1. TWINS Topic Conference LU VI Block 10 Tindoc.Tugano.Urquiza.Uy.Velasco.Ventigan.Ventura.Verdolaga. VillanuevaM.VillanuevaR.Visperas.Y abut.Yambot.YapB.YapJ

2. EV, 33 YEAR OLD G2P1(0010), SINGLE Labor pains Chief Complaint (+) HPN, 2005 (+) goiter, Sept. 2011 (-) PTB, BA, CA Past Medical History

3. EV, 33 YEAR OLD G2P1(0010), SINGLE (+) HPN, parents (-) DM, BA, PTB, CA Family Medical History HS graduate, secretary (-) smoking, alcohol, drugs First coitus at 23 y.o. with1 nonpromiscuous sexual partner (-) OCP, IUD Personal/Social History

4. EV, 33 YEAR OLD G2P1(0010), SINGLE Menarche at 10 y.o. Interval of 30-33 days 4 days duration 4 pads per day LNMP: Jan 21, 2011, unsure PMP: Dec 2010 EDC: Oct 28, 2011 AOG: 36 4/7 weeks by early UTZ Menstrual History

5. EV, 33 YEAR OLD G2P1(0010), SINGLE Obstetric History GDateAOGMode of Delivery 120072 mos. Spontaneous Abortion 22011Present pregnancy

6. HISTORY OF PRESENT ILLNESS OBAS Labor pains Watery vaginal discharge Good fetal movement

7. REVIEW OF SYSTEMS abdominal pain fluid leakage fever headache BOV vomiting dec fetal movement vaginal bleeding dysuria edema

8. EV, 33 YEAR OLD G2P1(0010), SINGLE Antenatal visits Lying-in clinic >10x c/o PGH High Risk Primary antenatal condition (+) gestational Diabetes Mellitus Quickening 24 weeks AOG

9. PHYSICAL EXAM General Awake Coherent Stretcher -borne NICRD Vitals 170/110 HR 92 RR 44 T 36.0 Ht 155 cm Wt 107.2 kg HEENT Pink conjunctiva e Anicteric sclerae (-) CLAD (-) TPC (-) ANM Lungs Equal chest expansion Clear breath sounds (-) rales, wheezes

10. PHYSICAL EXAM Heart Adynamic precordium Distinct heart sounds Normal rate Regular rhythm (-) murmurs Abdomen Globular FH 36 cm EFW 3.4-3.6 kg FHT 130s RLQ, 140s LPU Cephalic- transverse IE Normal external genitalia Nulliparous vagina Cervix open Uterus enlarged to AOG (-) AMT Adequate pelvimetry

11. BPP/BIOMETRY/DOPPLER STUDIES Twin live intauterine pregnancies, both with good cardiac and somatic activites Impression Cephalic in presentation, 34 weeks by BPD and 33 weeks by FL. Adequate amniotic fluid volume. EFW is AGA. BPP 10/10. Doppler flow studies show normal values Twin A

12. BPP/BIOMETRY/DOPPLER STUDIES In transverse presentation, 33 weeks by BPD and 33 weeks by FL. Adequate amniotic fluid. EFW is AGA. BPP 10/10. Doppler flow studies of the umbilical artery show normal values Twin B Placenta is anterior, high-lying, grade II. Placentation appears monochorionic, diamnionic. Doppler flow studies of the uterin contractions show normal values

13. EV, 33 YEAR OLD G2P1(0010), SINGLE Pregnancy uterine, 36 4/7 weeks AOG by early UTZ, twin gestation, cephalic- transverse in preterm labor; gestational diabetes mellitus, chronic hypertension with superimposed preeclampsia, sublinical hypothyroidism, G2P1 (0010) Assessment Primary low segment cesarian section secondary to malpresentation of 2 nd twin Plan