Baby A still behind

I had my ultra sound at my high risk doctor yesterday. Here is basically what is going on.

Things are pretty much the same with the babies. Deniz (my little boy) is right at the proper size for 26 weeks. He weighs about 2 lbs.

Sibel (my little girl) is still running 3 weeks or so behind. Her blood flow is a little slower, but still ok. The fluid is a little less too, but still ok. I have another u/s in 4 weeks and that is when we will really start to make decisions. If things continue to be ok then he will leave her in and monitor every 2 weeks. If the blood flow and fluid levels decrease then he is going to give them steriod shots and I will have to deliver them about 1 hour away in Philadelphia. Of course they will have NICU time, but they should still be ok, I hope.

Have some of you had such big weight differences at 26 weeks? How did things work out?

 

I didn’t… but I know a few moms on here have and had great success stories in the end… I just wanted to send you a :hug99:

 

I have b/g twins and had a similar problem. My girl (baby A) was always behind. As long as she made some progress at each check, they said it was okay. Since they were di/di there was no risk of TTTS. At my 35.5 week u/s, she'd only gained an ounce since two weeks before. They estimated she was 4lbs 1oz while ds was 7lbs! The peri said that she looked fine and had made at least a little progress so they let me continue <_< . When I delivered at 37.5, she was 6lbs 2oz and ds was 8lbs 3oz. We didn't have any blood flow issues, but her fluid did fluctuate a bit and everything turned out to be fine. Good luck with everything!

 

My scenario is with mild TTTS (which you don't have to deal with at all) and what I suspect are placental share issues with a mono/di pregnancy, so I can't really compare. At my 26 week appointment, my Donor baby was measuring an estimated 1 lb. 9 oz. while the Recipient was measuring ahead at 2 lbs. 9 oz.

From my understanding, it's not unusual for the babies to have some weight differences - some of which in di/di is probably even more genetic than in a mono/di pregnancy. Also, bear in mind the margin of error in ultrasound. We were told that it was like +/- 6 ounces at 26 weeks. And then as long as they are continuing to grow on their own growth curves (without comparing them), that's a good sign. And last but not least, your docs are monitoring your little babies and will make the decision to deliver at the appropriate time instead of ignoring the circumstances!

 

My B/G twins were always measuring a few weeks apart. they were born at 38+3. Baby A was 7 lbs and baby B was 5.11 lbs. Good luck!

 

Yes, my Baby B was small and had some blood flow issues. I don't remember now what the exact difference was, but at birth it was almost 1 lb and both babies were IUGR and tiny.

It was scary and did cause us to decide to take them early, that combined with raising blood pressure leading to Pre-Eclampsia. We had weekly check-ups from 28 wks on and every week was a roller coaster of emotion since we never knew when Annika would fall off so far that we'd have to deliver right away. That day luckily didn't come until 35 wks.

As you can see, it all turned out ok. They stayed in NICU for 3 wks just until they could eat well on their own without the ng tube; thanks to gestation and the steroid shots they never had any cardio-respiratory problems.

You can pm me anytime if you need to chat! :hug99:

 

My baby B is smaller too. they noticed a difference at our 24 week ultrasound and it has remained the same since. I have been monitored by u/s every 2 weeks since 24 weeks. I had an ultrasound last week and they are almost a lb and a half apart at this point. My doctor assures me that since she continues to grow at each ultrasound and the blood flow looks normal that she is fine. I worry that she will not be born over 4 lbs though and will not be able to go home with me. Hopefully that will not happen. My doctor said that they will continue to closely monitor her but that he is not concerned at this point.
I'm hoping they will stay in there for at least 3 more weeks to grow and I'm kind of praying that the ultrasound technician was wrong (she didn't really seem to be very good).

 

Thank you for all the reassurances. I am hoping that her fluid level and blood flow levels stay up so that we can wait till at least 34 weeks or so. It is scary to think that my little girl could only be between 2-3 lbs.

Do you think that if I try to drink more water that it could help the amniotic fluid levels? I am not sure if there is any corrilation between the two!

 

I'll be cheering for your little girl to catch up and stay strong. I know as far as your water question, my doctor told me to drink as much water as possible to avoid pre-term labor, I would imagine that it could only help. I drink plenty, one reason is because I'm soooooo thirsty, the other reason is that I hope it replenishes the small babies fluid levels. As far as the weight differences between your babies, I can relate. Our weight differences between our babies is 50%...quite scary. I started the Boost drinks and continue to drink lots of water.

