Delayed Diagnosis Of Bacterial Infection Causes Premature Twin Birth

Maternal Fetal Medicine Expert

This case involves a female patient who was confirmed by ultrasound to have a twin pregnancy. The patient was seen by her obstetrician at 22 weeks gestation with complaints of leaking clear fluid and pelvic pain. The obstetrician did not measure cervical length or recommend any further investigation of the patient’s symptoms. The patient was advised to return for routine follow-up in 4 weeks. The following week, the patient presented to the emergency room with complaints of fluid leakage and pelvic pain. She was admitted and treated with antibiotics for a urinary tract infection. It was later discovered that the patient had developed chorioamnionitis due to prolonged labor. The twins were born with birth defects and one of the twins passed away within 36 hours of birth.

Question(s) For Expert Witness

  • 1. Please describe your background in maternal-fetal medicine.
  • 2. How often do you manage patients like the one described in this case?
  • 3. Under what circumstances would you measure cervical length for a patient with this type of presentation?

Expert Witness Response E-052557

I am a maternal-fetal medicine specialist, and I practice at a center that performs fetal therapy, including laser therapy for twin to twin transfusion syndrome. I see many patients with mono/di twin pregnancies because I work at a referral center for this type of pregnancy. In a typical work day, I’ll see at least 2-3 patients with mono/di twins. In any patient with twins and complaints of leaking fluid or pelvic pain, I would do an evaluation including checking for rupture of membranes and cervical exam (manual exam or ultrasound-based, depending on the specific circumstances). Also of note, in a mono-di twin pregnancy she should have been followed with ultrasound every two weeks to look for development of twin to twin transfusion syndrome. If that develops, one of the complications is preterm labor with or without rupture of membranes.

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