Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first tw...Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first twin is usually followed by the unavoidable delivery of the second twin and most fetus dies shortly after delivery. Studies have noted that delayed delivery of the second fetus in a twin pregnancy is an effective management choice and the use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. We present a case of previable premature rupture of membrane of a dichorionic diamniotic twin gestation leading to the loss of the leading twin and subsequently having emergency cervical cerclage for the second twin and caesarean delivery at term. Case Presentation: She was a case of a 29 years old, G<sub>6</sub>P<sub>1</sub><sup>+4</sup> with 1 living child at a gestational age of 17 weeks plus 5 days who initially was diagnosed with dichorionic diamniotic twin gestation following an early ultrasound but presented with a history of bleeding and passage of liquor per vaginam. Ultrasound done on admission showed cervical funneling and a stable state of the second twin. She subsequently had emergency cervical cerclage after stabilization on account of previable premature rupture of membrane of a dichorionic diamniotic twin gestation with the loss of the leading twin. A repeat ultrasound done prior to discharge showed closed cervical os and a good state of the fetus. She then had elective caesarean delivery at term with a good feto-maternal outcome. Conclusion: Emergency cervical cerclage should be part of the options of management after stabilization in cases of previable premature rupture of membrane in a dichorionic or multichoronic gestation so as to save the viable once.展开更多
Objective:To identify the occurrence of the amniotic deformity adhesions,mutilation(ADAM)complex and imperative role of fetal autopsy in diagnosing this condition.Methods:A retrospective descriptive study spanning nin...Objective:To identify the occurrence of the amniotic deformity adhesions,mutilation(ADAM)complex and imperative role of fetal autopsy in diagnosing this condition.Methods:A retrospective descriptive study spanning nine years,from January 2014 to January 2022,was conducted at the Department of Pathology within a tertiary care hospital in South India.The study focused on analyzing the clinical presentation,prenatal ultrasonogram,and morphological features of fetuses with the ADAM complex,limb body wall complex,or amniotic bands.Results:Among the 438 fetuses assessed during the study period,five fetuses showed features of the ADAM complex(0.01%).The most frequent gestational age observed was 12–18 weeks andmost fetuseswere female.The common anomaly encountered was limb defects,followed by abdominal and cranial anomalies.Conclusion:The diagnosis of the ADAM complex relies primarily on fetal autopsy to differentiate it from similar conditions like anencephaly or body-stalk anomalies.The pathologist plays a crucial role in understanding the complexities of the ADAM complex.Advanced antenatal imaging and therapies offer potential for prevention through improved counseling.展开更多
文摘Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first twin is usually followed by the unavoidable delivery of the second twin and most fetus dies shortly after delivery. Studies have noted that delayed delivery of the second fetus in a twin pregnancy is an effective management choice and the use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. We present a case of previable premature rupture of membrane of a dichorionic diamniotic twin gestation leading to the loss of the leading twin and subsequently having emergency cervical cerclage for the second twin and caesarean delivery at term. Case Presentation: She was a case of a 29 years old, G<sub>6</sub>P<sub>1</sub><sup>+4</sup> with 1 living child at a gestational age of 17 weeks plus 5 days who initially was diagnosed with dichorionic diamniotic twin gestation following an early ultrasound but presented with a history of bleeding and passage of liquor per vaginam. Ultrasound done on admission showed cervical funneling and a stable state of the second twin. She subsequently had emergency cervical cerclage after stabilization on account of previable premature rupture of membrane of a dichorionic diamniotic twin gestation with the loss of the leading twin. A repeat ultrasound done prior to discharge showed closed cervical os and a good state of the fetus. She then had elective caesarean delivery at term with a good feto-maternal outcome. Conclusion: Emergency cervical cerclage should be part of the options of management after stabilization in cases of previable premature rupture of membrane in a dichorionic or multichoronic gestation so as to save the viable once.
文摘Objective:To identify the occurrence of the amniotic deformity adhesions,mutilation(ADAM)complex and imperative role of fetal autopsy in diagnosing this condition.Methods:A retrospective descriptive study spanning nine years,from January 2014 to January 2022,was conducted at the Department of Pathology within a tertiary care hospital in South India.The study focused on analyzing the clinical presentation,prenatal ultrasonogram,and morphological features of fetuses with the ADAM complex,limb body wall complex,or amniotic bands.Results:Among the 438 fetuses assessed during the study period,five fetuses showed features of the ADAM complex(0.01%).The most frequent gestational age observed was 12–18 weeks andmost fetuseswere female.The common anomaly encountered was limb defects,followed by abdominal and cranial anomalies.Conclusion:The diagnosis of the ADAM complex relies primarily on fetal autopsy to differentiate it from similar conditions like anencephaly or body-stalk anomalies.The pathologist plays a crucial role in understanding the complexities of the ADAM complex.Advanced antenatal imaging and therapies offer potential for prevention through improved counseling.