:hug99: I'll be keeping you and your babies in my prayers!

 

Thank you Jenn. I have been reading your string too. I think that I am going to try to boost also. Can't hurt, right? I am also going to make an effort to sleep on my left side only. I had carpal tunnel on my left wrist, so it does bother me some, but I can live with it! I want my babies to have the best chance possible!

 

Baby B was always behind - the the point where she was diagnosed with IUGR. In the end at 38 weeks A was 6.10 B was 5.7 both perfectly healthy. I am glad my DR errored on the paranoid side though. I was uptight myself.

They are now HUGE perfectly healthy 16 month olds. (Baby B is the smallest child of my 4, but that still means she's in the 80% on the scale. All the others are OFF THE CHARTS HUGE!) It helped me when my peri told me his sister has 16 yo twin girls. One tall and skinny, one short and fat. They are different people, and that's OK!

eta: I think it didn't hurt to take it REALLY easy and drink 3-4 ensures a day. Get in those calories!

 

Thank you Kimberlee. I am going to try that. I am still eating pretty well for the time being, so I will only do one shake a day now. I know my appitite will go down soon though. I also have to remember that my daughter was only 6lbs 5 ounces when she was born full term. I know that is not tiny for a baby, but it is on the smaller side. So, that might be one of the issues. However, I am pretty sure that baby A does have IUGR.

 

Do try to get the water and the calories, but don't beat yourself up if it doesn't seem to make much difference.
I begged my OB to tell me how to help them grow, and he was so sweet in reminding me that it WASN'T MY FAULT. He used the analogy that if I am the grocery store and my babies are the customers, no matter how many truckloads of food I deliver to the store each day, if the employees are on strike, there won't be enough food on the shelves for the customers. Your employees are on strike. Keep delivering the food and monitoring the situation.


Hope that wasn't too convoluted

 

We had a three week difference at 26 weeks. Jessy had a 2 vessel cord. Other than size difference you would never know that at 34weeks she was born weighing 2lbs 13 oz!

 

Thank you for all the great responses. It really makes me feel assured that things will work out. My doctor did tell me that it was not my fault. I just want my little ones to behealthy!

 

I am so glad I found your thread today. Yesterday at my 2 week checkup my OB said she was getting concerned because our boy went from 12% bigger at 27 weeks to a little over 20% bigger than our girl. I am now 32 weeks. She wants me to start weekly checkups with NST's and is sending me for another Level II US next week. She told me she would be more concerned if they were ID and that boys of b/g twins always seem to be a bit bigger.

Of course as the day went on I got more and more worried. I was just getting ready to post a new thread when I saw yours. It is a little reassuring that I am not alone.

 

There seems to be quite a few of us that are having this problem. I just know that it is best to stay optamistic. I am hoping that a little extra care will help my little girl out! I was home sick yesterday (24 hr bug) and I laid on my left side all day. She loved it. She was kicking really hard by night time! I am going to concentrate on doing that more. Hopefully it will help!

Good luck

 

Hi,

This is pretty much exactly our situation with IUGR too. We started the doplar monitoring process 2x a week for IUGR for Baby B at 24 weeks when they became viable babies. At that point i was put on moderate bed rest so I would only burn calories for the babies growth to make them as big as possible. I also had two rounds of steroids, one at 24 weeks and the other at 26 weeks when I was admitted for round the clock monitoring. We were waiting for Baby B's endo-diastolic blood flow to reverse and then he'd go into distress. We made it to 28 weeks 6 days. Baby A was born at 2lbs 15oz, and Baby B at 1lb 7oz. They are three weeks old now and Baby A is 3lbs 6oz, and Baby B is almost 2lbs. They are tiny but they are doing really well in the NICU.

I just want to let you know that it sounds like you're doing everything you can. Just rest and eat a healthy protein high diet so that your calories will go to make the babies as big as possible. Have they put you on at least moderate bed rest? And the steroid shots I think are what really gave my boys the fighting chance they needed. Baby B was off his ventilator two days later.

Also, you should know that because one baby is in distress his body will develop more tolerance and will do better after birth because he was ready for it. The other baby, if they aren't having any problems like their sibling, will probably struggle more because their body wasn't prepared for the change in environment. That really scared me at first when Baby A wasn't doing as well as little tiny Baby B. But once the nurses told me that it made sense and now both are doing really well.

