Confused by what the doctors say

I've been seeing my obgyn as well as a maternal fetal specialist that my obgyn referred me to.

At 12 weeks, I was told that I was having fraternal twins, that they had separate placentas. There was exactly 2 weeks difference in size between the two babies measurements. This was 4 weeks ago.

Last week I went back to the specialist for another scan. Both babies are growing at the right rate, but are still 2 weeks difference in size. The doctor last week said that the twins were definitely di/di. Much concern for the smallest twin as good scans and images of it's internal organs etc weren't possible.

Today I went to my regular obgyn for a regular appointment, and he wound up doing a scan because of the findings from last week's scan. The littlest one still cannot be seen well enough to view it's internal organs. It's heartrate was up from the last two scans, at 189 instead of the 164-168 that it's been since I found out I was having twins. The littlest one barely has any fluid in it's sac (I don't know the amount but it is a huge difference from last week's scan, and a huge difference from the fluid seen around the big baby). My obgyn told me that both babies have separate inner amnio sacs but are sharing the outer one.

So, what does that mean, sharing the outer amnio sac? I don't believe that's the placenta, as I was told in the beginning that there were two placentas, right? I'm confused.

 

Sharing the outer sac but not the inner means that they're monochorionic/diamniotic. That means mono/di which is identical. A lot of doctors will immediately assume that twins with separate placentas are fraternal (or di/di) but something like 30% of identical twins have separate placentas. Sounds like the second doctor did a more thorough analysis and was able to pinpoint things a bit better. Did s/he seem to indicate that any of this was a problem, or just something of note?

I ask because the difference in fluid between the two could be a sign of Twin to Twin transfusion syndrome. It's worth a call to your doctor (whichever one you're more comfortable with) to ask about the fluid levels and whether you need to come in more frequently for monitoring. I'm sure someone who had TTS can share more info on diagnosis if you're interested.

 

Exactly what Tricia said.

Have you been referred to a peri? Is that what the second doctor was?

Maybe you could call the second doctor back and ask for clarification on these points:
Are your twins now considered mono/di or di/di? It does sound like they're mono/di.
If so, is he concerned about TTTS? How does he plan to monitor for it?

If in doubt, request a transfer to a high risk doctor (just because they're better prepared to look at these factors) and try to get in soon. Don't let them give you information that you don't understand- ask "what does that mean?" I didn't know a thing about twins before we got pregnant with ours and I feel like the doctors can treat you like you must already know everything.

And, always, come ask here. These ladies have seen it all and would love to help.

Edited to add: My girls were mono/di and they're almost three and wild women now. Don't google too much or fret yet. We will help you make sense of everything. :grouphug:

 

The specialist I see is a high-risk doctor; I've actually seen two different docs at the high-risk clinic. I'm assuming my regular obgyn was able to see more/determine more today regarding the twins just due to the fact that I am further along now. My obgyn was talking about the concern for the littlest twin having such low fluid, told me that I will be completely transfered to the high-risk clinic due to that fact, and that's when he told me that the twins share an outer amnio sac.

I go back next week on Thursday to the specialist, so I guess I won't really know anything until then. I've tried looking stuff up on google and found some info on the twin to twin transfusion syndrome, and I'm just left more frustrated since I do not know for certain what is going on.

I appreciate your quick responses; you both said what I had determined from some research today. Now I guess I just have to wait and see what the doctors say next week.

 

I think Tricia and Stephanie had some great suggestons and advice for you.
Please keep us posted on what you find out next week.
We're all here for you!

 

I called my obgyn this morning for a bit more clarification. He says the twins are sharing a placenta. Does this mean identical? I'm sure it means more concerns for twin to twin transfusion? I don't understand why at 12 weeks and 15 weeks I was told they had separate placentas and were fraternal. I'm so confused now and am trying to get ahold of the specialist in KC to get a better understanding. Do you ladies think that waiting until next Thursday to been seen again with a scan is too long to wait? If it is twin to twin transfusion going on, would there be anything that could be done at this point? (I'm actually 16 weeks, but because of the size of the big baby my due date was moved, making me 17 weeks.)

 

I'd like to know what your specialist has to say. I dont have any experience with twin to twin transfusion...but try not to worry yourself just yet. :hug:
Do you live near Kansas City?

 

If they are sharing a placenta (and not two separate placentas that have fused), then they are definitely ID. TTTS is a concern with mono/di twins because the nutrients in the placenta are being shared (which affects the amniotic fluid levels). There is quite a bit that can be done if TTTS did present, but monitoring is the first step.

Start here, at the TTTS Foundation website. There, on the first page, you'll see a list of questions they advise you ask of your doctor.

Many, many moms are here had mono/di twins who are now rambunctious and healthy kids. TTTS is a risk, but not a guarantee. We were monitored extensively for it and never presented. Friend-to-friend, limit your research to that site. There's a ton of misinformation out there and you don't want to worry unnecessarily.

Keep us posted!

 

Thanks for your response, ladies, and for the site information. I do live about half an hour away from Kansas City; the high-risk clinic I go to there is inside KU Med Center, and it helps my piece of mind to know that KU Med is ranked 3rd in the nation. I just got off the phone with the nurse at KU Med, she's taking the information to my doctor there, so maybe things will begin happening now so I can know what is going on and do what can be done for my babies.

 

I live in Topeka KS so I am close by too.

I am glad you have called your doctor at KU Med, hopefully you will get some answers soon!

Steph-what a great and informative post on TTTS, thanks!!