Twin gestation in a uterus didelphys with only one functional cervix: A case report.

INTRODUCTION: Twin gestation in a uterus didelphys with one fetus in each uterine cavity is rare and presents unique challenges in antepartum and intrapartum care. CASE PRESENTATION: A 35-year-old woman with a uterus didelphys became pregnant with twins, with one fetus in each uterus, after intrauterine insemination of a single visible cervix. Multiplanar ultrasonography showed the presence of one complete cervix and a second hypoplastic cervix; it was unclear whether she could deliver both twins vaginally. Her pregnancy was complicated by fetal growth restriction of twin B. At 38 weeks, the patient underwent scheduled cesarean section and delivered two viable twins. CONCLUSION: Determining the precise anatomy of Mullerian duct anomalies, including the cervix and vagina, is important for obstetrical management.

Parturient With Barnes Syndrome (Thoracolaryngopelvic Dysplasia) Undergoing Cesarean Delivery of a Neonate With Barnes Syndrome: A Case Report.

This case describes a parturient with Barnes syndrome, a rare disorder characterized by subglottic stenosis, thoracic dystrophy, and small pelvic inlet, who underwent cesarean delivery of a neonate diagnosed with Barnes syndrome. Live simulation training was performed by multidisciplinary team to prepare for the spinal anesthetic, personnel flow between 2 operating rooms, and management of various airway scenarios for the newborn. After delivery, the neonate underwent laryngoscopy-bronchoscopy with successful intubation in the operating room because of labored breathing. Airway evaluation revealed subglottic stenosis, tracheomalacia/bronchomalacia. Collaboration among perinatologists, obstetric/pediatric anesthesiologists, pediatric head and neck surgeons, and neonatologists was integral to perioperative management of both the mother and child.

Twin-to-twin transfusion syndrome: prenatal diagnosis and treatment.

CLINICAL PROBLEM: Twin-to-twin transfusion syndrome (TTTS) increases perinatal morbidity and mortality for 10 to 15% of monochorionic (MC) gestations. PATHOPHYSIOLOGY: MC gestations are at risk due to the angioarchitecture of the shared placenta, with anastomoses of varying type, size, and quantity. TTTS results from progression of a chronic perfusion imbalance across unbalanced placental anastomoses, typically arising between 15 and 26 weeks gestation. The resulting abnormal fetal blood volume levels and compensatory physiological responses lead to an increased risk for fetal death, end-organ damage, and preterm birth. PRENATAL DIAGNOSIS: Surveillance with ultrasound is essential for detection and treatment. TTTS is diagnosed once polyhydramnios occurs in the recipient (maximal vertical fluid pocket [MVP] > 8 cm) and oligohydramnios in the donor (MVP < 2 cm). The Quintero et al method is commonly used for staging, utilizing the presence or absence of donor bladder filling, abnormal fetal Doppler values, fetal hydrops, and demise. TREATMENT: Fetoscopic laser photocoagulation of placental anastomoses is an effective treatment addressing the underlying pathophysiology. Further research is needed to improve survival rates, reduce risks of fetoscopy, and gain understanding of the prediction, assessment, and optimization of long-term outcomes for TTTS survivors.