Good luck!

 

QUOTE(Terrebeth1 @ Apr 22 2008, 10:40 AM) [snapback]733248[/snapback]
Thank you for all the great responses. It really makes me feel assured that things will work out. My doctor did tell me that it was not my fault. I just want my little ones to behealthy!


Your doctor is totally right, it's not your fault and there isn't anything you could do to prevent this. All you can do now is stay positive, rest, and eat a healthy protein diet to make those babies fat. Remember, stay positive. There are a lot of ladies here that have been through this and they really helped me get a good frame of mind for what you're going through.

Big hugs!

 

Wow! That is awesome that they are both doing so well. It is truely amazing what they can do nowadays. I am hoping since she still has decent blood flow that we are able to make it to closer to 32-34 weeks. I will feel a lot better then. My doctor refuses to take them before next u/s at 30 weeks. Before he was saying 32 weeks, so he did drop a little. As I am typing, my little one is kicking the daylights out of me. Actually, I think they both are! Hopefully that means she is still doing well in there!

I will say some prayers for your little ones. It really makes me feel better that I am not alone!

 

I'm in the same boat. 2 weeks ago Baby A was measuring a week behind, now she's measuring 2+ weeks off and Baby B is a week ahead. Baby A weighs 3.5 and Baby B 4.12. that seems like such a big difference to me. I was told the same thing, that as long as her blood flow and fluid looks good she's within the normal range. I start NST's next week twice a week. That will be a pain but reassuring.

 

That is good that they are at such good weights. I just hope you get your bp down so that you can go home and get things ready before they make their arrival!

 

QUOTE(Terrebeth1 @ Apr 24 2008, 12:10 PM) [snapback]737190[/snapback]
My doctor refuses to take them before next u/s at 30 weeks. Before he was saying 32 weeks, so he did drop a little. As I am typing, my little one is kicking the daylights out of me. Actually, I think they both are! Hopefully that means she is still doing well in there!


My peri's biggest concern with the endo-diastolic flow was the reversal of blood flow and said that this would happen very suddenly and you won't feel anything. I would talk to your doctor again about monitoring and what makes him feel like he won't need to pull them out before 30wks. I suggest this only because anything can happen and really we were just playing a gambling game of how can you save the baby with IUGR and impact its twin as little as possible while giving both the best chances. You are far enough along that with a good level III or IV NICU they stand very good chances.

And it's funny that you mention they are very active. That is a very good sing indeed. Every day my peri would see me and say "This baby is not showing signs of being sick. He's within the proper size ranges, he's just as active as his brother. If it weren't for the doplar ultrasound you'd never know this baby is struggling." Then every other day we'd see slightly decreased activity and continued or worse doplar readings until one day he saw some reversal of blood flow.

It's scary, but stay positive. There are a lot of great success stories out there. One mom on TwinStuff sent me this blog about a family who went through the same thing. The parts you'll be most interested start back in December 2006. It's a lot to read, so do it in bursts and take it with a grain of salt. I liked it because she and her husband did such a great job of explaining IUGR. http://twoby.blogspot.com/2006_12_01_archive.html

One other recomendation: Ask your hospital if you can have a tour of the NICU. That was really helpful for me to put it all into perspective before I had the boys. It made me feel better knowing where they would be going after delivery, what would happen to them, that my husband could be with them, etc.

Big Hugs! Keep us updated!

 

Jessy had no flow a couple of time but never reverse the would have taken them if we did. Jessy had low movement with this

 

Lilly~ I read this post yesterday and throughout the day, when I had time, would take a look at the blog. I am a little unsure of a few things. Do you know what the difference is between full absent ended diastolic flow and reverse end diastolic flow? All I know is that my doctor said that her flow slowed a little. He did not use any term like that. I want to do a little research and look into things because if it might help for me to get IV fluids like she did, then I am so willing to do that. That seems very easy to me. I would be willing to go on bedrest if he want me to also. I will do anything to keep them cooking longer!

Twinexmom~ My little one has not had reverse blood flow yet either, just slowing a bit. I hope it does not get to that point.

 

My little one had absent end diastolic flow for a couple weeks, and then the other one did. The S/D ratios were a bit high for a while too - but mine were due to TTTS.

