Frequency of Ultrasounds

I am expecting identical twins in July. Right now I'm twelve weeks and due for my next appointment on 2/5 at 15 weeks. My OB says if we can pick up both heartbeats on the doppler that I won't have another ultrasound until about 19 weeks. I asked him about the schedule after that and he said "at least one per month". From the research I've done, it seems like the that's not often enough for twins sharing a placenta? For those of you who have had twins and those further along, how often did you have u/s? I feel like I need to put pressure on my ob for u/s every two weeks...what do you think?

Jennifer

 

I am expecting identical twins in July. Right now I'm twelve weeks and due for my next appointment on 2/5 at 15 weeks. My OB says if we can pick up both heartbeats on the doppler that I won't have another ultrasound until about 19 weeks. I asked him about the schedule after that and he said "at least one per month". From the research I've done, it seems like the that's not often enough for twins sharing a placenta? For those of you who have had twins and those further along, how often did you have u/s? I feel like I need to put pressure on my ob for u/s every two weeks...what do you think?

Jennifer

 

For what it's worth - I had mono/di twins sharing a placenta and had big u/s at 18 wks. They are not doing another growth one until 24 and 28 and then at that point they'll start every 2 weeks until I think 34 or 36 then every week.

I think that's pretty normal although I've seen others do more too.

Hope that helps,
Krista

 

If your twins are sharing a placenta, you DEFINITELY should push for u/s at least every two weeks. It sounds like you've looked into this already and most likely know a little bit about the risks of TTTS. We lost our girls last year to TTTS. I didn't have very frequent u/s and often wonder if we had caught it in time, perhaps we could have tried some treatment. I was also misdiagnosed as having two placentas, so I'm sure that had something to do with the frequency of ultrasounds, although my OB thought TTTS could happen with two placentas anyway, so I'm not sure why he didn't look into things further when I started showing signs of TTTS. Most doctors are really not very knowlegdgeable about this, so often YOU have to make things happen. Also, make sure the sonographer knows what to look for (last time ours did not). Are you going to see a peri as well?

For this pregnancy, I see my OB and a peri. My peri visits are every two weeks and I see my OB in between. Part of the frequency of visits is because of my past history. TTTS occurs in roughly 15% or monochorionic twin pregnancies, so there is a big percentage that aren't affected. Because of this, I think most OBs don't do ultrasounds as frequently, but I would rather be safe than sorry.

Congratulations on your twins!! And please make sure that you are their strongest advocate, as far as care goes.

 

By the way, a lot of obs/peris just do growth scans every month. But there are other things they can look at in between. Really, fluid levels are of upmost importance for monochorionic twins. So far we have only had FULL growth scans monthly, but in between they look at fluid levels, bladders, cervix length. They also do a quick measurement of heads and tummies just to see if the babies are growing concordantly. My OB also does a quick u/s to check fluids and to see if the babies have free movement.

 

I also have mono/di twins and am having monthly u/s, although I see my OB every two weeks since about 20 weeks. I asked my ob about more frequent u/s, especially in light of TTTS possibility, and she said that they are not necessary; that it won't develop so quickly and that since they are monitoring me pretty closely she's not too worried. She also said that "you could have one every day, but it gets pretty expensive"

 

Sorry I keep coming back to this thread. I would say if you end up with only monthly ultrasounds (which I still wouldn't recommend), make sure they are monitoring your weight gain and fundal height in between. A sudden huge weight gain or huge jump in fundal height could indicate a problem...and that would warrant an ultrasound to make sure things are okay. Actually, some cases of TTTS CAN happen quickly, and it's obviously better to catch it in the earliest stage.

 

No Melissa, my OB hasn't recommended that I see a peri. I have questions about that also; do most twin mothers see one also? I live in a semi-rural Alabama town, Montgomery--I've checked the yellow pages and switchboard.com and it doesn't appear that we have a peri here. However, I'm sure there are several in Birmingham. My assumption was that my ob probably won't refer me to a peri unless I'm having some problems?? I don't know any twin moms, so I don't know what the "norm" is.

