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!

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