Confused - monitoring of identical twins share placenta

Hi all, I'm new to this forum - but so glad I found it! I am 21 weeks pregnant with identical twins that share the same placenta. I haven't had any issues thus far (and keeping fingers crossed). For my Level II - my OB had me see a high-risk doctor. A friend recommended a Dr that she used to work for and loved. So, the Dr knew that I was coming in.

The high risk Dr wanted to put me on a strict schedule of weekly monitoring for signs of TTTS - progesterone shots - monitoring of my cervix and for contractions. It seemed a little overwhelming to me at first - but thought that this Dr was going to really watch me, which was a good thing. But, afterwards, it all kind of sunk in and seemed extreme - especially since there are no signs of TTTS at this time, babies are growing together at the "normal" pace", I've had no issues - I'm growing at a very normal pace and feel very good.

When i saw my OB - he thought that the regiment was a bit overkill as well. he agreed for increased monitoring, but not to that extent. He also said that there has been no evidence for preventative success with progesterone shots with twins. So, my OB suggested I get a 2nd opinion. I have another appt scheduled with a different high risk doctor next week.

Just wanted to get some feedback from others out there who have had identicals - or are currently prego with identicals. Any shared experiences would be so helpful!! Thank you!

 

First of all Congratulations on your Twin Pregnancy and Welcome to TS!!

It may seem like overkill, but things can change SO fast with a Twin pregnancy. I can tell you that up until 24 weeks I had absolutely no problems to speak of, not even morning sickness and by 24 weeks I was in the hospital on strict hospital bedrest in PTL. I think there is absolutely no harm in keeping a close watch on everything, that way if something were to happen it can be dealt with promtly and benefit your babies.

Best of Luck to You!!

 

I found out we had TTTS at 19 weeks and by 20 weeks we had Fetal Laser Surgery... If I had it to do all over again I would be happy that they would monitor me like that. We were TTTS Level III and getting close to level four quickly. We had a successful laser surgery but weren't really sure for nearly 3 weeks post op..We had babies delivered at 29 weeks and 2 days. They are now over 4 mths old adjusted only 1 1/2 months old. If I had been offered that kind of watchful eye early on I would take it, but that is just me knowing what we have been thru this past year. Doesn't mean we still wouldn't have had all this done, but just better watching

 

wow - thanks for the quick replies. This is very helpful. were either of you on progesterone shots?

 

I agree with your OB. TTTS while it can be deadly only happens in less ID twin pg than it happens in. If I remember correctly for every 25 TTTS cases there are 75 ID pg without TTTS.

With our pg we had u/s every 3 wks along with the cervical length u/s. Starting at 30 wks they u/s were every 2 wks along with weekly Non Stress Tests. At 35 wks we had u/s twice weekly, weekly NST's. The cervical length u/s were stopped at 36 wks. We had a C section at 37 wks ending a non eventful pg.

With all that being said...my risks for somethings going wrong (uterine rupture....etc) were much greater than most due to the fact that this was our 17th pg (11 live births along w/ 5 miscarriages) and advanced maternal age(neither of those being a factor of risk of TTTS obviously.)
I was monitered closely due to those factors also.

I've never heard of standard progesterone shots being given when the pg's already advanced as far as it has.

I'm glad your having a 2nd opinion done!

Good luck w/ your pg.

Edited to say I was not on progesterone shots either.

 

Thanks Lisa! My OB said that when he spoke to his prenantal Dr friends - they said the same thing... once every 3 weeks until 30 weeks - then either once a week or once every 2. We'll see next week what the other high risk doctor says - next week can't get here fast enough!

 

I am currently pregnant with identical twins that share a placenta but have separate amniotic sacs. I started going to a specialist from the start (at 9 weeks and then at three-week intervals). I never had any progesterone shots. They watched for TTTS each time. I did got at 2-week intervals after I had PTL at 26 weeks, but that was increased to 3-week intervals again once they saw that the contractions were not affecting my "cervix of steel." I go in for a scheduled c-section tomorrow. Good luck and congrats on your twins!!!!

 

Congratulations on your twins and welcome to twinstuff!! I'm glad you found this site- it was very helpful throughout my pg- there are so many supportive and informative people on here!!
I had u/s every 2 weeks at the peri's beginning at 18 weeks right up til the end of my pg. They checked my cervix length (via u/s) and I also had NST's starting at 28 or 30 weeks. I think every doctor is different and some are more conservative. I felt very comfortable with my care and I think you should, too, so a second opinion sounds great.
Oh and I never had progesterone, either. Good luck and keep us posted!!

