This is a nice photo of a diamniotic/dichorionic placenta, part of a pregnancy involving two separate embryos in the same uterus.
Note the thick intervening membrane and lack of blood vessels traveling between the two placental discs, both characteristic of a di/di placenta.
Case: a 30 year old woman presents to the ED with acute left lower quadrant pain. A CT showed pelvic fluid and a 8 cm teratoma in the right lower quadrant.
I had the opportunity to do an abdominal cerclage with one of my MFM colleagues this week, which was fantastic. This is a procedure that is rarely done, and for me is something pretty new. I had the opportunity to do a few of these in residency, but hadn’t done one for over 5 years and never in a pregnant woman, so that was a great envelope-pushing experience for me.
For my colleagues that haven’t had the opportunity to do one of these procedures, I want to lay out how its done. In short, the goal is to place a cerclage between the ascending and descending branches of the uterine arteries, at the connection of the lower uterine segment and internal cervical os. When you’re done it should look something like this –