Do most of you see a peri also?

Thanks for the info on TTTS signs and I'm sorry for your loss. Yes, that is my concern for wanting u/s every other week. I am going to revisit this with my ob after my 19 week u/s.

Jennifer

 

Shared placenta pregnancies should have u/s every 2 weeks. I've dealt with 2 cases of TTTS (one tragic). Growth rate and fluid difference should be measured at every appt.

TTTS can happen VERY quickly (that doctor who said it doesn't happen quickly is VERY WRONG!)

Go to tttsfoundation.org for more info. Also the health board on here has great info too!

 

The website Safari mentioned is a great place to go for info. When you say you are going to "revisit" this after 19 weeks, does that mean you probably won't try to talk to your OB before that? It would be best to have frequent ultrasounds from about 14 weeks, because TTTS can show up even at that point.

I would definitely recommend a peri. The OB I had last time had the mindset that he knew what he was doing and would only send me to a peri if problems surfaced. Unfortunately, when problems did surface, he was completely blind to them. I wish we would have known that our girls were monochorionic from the beginning. Even though I switched OBs for this time, it was still OUR idea to see a peri, and I'm so glad we are. They have better ultrasound equipment, etc. We also live in a rural area and have to drive almost 2 hours to get to the peri. We also have to find a babysitter for our daughter each time, but it is definitely worth it to us. While no doctor is perfect (and there are always things I disagree about), why not get the best care that you can find in your area?

Both Safari's story and mine show that TTTS is a very serious issue. Don't freak yourself out about it, but make sure you are informed...for your babies' sakes.

 

Yes, I meant I would talk to him again about it at 19 weeks. I already have an u/s scheduled for that appointment. The only time I'll see him between now and then is at my 15 week appt. You're saying that based on your experience I should have an u/s then too? About the peri, I don't mind the two hour drive, I just didn't know if I had to have a referral from by ob? I'll ask about that at my next appointment. I have visited the tts. org website and that's where I got my info, and the suggestion of more frequent u/s. I wonder why ob's aren't more careful with this. It seems that in the day of lawsuits and medical malpractice that we are in, docs would be extra cautious and well informed. I definitely will fight for what is in my babies' best interest; I just want to know what is the norm!

 

My OB did an u/s every visit. She didn't like to use a doppler on twins and preferred the u/s.

 

Please take the advice of Melissa and Safari! Every two weeks you should be having an ultrasound. My dd had mo/di and thankfully her peri and ob were totally strict about this. The peri saw her every other week no exceptions! Her ob saw her the opposite weeks. TTTS is rare but you've read it here it happens and can be tragic. Don't risk it!
Lindy, mom to Stephanie who is mom to
Cameron and Corey

 

Yes, you should definitely have an ultrasound at your 15 week appointment and every two weeks from then on. If you decide to see a peri, just state matter of factly to your OB that you wish to see one. A lot of times OBs (and even peris) tend to have a "roll-their-eyes" attitude, like they think you don't know what you're talking about. Be firm. I would call the office ahead of time and tell them you need an ultrasound at 15 weeks.

You can also print out some of the information from TTTSfoundation to show your OB. If he still doesn't agree, then I would look for a different OB. You could even contact Dr. DeLia and have him talk to your OB. Dr. DeLia's information can be found at the foundation. His email address is [email protected].

 

I had an u/s every two weeks, but that was just to check for their heartbeats. And the ob maybe did a quick measurement here or there, but not every time. I had longer, in-depth level II U/Ss about once a month from 14-28 weeks. After that, it was every 10 days or so.

(My twins were fraternal though and if I was expecting identicals, I don't know what my doc would have done.)

 

My twins are sharing a placenta, and I've had U/S every 3-4 weeks since 20 weeks.
HTH
Michelle

 

I appreciate the advice. Being new to the twin world, I have my worries, but I don't want to "overreact". I'm glad to get feedback that my concerns are reasonable. I've had two easy singleton pregnancies, so I've had no idea what to expect with a high-risk pregnancy. I will definitely ask for an u/s at my next appointment on the 5th. Thanks everyone for your help.