I believe that reverse end diastolic flow is much more serious than absent end disatolic flow - I think it basically means that the baby isn't getting enough blood/nutrients. The S/D ratio (systolic over diastolic) is a good thing to know too - your dr should be able to tell you what is in the normal range - over 30 weeks, anything under 3 is good, before that, it can be a bit higher and be ok.

My smaller twin (due to two vessel cord, velamentous cord insertion and donor baby of TTTS) was only 5lb2oz at 38w4d - technically, she's a low birthweight baby, and had stopped growing. I was on full bedrest from week 17. I drank protein drinks and ate lots of calories to get them both to grow. With that treatment, my little one kept growing... they were both a couple weeks behind my gestational due date, and the little one was always a couple weeks behind that. Their discordance was only up to 20% though. But, after the bedrest/protein drinks, the dopplers got better and the fluid levels got better and they kept growing. I was surprised that we got as far as we did.

Keep us posted - You should ask your dr about the doppler numbers and what exactly they mean - they should be able to talk to you like you have a brain and understand these things, you know?

Jenny

 

QUOTE(ferfischer @ Apr 28 2008, 03:53 PM) [snapback]744187[/snapback]
My little one had absent end diastolic flow for a couple weeks, and then the other one did. The S/D ratios were a bit high for a while too - but mine were due to TTTS.

I believe that reverse end diastolic flow is much more serious than absent end disatolic flow - I think it basically means that the baby isn't getting enough blood/nutrients. The S/D ratio (systolic over diastolic) is a good thing to know too - your dr should be able to tell you what is in the normal range - over 30 weeks, anything under 3 is good, before that, it can be a bit higher and be ok.

Keep us posted - You should ask your dr about the doppler numbers and what exactly they mean - they should be able to talk to you like you have a brain and understand these things, you know?

Jenny



Ferfischer is right about the reverse vs absent (see post above). They are not receiving enough oxygen and nutrients. I'm not very good at explaining what happens in these cases, but here's my layman's terms. Normally the heart beats with two pumps of pressure, one stronger than the other. Reverse end-diastolic flow is dangerous because the baby's heart is too weak to keep the blood from flowing back out of it's body and can't prevent it from happening. Absent is when the blood is being pumped into the heart and nothing comes back out at all, so it's just pumping in, in, in, in... This is how our boy's situation started out and then eventually it reversed. Our specialist explained that he'd seen babies pass very suddenly when they eventually have reversal of blood flow, he said it was not an "if" but an actual "when" and that's why he was being so paranoid. He was exactly right, and had we not had such a cautious and experienced peri-MFM we would have lost our Baby B.

Your specialist should be able to explain it and you should ask them to show you what they're looking at on the monitor during the doplar. Don't be afraid to question them or suggest options. Steroid shots were a big part of the conversation too.

It's very scary, but stay positive. They can do some amazing things in the NICU now and there are a lot of success stories.

 

Thank you for all the wonderful information. I was in the hospital from Monday night until Tuesday afternoon. My ob will not release me back to work until I see the high risk doctor, unless he keeps me out. Either way, I will do whatever is best for the babies. So, now I am going to get a list of questions ready for the doctor so I am prepared Friday morning. They basically told me that they are too busy today to see me, so I have to wait. BTW, that is only because I am already out of work. They also don't want me to go back to work until my appt.

Oh, yesterday they did an u/s at the hospital. The tech there also works for my high risk doctor. She said the machines at his office is better, but I did ask her to check the blood flow. Nothing negative was on the report, so hopefully it was not as bad yesterday. I will talk to him about it since now I know what the different options are. I have no problem going to the hospital twice a week to get fluids. I will do whatever it takes to keep these babies healthy and in there longer!

 

Good luck and please keep us posted. It's a long and bumpy road and we're all hear to support you.

Big hugs!

 

Thank you so much. I will update after my appointment. I just hope I am able to hold off longer. It would be awesome if I can make it to 34 or35 weeks. Maybe I can deliver locally then!

 

Ok, I definitely went in more prepared this time. I can't blame the doctor for not explaining things when I did not specifically ask him to explain more in depth.

First, he is also not sure of why I had some bleeding Monday night, but is not concerned really because it was not a lot and there does not look like anything is wrong. It could be my cervix changing a little. It is still long and closed though.

2nd- Baby B is doing great still. He is still measuring where he should be and is about 3 lbs now.

