[Solved]: Case 4: Operative Report PREOPERATIVE DIAGNOSIS:…

Case 4: Operative Report PREOPERATIVE DIAGNOSIS: Term intrauterine pregnancy with monochorionic diamniotic twin gestation POSTOPERATIVE DIAGNOSIS: Term pregnancy delivered vaginally, Twin A in vertex and Twin B in complete breech PROCEDURE PERFORMED: Normal spontaneous vaginal delivery of Twin A Breech extraction of Twin B INDICATIONS: 32-year-old G2 P1001 at 37 weeks and one day gestation with Mo-Di twins who was admitted to labor and delivery for induction of labor. The patient was found to be cephalic for twin A, breech for twin B with concordant fetal weight. After counseling the risks, benefits and alternatives to vaginal delivery with breech extraction, the patient opted to proceed with this mode of delivery. DETAILS: The patient was induced with Cytotec followed by augmentation with Pitocin. She quickly progressed from 5, 90 and -2 to complete and +2. At this time, the patient was transferred to the operating room where she was placed in the dorsal lithotomy position. Twin A was delivered from the cephalic presentation without difficulty at 6:44 am with Apgars of 9 and 9. The cord was clamped. A segment for cord gases was collected but cord gases were not sent given the Apgars. The patient proceeded to contract and push effectively. Twin B was in complete breech presentation. Each leg was tucked in and delivered separately. The torso was then wrapped in warm surgical towels. The body was rotated to the lateral with the right arm located, tucked and delivered atraumatically. The body was again rotated and the left arm was located, tucked and delivered atraumatically. With my assistant putting pressure on the uterine fundus, the head was delivered at 7:12 am with Apgars of 8 and 9. The cord was clamped. The infants were both handed off to waiting pediatrician directly after delivery. The placenta was delivered spontaneously without difficulty. Pitocin was started. As the patient continued to have trouble contracting, a dose of Methergine 0.2 mg was given IV. Subsequently, the uterus was found to be firm with minimal vaginal bleeding. The placenta was sent to pathology. Total EBL was 500 ml