Monday, January 19, 2015

Growth Discordance

So having twins is emotional. there is just no way around it. Working in the OB field where we see the worst of the worst cases, I don't think makes my emotions any better either. My mind constantly goes to the worst case scenario, or I take care of a patient with a similar history with a less than favorable outcome...sometimes ignorance really is bliss.

But there is so much more that goes into having twins that just one baby. They monitor you for twin to twin transfusion syndrome (TTTS) which is basically just making sure that each baby is getting the proper amount of blood supply. Since they share a placenta one baby can actually take blood away from the other and it's a very dangerous and often deadly situation. I've had two friends lose one or both babies to this!

Then there is Twin Anemia Polycythemia Sequence (TAPS) This is where one baby just because of how the placenta is made up is getting more blood than the other. causing one to have a higher hemoglobin (total blood count) than the other one. This is also a deadly complication.

There is also Intrauterine Growth Restriction (IUGR) or in twins Selective IUGR (sIUGR). Another somewhat less than ideal complication where one baby just grows at a much slower rate than the other for whatever reason. This can be very tricky because you're wanting to make sure that both babies are growing appropriately and if one isn't there could be a reason for it, which could mean early delivery even if that means that the other baby isn't ready.

These are the 3 things that have me most worried. Luckily thus far there is no signs of TTTS. which is amazing. This was the ONE thing I remembered most from my OB clinical and I remember the minute the ultrasound tech told me I was having twins, I was most scared for this.  Probably because i've had 2 friends lose one or both of their twins to this, as well as another friend who darn near lost hers.

The other two honestly weren't on my radar until 2 weeks ago when we found out that baby B (Laynie) was at what they called a significant growth discordance. They said they classify it to be a significant discordance at 20% difference and she is at 25%. He said typically their scans can measure 5% in either direction if they were to scan her again. So either way it was a concern. He did say that she had a chance to catch up which is awesome and she's not at the worst case he has seen which can be as much at 60-70% so thats good. He also said that due to my gestational age there isn't much we can do about it at this point other than to wait and see how she continues to develop. But basically what he thinks is that even though they share a placenta they aren't sharing it 50/50. So she may just not be getting an equal supply. He was nice enough, but he also seemed like he was in a huge hurry and I didn't get to ask all the questions I had hoped to.   I left the appointment feeling a little bummed and blue but ok.

Then a few days later after thinking about things I had a million questions. So I called the office in full out hysterical crying and a different doctor, one that I've  had every other appointment reassured me that they aren't ready to classify her IUGR yet, and that she looks good except she's just smaller. she made me feel so much better. She said we are still hoping to get my to 34 weeks. which is great. Although I would still love 37 weeks!!

Then I went to my OB appointment and I swear I have the best doctor ever, she always has a way of making me feel more at ease about everything.  She explained to me in better detail why the do dopplers on the babies cords, which is to make sure the blood is flowing correctly and she explained how depending on findings will also help them determine when they will delivery if they need to deliver early. She also helped put me at ease when it came to the possibility of delivering early. She is just so sweet, and is amazing! I'm so glad she is my doctor!

But either way I'm just hoping for good news tomorrow morning when I go for another ultrasound. I intend to talk to the MFM doctor about the possibility of TAPS and IUGR so long as we are still good with no TTTS.

But I have ever since I found out I was pregnant with these beauties had goals of where I would like to be before we even think about delivering. So here they are.
1. 24 weeks--simply because they will try to save the babies at this age, instead of just comfort measures until they pass.
2. 30 weeks-- babies really do so much better after 30 weeks with eating, and breathing
3. 35 weeks-- they wouldn't necessarily have to go to NICU, they could go to CCN/NCC
4. 36 weeks--they would at least have a fighting chance to be with me in the room instead of going straight to NICU/CCN/NCC
5. 37 weeks--they wouldn't have to have carseat studies and blood sugars for 24 hours!

So we are almost to goal #1 so I'm hopeful we can get to all 5, but we will take it one step at a time. :)

Grow Laynie Grow,  keep cooking Lorelai!

