Really Worried :(

Yesterday my OB sent me to the children's hospital to get an advanced diagnostic ultrasound and see a twin specialist. He said it was routine nothing to be worried about and that he likes every mother carrying twins to go there at least twice during pregnancy. So I get into the car with my mom to make a fun day out of it but things didn't go so well. I ended up being there with more than one specialist from 10 am to 5 pm because apparently the twins placentas fused together. I am currently 29 weeks along and baby A closest to my cervix is 2.4 ounces and baby B closest to the placental artery is 3lbs. Their concern is that in the past 5 weeks baby A has only gained 10 ounces. This is because Baby B is getting 100% nutrients and baby A is only getting 79%. The thing is they are fraternal and are in their own sacs. Originally they had their own placentas but because they implanted next to each other they fused. The specialists concluded that if baby A's percentage drops below 70% then they will have to deliver the babies. I am soo worried about delivering so early and having the babies in the hospital so far away. I live 2 hrs away from the closest children's hospital so they will be far away from me for a while. They also said at 32 weeks if the babies are still doing ok then they will have to start doing stress tests on the babies to make sure they are well responsive?? Has anyone heard of this?? If anyone has any advice or experience with this I would appreciate anything. i have googled to try and find out information on this type of situation but cant really find anything specific.

 

I know there are other TS members that can weigh in here with similar experiences, I just wanted to point out that it is a very good thing that you have a specialist keeping a close eye on the situation and there are so many things they can do now even if they have to deliver early. It's not an ideal situation living so far away from the children's hospital, I can understand that. :hug:
Please keep us posted.

 

My fraternal twins had their placentas fuse as well but they never had a big weight difference. They were always within a few ounces of each other. I did have regular ultraounds and NST's. Honestly I don't think they even knew they were fused until the twins were born, at least it was never mentioned to me.

 

How are the NST's done? Does it cause any potential harm to the baby? I perform stress tests on adults so I know all the risks that come along with doing it on them but don't understand how its done to a fetus inside the womb.

 

NSTs starting at 32 weeks are perfectly normal. My girls were always within a couple ounces of each other and we had weekly NSTs starting at 32 weeks as well as regular BPPs. I know others can speak to the weight differences better than I can but with twins once you pass 32 weeks the monitoring generally steps up even with no complications.

 

I am a little bit comforted in the fact that I just spoke with my Ob and he explained what the NST was. When they doc said stress test my mind instantly thought of them causing the babies heart to race or something but its basically just belt monitoring for the babies which is no biggie. The thing im really concerned about is baby A not getting enough nutrients to properly gain weight and develop.

 

During a non-stress test (NST), they monitor fetal movement, heart rate, and any contractions you may be having... all you have to do is sit in chair and they put sensors on your belly. The NSTs that I had lasted 1 hour.

I can't speak to the weight difference either, but my twins were born at 31 weeks and had to stay in the NICU to grow for 3 weeks... just for a frame of reference. NICU time can vary greatly based on your twins' needs (obviously). Did your doctor mention steroid injections to help lung development... just in case? I had 2 rounds of steroid injections 3 and 4 days before my twins were born. I think it helped them tremendously as they did not need a ventilator and had no other breathing issues.

Hang in there, mama and think positive thoughts!

 

Mama2BeOf4, how far along are you?

I don't know about postential complications of fused placentas, but I imagine what they're monitoring is IUGR? I'll research some, as I'm now curious.

NST's are very standard (some would argue that they're not always necessary) and we were told that ours would begin at 30 weeks (and they did, but I delivered the day of my first NST).

My girls were delivered at 30 weeks with no long-term effects. We did do NICU time, but it worked out. Don't worry yourself too much yet!

 

I don't know anything about fused placentas, but I have mono/di twins (so one placenta) and my doctor told me after 28 weeks they are going to switch from doing biweekly size/blood flow ultrasounds to doing weekly biophysical profiles which include NST's. I think it's normal to have more monitoring the farther along you are. Good luck!

 

I think you've gotten some great info from others. Just wanted to add that if your twins are the same gender, being in separate amniotic sacs and having separate placentas does not guarantee that they're fraternal.

Hang in there mama! It sounds like you're in good hands and being monitored closely. :hug:

 

You've gotten some wonderful answers. I just wanted to add/ask .. is there a Ronald McDonald house near your hospital? You might be able to arrange to stay there in the event you do deliver early. It happened to a friend of mine and her Singleton was in the nicu for 3 months , she was 4 hours away from her hospital and able to stay there. :grouphug: hang in there!

 

Yes! This! I stayed at the RMH while my girls were in the NICU for just this reason- we were two hours from home. I adore the Ronald McDonald House and they are my absolute favorite charitable organization.

 

Just wanted to add my congrats on your babies! You have gotten some great info!