Jennifer

 

Hi!
I 30 wks 4 days pregnant with mo/di twins and they share a placenta. I started seeing the peri (where they do an ultrasound and tvs) at 20 weeks, then every 3 weeks until last week at week 30 and I am now going weekly. This Friday they are starting to start doing the u/s with doppler to check the blood flow from the umbilical cords and also start my Non Stress Tests. My twins weights are not that far apart that they are concerned yet, but they are keeping a close eye on it. I am lucky that I live close to a good hospital (which is where my peri's office). I have also been seeing my ob every two weeks.
I would definitely talk to your doctor about your concerns and if he/she does not take you seriously consider looking for another provider (if it is possible).
Good luck!
Alex

 

I had ultrasounds every 8 weeks and then 2 on one week when I was 35 weeks along. I ended delivering at 36 weeks 1 day.

 

I am 21 weeks with boys that are sharing a placenta. As soon as they saw that there was only one placenta they sent me to a peri. This was at 15 weeks. My peri has been seeing me every two weeks to check growth. The last time I was there he told me to come back in 3 weeks because everything was looking very good. But he also assured me that TTTS could come on very quickly so if I noticed a sudden change in my fundal height to make an appointment right away. I also see my OB every two weeks they do urine tests check bp,fundal height, heartbeats, and cervix. So I would definitely express your concerns and just ask as many questions as you want these are your babies!

 

For identical twins, you should have an u/s at least every two weeks to watch for TTTS. TTTS isn't common but it can happen quickly and you need to treat it fast. You definitely should push for u/s every 2 weeks.

 

quote:
Originally posted by Safari:

TTTS can happen VERY quickly (that doctor who said it doesn't happen quickly is VERY WRONG!)




Definitely. Our girls had TTTS and we had weekly u/s. The second time the girls took a turn for the worse they looked perfect one Thursday and needed suddenly needed an huge amnioreduction when we checked them by u/s a week later.

 

During my first twin pregnancy they did an u/s every month from the very beginning. With this twin pregnancy I have a different dr. and he said I will only have one u/s unless something happens.

 

My identical twins shared a placenta and had U/S w/our peri every other week from 8 weeks on, when they determined they were ID - I also had a level 2 u/s every month after I hit 19 week - TTTS can come on very fast - it happened to us before we even knew it - it was determined at delivery - and that was with all the extra u/s.

 

Hi Jennifer,

I have an ob appt. today - i found out last week i have id twins sharing a placenta - so i am going to ask today about the frequency of u/s - it is hard not to worry, but i'm trying to do my best...my ob doesnt refer out to peri. unless there is a problem - i will ask today now if that's changed being that i have one placenta.

 

I also have mono/di twins sharing a placenta and I just saw a peri for the first time last week. I had to ask my OB to refer me, she said that she could do all of the monitoring herself but I really felt that I wanted to see a peri so she finally agreed. The peri was wonderful and did a level II ultrasound and said that he wants to see me every other week now. I would definitely tell your OB that you've read the information on TTTS and would like to be monitored more closely. Good luck, let us know how it goes!

 

I had u/s every 2 weeks from 8 weeks along on till I started the specialish then it was ever week at the end it was every 2 days I got to see my 2 angels grow on camera the whole time even the day they came to see mommy and daddy in person we seen them before they where born.
we had a ememrgency cseaction at 37 weeks

 

Mine aren't sharing a placenta....they just look close together.

But I see the ob every 3 weeks upto 30 weeks
and he uses a u/s machine there just to check them out.

I also go for an ultrasound every 2 weeks, which started yesterday at 20 weeks all the way up to 38 weeks.

If I was in your situation, I would request more. Mine aren't at as high of a risk of yours and think you should have u/s about the same if not more than me.

Juli