 

Having gone through TTTS with our twins - I would be happy that your doctor is monitoring you very closely for TTTS. It is scary and nothing to mess around with. We found out at 14 weeks that our boys had TTTS, and at 18 weeks their health had deteriorated significantly. Luckily we had a very successful laser ablation surgery at 19 weeks and they are happy, healthy 2 year olds today.

We did not do progesterone shots, although I have a friend who absolutely swears by them. She did not know her boys were ID until after they were born - her doctor also swears by them. She pushed me to have them, but, I spent 14 weeks of my 32 week pregnancy, either on bedrest or in the hospital, being monitored. So, I didn't really need them.

 

I'm currently 32.5 weeks pregnant with mono-di twins.

I was told we were having twins at our 7 week ultrasound.

I had another ultrasound at 10 weeks and was told things looked good, but nothing more.

At 12 weeks I was sent for the scan where they measure the neck folds. The tech was very serious and said she was going to have the doctor come take a look. I assumed something very bad had happened. The doctor (a neonatal specialist) came in and was equally serious. She told me my twins were "monochorionic-diamnionic" which sounded really bad to me. As you probably know that is just the big fancy way of saying "identical." She then went on to outline all the risks associated with it and what TTTS could mean. I was about to throw up.

She stated how closely I would be monitored, precautions to take, etc. I asked what the chances were and she said around 10%. I said, "so there is a 90% chance that things will be fine?" She replied, "10% is not a small amount."

So I was scared to death for 2 weeks until I saw my regular OB again. He assured me things were looking great and that there is no reason to be concerned until we have actual reason.

I came to realize that the specialists are called in when situations aren't good typically and that they obviously see a lot more of what could go wrong which is why their view on it is so different. OBs see more of the typical pregnancies and therefore are more relaxed.

In my case I ended up sticking with just my OB. I did have a few more ultrasounds than a singleton pregnancy and saw him every 3 weeks (and then every 2 weeks) whereas singletons see him monthly. For me personally that was the best route to take. I found myself worried sick before each appointment and don't think I could have handled all the extras.

At 31 weeks he had me start going for weekly ultrasounds to check growth and fluids. I also see him weekly now and go for NSTs 2x a week.

Everything has progressed beautifully thus far.

It really comes down to what you are comfortable with. I think you'll find that those who have experienced problems will say go with the frequent appts and those who have not will say stick with the more relaxed plan. Ultimately, it is where your comfort level lies.

Good luck with the remainder of your pregnancy!

 

Wow, what great feedback. I am so glad I joined this forum. It is so good to hear both sides.

I can definitely see that there is a need for more studies on TTTS and progesterone. I'll see how we feel after talking to the other high-risk Dr. I can't believe I am only 21 weeks - I feel like I have so far to go...

Thanks so much everyone!! I'll be sticking around - what a great bunch of mommies and expectant mommies

 

I'll chime in on my experience so far. I am 20 weeks preg with identical boys. We found out at 8 weeks that it was twins and they are sharing a placenta, at which point my OB explained the risks and said I'd be seeing a specialist as well as her to monitor us. I go to my OB every 4 weeks and I go to my Perinatal apt every 3 weeks. My OB does an ultrasound every apt, but doesn't measure the babies or anything, she just checks their heart rates. My last peri apt they started measuring my cervix internally, and basically I'll keep going to them every 3 weeks until 30 weeks, then I'm not sure how often I'll go. My OB is spacing my apts with her so every other week I see one of them.

Congrats on your twins, and welcome to Twinstuff! Good luck at your second opinion next week!

 

Thanks Amy H!

Well, I had a little relief tonight... my OB called me to see if I had any questions since our visit on Monday. WOW - that was impressive! He assured me that I am doing great. I asked him the question that if my twins were to develop TTTS - how long does it take to really go downhill - and he said a few weeks - which is the reason he (and I see others) feel that once every 2 to 3 week monitoring is sufficient up to about 30 weeks, and then it may increase. I sure did feel a lot better. again, I appreciate everyone's support!

 

My daughter had di/mo twins and was monitored every two weeks by the perinalogist and once a month by the OB. As much of a hassle as it was she felt it was worth it to know the babies were ok... during the last 8 weeks she saw the ob on the weeks she didn't go to the peri so she was monitored every week by one or the other.. She did do the progesterone shots for awhile but changed ob's and the new one (who had way more twin experience) didn't feel it was neccessary to continue them. She had two healthy babies at 36 weeks/1 day via scheduled c/s.