 

I can add nothing more than the previous posters. So sorry that you are having some complications, but on the bright side, you have good doctors and an early catch on a serious development. What a GREAT idea with the Ronald McDonald house, ... I never really knew what that organization was for exactly. I hope you don't have to drive the 2 hours for the NST --- is that at the hospital or your doctor's office? And at least you're 29 weeks. I hope your babies can keep baking but your weights are pretty good. I hope they can help Baby A get more nutrients. Good luck to you and keep us posted!

 

Stress tests are totally normal with twins. I had them every week from about 28 weeks, then twice a week at the end. My girls didn't have the fused placentas, but we did have growth issues with Sabrina (still do). I delivered at 37 w 5 d and she was almost 2 1/2 lbs smaller than Sydney. She was always quite a bit smaller (at my 1st u/s at 9 weeks she measured as being conceived 5 days after Sydney) but hadn't grown at all the last month. She's 7 and has never been on the charts because she's tiny. But she's actually my least likely child to catch any bugs, so seems to be pretty healthy despite her size.

I just wanted to let you know that I know it's impossible not to stress, but try not to. Most issues actually end up relatively minor. It sounds like you have good drs who'll take great care of you and your sweet babies.

 

I was going to post yesterday, but realized I never did. My girls had 2 placenta's, but at my 27 week (ish) ultrasound at the peri, baby b did not grow as much as baby A. I was told to stop working immediately, and was put on limited activity. I was monitored but never had NST done.
I deliver my girls at just before 34 weeks when my water broke.

 

I am 29 weeks according to lmp dating. I am not really sure what IUGR is but they said because the placentas fused and Baby B is closer to the artery that transfers the blood/nutrients she is getting more which is preventing A from receiving what she should .

Yes i will have to drive almost 2hrs to the hospital to get the NST's which is a bummer but worth it.

and.. Yes there is a Ronald McDonald House I just spoke with the hospital. Its next to the children's hospital which makes it soo much more comforting to know that I can be there with these little ones. @ AKilburn thank you soo much for that idea!

@ Miss_bossy18 they said they were positive they were fraternal early on because of the membrane division. They are the same sex but look totally different on the 3d pics. One actually resembles my oldest son as the other resembles my younger son. Its pretty awesome!!!

Thank you everyone for your support, ideas, and suggestions its really helping .

 

Just because they are in separate sacs does not mean that they cannot be id. A certain percentage of di/di twins are actually identical. There are a few ways to tell if they are id or not mostly after they are born. They are fraternal if they are boy/girl, if they have different blood types, have different facial/body structures after birth, or through DNA testing. I was also told that my girls were fraternal based on being di/di by the u/s tech. It turns out that they are but that was not actually something we could have known when she told me.

 

Iugr is intrauterine growth restriction. My girls are Id and in the same placenta but we had the added challenge of both girls being implanted weird (to the side instead of middle and the mirrored each other) and jessy only have a 2 vessel cord. They did very few nst on me as the way the were laying weird(transverse on above belly button and one below). We did twice weekly biophysical profiles though. They checked for growth, activity during scan, cord blood flow and practice activities (breathing, flexing limbs, sucking thumbs and pretty much anything else babies do once born). Once jessys growth got to the point they though it wasn't going fast enough compared to how they thought she would do once born they delivered them(34 wks 1 day). I did lots and lots of ensure and laying on which ever side they tell you. I was on 10 weeks if bed rest. Luckily Jess ended up weighting 1/2 lb more than us predicted

 

I am betting they're identical. IDK why. 30% of identicals and di di which appear EXACTLY like fraternal twins would on ultrasound.
I'd start doing a ton of left side lying and drink tons of Boost and Ensure shakes.. Eat EAt EAt. Just try to pack the weight on those boys!!

Good luck!

 

So I got amazing and stress relieving news today!! I got a second opinion on the results of having a fused placenta which was causing the growth restriction and the specialist was wrong!! I had a friend do an ultrasound and then saw another specialist who did a seperate ultrasound and confirmed that there are in fact two placentas and both babies are growing normally! The placentas were also in different locations then that described of the first specialist! I was shocked at the false assesment and information that I was given by who was supposed to be one of the top twin drs who worked at the children's hospital. Aside from their stress they have caused the past three weeks, I am soo relieved that our little girls are doing fine. Baby A is still smaller but is completely healthy weighing in at 3.5 lbs and baby B weighed in at 4.4lbs. We are still going to do the weekly nsts to make sure their heartbeats stay strong and plan on delivering around 36-37 weeks if all goes well!! Thanks again for everyone's support and I will definitley keep you updated!!

 

That is great news! How far along are you?

 

Wonderful news!!

 

Great!!!

 

Between 31-32 weeks
Thank you everyone!