20 Weeks with the Twins

Week of January 8th 2015
January 14th 2015
20 weeks 6 days

How Far Along? 20 weeks, for a normal pregnancy we're half way!

Due Date:  May 28th, though I'm just hoping to get to May

Total weight gain/loss: I haven't been good about weighing myself but I think I'm up 15. 

Maternity Clothes? The best darn things money can buy/make

Stretch Marks? None that are new. 

Sleep?  What is that? I sleep for a few hours, then I have to turn which is a whole process so I wake up, and then have to attempt to fall back asleep. My arms and hands have been falling asleep while I sleep which wakes me up, making my life harder. 

Best Moment of this Week? I got offered a part time position on my unit!! I'm so thrilled about this. I hope to be able to work until the girls are born at full time hours, but with my sleep going the way it is, it's been harder and harder for me to keep up, and with our new management system at work, you have to apply and do all this crap just to switch FTE's so it's a huge weight off my shoulders knowing that once these babies are born I only have to come back at part time hours. However it will be quite stressful when/if she puts me on limited duty bc I can't pick up extra. 

Another good moment this week was my ultrasound to check on our little loves. The only bad part about this was learning that our Laynie girl is at what they call a significant weight discordance. The cut off for the weight discordance is 20% and she is at 25%. I have to say this hit me pretty hard and I was rather depressed for a few days because of it. The doctor told me that there was nothing we could do at this point and that they would just continue to monitor her more closely. But its all so sad and scary. I don't know how other people feel but when something goes wrong with a baby that you're carrying inside you, you can't help but feel a little guilty and feel like you're doing something wrong. Now in my limited medical knowledge head, I know this is not true and that none of this is my fault and that there are things going on here that are out of my control, I still can't help but feel otherwise. But I'm trying to stay positive and I think I may just write a post completely dedicated to this, because this has been very hard on me. 
Baby A -- Lorelai
Baby B -- Laynie

Movement? YES!!!! I love and cherish every kick! I haven't been able to time Adam being home and them kicking to have him try an feel. not that he will want to anyway. 

Food cravings? nope

Food aversions? nope

Gender? We found out via our ultrasound that they are for sure girls. I have a huge reel of pictures from their scan and I got my money shots that I was hoping for. And all looks good with both girls!

Labor Signs? Not sure if I would classify it as labor signs, but definitely feeling the contractions more and more depending on my position. 

Belly Button In or Out? Still in thank goodness!

What I miss? just sleep

What I am looking forward to: Just getting closer and closer to viability and getting to meet these precious babies. I also have and OB visit Friday that I'm very much looking forward to, so I can get her take on all thats going on. She has such a wonderful way of easing my mind and making me feel better! Best Doctor ever!

Size of the Baby:

Baby's now the size of a cantaloupe!
Baby gulps down several ounces of amniotic fluid every day, both for nutrition and to practice swallowing and digesting. And, these days, those taste buds actually work! Studies show that after birth, babies respond best to tastes they've already had via amniotic fluid. Meaning, think about what you'd like your future child to eat as you prepare your own lunch

19 weeks with the twins

Week of January 1st 2015

Jan 7th 19 weeks 6 days.
Better late than never
How Far Along? 19 weeks

Due Date:  May 28th

Total weight gain/loss: I'm not quite sure, but I still think about 13. 

Maternity Clothes? Yes, Love them, and I'm really loving the ones that my sister bought me for christmas! 

Stretch Marks? Yes, but they are from the boys, still no new ones just yet. 

Sleep?  I broke out my maternity pillow so that has helped with my pelvic pain I was having at night, which is a huge relief. But it's getting harder and harder to sleep during the day again. :(

Best Moment of this Week?  It's been good. Since I'm writing this a little late, I can say that we went to Chicago to see my sister this weekend and my mom dad and I went to see newsies on broadway. It was really good. Sister and I love that movie so it was fun to see it in the theater. Even my dad said he liked it which Stace and I were worried about since it's more of a musical. But it was really fun getting to spend time together as a family. It was kind of sad though too bc I know my time to visit her is coming to an end. It will just be too hard to stay up there and visit with all 4 kids. So this very well could have been the last time we were able to go. I'm forever grateful that Adam was agreeable to go. 

