Comment