Question

A 33-year-old G2P1 with a known twin gestation presents to your office at 23 weeks gestation and notes that two days prior she had a nosebleed. She has not been seen in your office for the last seven weeks. Ultrasound today shows a demise of one twin that has measurements consistent with 21 weeks gestation. What is the next step in the management of this patient?

A. Immediate delivery of the surviving twin
B. Continued management as a singleton pregnancy
C. Maternal fibrinogen level
D. Abdominal x-ray to assess for Spalding's sign
E. Nonstress test of the surviving twin

Answer 1

Immediate delivery is not the next step in management of a twin gestation with one demise at 23 weeks. Monitoring the surviving twin with a nonstress test and watching for maternal complications is the appropriate course of action.

Step-by-step explanation:

A 33-year-old G2P1 with a known twin gestation at 23 weeks presents with the demise of one twin measuring at 21 weeks gestation. The management of this patient does not include immediate delivery of the surviving twin. Delivery at this stage could drastically reduce the viability of the surviving twin, and an ultrasound does not indicate delivery is imperative. Instead, management should focus on monitoring the health and development of the surviving twin and maternal health. An option to consider would be a nonstress test of the surviving twin to assess fetal well-being, in addition to monitoring the mother for any signs of complications, such as disseminated intravascular coagulation, which may prompt tests like checking maternal fibrinogen levels.