Movement? YES my favorite part of pregnancy by far!!! I love feeling these little ones kick me, for me it's their little way of letting me know they are ok. I wouldn't trade any of it for anything!

definitely getting bigger :)
Food cravings? i can't say that I have any

Food aversions? none really, thank goodness

Gender? Still Girls I'm assuming. I go tomorrow for another ultrasound and I'm just hoping that they actually do a whole anatomy scan because they haven't yet. Since we didn't find out gender with boys, I've never had that "action" shot of the "hey yes we are girls!" 

Labor Signs?  I have occasional contractions, but nothing painful.  

Belly Button In or Out? Still in thank goodness!

What I miss? sleeping soundly. 

What I am looking forward to: My ultrasound tomorrow. Excited to see these beautiful girls again!

Size of the Baby:

Baby's now the size of a mango!

Vernix caseosa, a greasy white substance made of lanugo, oil, and dead skin cells (yum) now coats baby's skin, shielding it from the amniotic fluid. (Picture yourself after a nine-month bath, and the need for protection makes sense.) You might get to see the vernix at birth, especially if baby is premature.

18 Weeks with the Twins

Week of December 25, 2014

Christmas Day. 18 weeks!
How Far Along? 18 week

Due Date:  May 28th

Total weight gain/loss: 11-13

Maternity Clothes? Oh yes! so Comfy!

Stretch Marks? Yes!

Sleep?  it's still been pretty bad, I think I need to break out my pregnancy pillow. 
we got home really late, but I still got my pic

Best Moment of this Week? i got to seem my girls twice!!! my OB did a impromptu u/s just to check on the girls friday and she said they look great! we also discussed that she won't let me go past 37 weeks, so it looks like May 7th will be the latest they will be here. I also got a u/s through my MFM doctor (who monitor's the babies) and their fluid levels are great, and they look awesome and I got a 4D of both girlies!! 

super tired. 18 weeks
Movement? yes, happening more and more everyday!!

Food cravings? christmas cookies are the devil!

Food aversions? none really!!! love not being sick the whole pregnancy!

Gender? GIRLS!

Labor Signs?  No thank goodness, but the braxton hicks contractions have continued!!

Belly Button In or Out? Still in thank goodness!

What I miss? sleeping comfortably!

What I am looking forward to: just spending time with family, and having a few days off!

Size of the Baby:

Baby's now the size of a sweet potato!
Baby's become amazingly mobile (compared to you, at least), passing the hours yawning, hiccupping, rolling, twisting, kicking, punching, sucking, and swallowing. And baby is finally big enough that you'll soon be able to feel her movements.

17 Weeks with the Twins

Week of December 18, 2014

How Far Along? 17 weeks

Due Date: May 28th
17 weeks 4 days

Total weight gain/loss: 11

Maternity clothes? Oh yes! My mom and I even went shopping for more! Bad thing is I'm already quite big so I'm having to buy Plus size which just makes me feel bad about myself! I don't want things to not fit in a few months!

Stretch Marks? Yes, but I've learned to love them finally!

Sleep: it's been a little bad this week. I can't sleep very well during the day, and I'm starting to have some pelvic pain, but I'll take it so long as these ladies keep growing!

Best moment this week: just getting one week closer! 

Movement: It's becoming more often if I'm paying attention to it. but still nothing I can quite track yet, but every time i feel them i get so excited!!

Food cravings: Nothing really!

Food aversions: nope, the gag reflex has reared it's ugly head but nothing in particular causes it. it's hit or miss

Gender: GIRLS!

Labor Signs: none

Belly Button in or out? still in!

What I miss: nothing. its been much more fun this time!

What I am looking forward to: my OB appointment tomorrow and my u/s on christmas eve!!!

Size of baby: 

Baby's now the size of an onion!
Baby's skeleton is hardening, changing from rubbery cartilage to bone, and fat is finally accumulating around it. His umbilical cord is getting thicker and stronger, and those little fingers and toes now feature one-of-a-kind prints.