A missed diagnosis:
At the start of my inpatient #Maternal Fetal Medicine rotation last month, I was called to triage to counsel a mother with monochorionic, diamniotic twins.
This particular patient, unemployed and underserved, had had very little prenatal care. She knew how far along she was and that she was having twin girls, but the high-risk chorionicity of her #pregnancy had been missed at her initial prenatal visit, and she had not undergone an #ultrasound since. It was only now, presenting to our triage with a painfully distended abdomen, that she learned her fetuses actually shared a single placenta. Because of this missed diagnosis, the #woman had not had the regular ultrasound surveillance that might have detected the twin-twin transfusion syndrome now affecting her #pregnancy.
The patient was so polyhydramnios, she was having difficulty breathing. She was in shock. We discussed that her condition was now considered Stage IV, and the twins were unlikely to survive. We offered her an amniocentesis, knowing that removing the excess fluid in the remaining amniotic sac would relieve some of the discomfort of her swollen #abdomen, but she declined.
The #woman asked us to scan her abdomen a final time. One of her fetuses was hydropic, while the other was severely growth restricted. She sobbed quietly, and her boyfriend, sitting on a chair by the bed, played tinny music from her phone to comfort her. After the scan we stepped out of the room, letting the patient rest a while.
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