3- Baby A is keeping on her own track. She is up to about a pound and a half now. Her fluid levels actually looked great today. He was really impressed about that because two weeks ago they were a little lower. He said that does make things look more promising. So then we got to the blood flow issue. I told him that I want him to explain it better to me so that I could understand. She has absent ended blood flow. He explained that since it is not as good that the blood goes to the most important organs in the body (brain). So he told me now that we are getting to a certian point in the pregnancy, that I will have to make some decisions. I had a hard time since my husband was not there. Basically, he wants to know when I would be comfortable taking them if she goes into distress. He feels more comfortable after 32-34 weeks. I told him that after researching and talking to people that I am comfortable at 30 weeks. Actually, before I answered that I asked him to compare my daughter's situation from two weeks ago to today. Is she better, worse, or exactly the same? He said that she is no worse at all and maybe slightly better since her fluid levels look better. So, he decided to send me across the street to the hospital and I got the first steriod shot. I go back at noon today for the second. I will get them every two weeks now. My next u/s is in two weeks. After that I will ask if I can come in at least weekly to check blood flow. They don't need to do complete u/s, but I want to make sure if it gets worse that we are on top of it!

I am really hoping that we are able to make it to 31 weeks or so since I know the survival rate does go up a lot. I need to believe that God gave me these two beautiful little babies and he wants me to keep them!

 

I forgot to add that he did not want me going back to work. He told me that I need to rest so that the babies get as much of the nutrients and calories as they can. I am too tired to go back anyway!

 

:hug99: Your posts sound so much like mine did that I started to cry! I really understand exactly what you're going through. Every week my appointment was like a roller-coaster; this week better, the next week worse. The whole time I obsessed a little with risk-factor charts, preemie websites, etc just praying they would hang in there till 28 wks, then 31 wks, then 34 wks . . . We made it to 35 wks exactly till my OB and peri agreed that it was time that we brought them out. Aside from 3 uneventful wks in NICU while they grew and gained the strength to eat on their own, they are just perfect!!

I'm sure it will be ok, with the monitoring you're receiving. It's good you're not working. Just drink up the water and have faith! :hug99:

 

Hi, Terrebeth. Here's my story:

As of 21 wks, both babies were measuring 95th percentile or higher.

At 25 wks, DS's measurements had dropped down to between 10th percentile (head) and below 2nd percentile! At that u/s, his fluid levels were also very low. We were scared to death, didn't know if we'd have to deliver in a few days and hope for the best or what. My OB sent me for betamethasone shots.

As it turned out, we managed to keep the babies in for another 9 weeks. We had growth checks every 2 wks, dopplers (cord blood flow) and fluid checks every week, and 2 BPPs/NSTs a week. DD kept growing normally, DS kept growing tiny bit by tiny bit and wasn't in distress yet, so they got to stay in. At 34 wks, dopplers were normal, but NST looked fishy, so happy birthday it was!

Birthweights are in my sig - DS was only 2#11 & 15" at 34 wks, DD was 6#3 & 19". It turned out that DS's placenta was abnormally small and over a third of it was clotted off. It just couldn't provide him enough nourishment. Wouldn't have mattered if I was eating 5000 calories a day, the placenta just couldn't deliver.

Ever since birth, the babies have been doing great! DS has always been a totally normal, healthy, thriving baby, and by 9 months old he was heavier than his sister! :yahoo: And he's only an inch shorter than she is now.

Long story short, this stuff is scary as he!!, but there are happy endings!

One thing - I would strongly urge you to push for at least 2 BPPs/NSTs per week, especially given the blood flow irregularities. It is a VERY good sign that the fluid levels have gone up, but close monitoring is essential. I wouldn't be comfortable waiting 2 wks for the next u/s.

And just one more thing - TRUST YOUR GUT. Around 33 weeks, I had a very, very strong feeling that I should deliver at 34 weeks. All my instincts were just screaming that we were reaching the end of the road. My OB and MFM persuaded me to plan on waiting until 36 weeks - I accepted their arguments with my head even as my gut was just screaming against it. And guess what? 34 weeks was exactly the point where DS started going into distress.

Good luck, and hang in there! Keep us posted. And please feel free to PM me anytime to talk about this stuff if you want. :hug99:

 

Looks like things are looking better for those babies...keep it up! I've been watching your thread and want you to know I'm praying for your little babies. Best of luck to you! Keep off your feet & keep 'em cookin'

Jenn