Need advice

So I went to the OB at 13 weeks for my monthly visit and all was well. I left happy, knowing I had one healthy baby. Then, the next day, I had an appointment at a perinatal's office for a detailed ultrasound for the NTT and discovered I was actually having twins. Well, now I don't go back to the OB until the end of the month at 17 weeks. I doubt I'll have an U/S since I have to go to another office at 19 weeks to have my detailed 18-20 week U/S. Is it ok to wait this long with mono/di twins?? What questions should I ask my doctor about my care and how this changes things??

Also, my OB belongs to a practice of more than 10 OBs. I was told on my first visit that he would not neccessarily be the one to deliver me, it would just be whoever was on call. Now that I'm expecting twins, I'm even more uncomfortable with the idea of this. Should I be seeing a peri instead?? If so, then how do I go about that? Should I wait until my next appointment and ask for a referral or call now?? I've read about the risks of TTTS, but at 13 weeks they were measuring just 2 days apart... This is my first pregnancy so I'm pretty clueless and would love any advice you guys have! Thanks!!

yusra

 

Okay, here's my advice based on my experience with my mono/di boys who were born June 13th.

#1 Looking back now, I wish I had told my OB that I didn't want to see anyone else in the practice but him. . . because too many fingers were in the proverbial pot, and no one seemed totally educated or in the know about my situation. Even after I was hospitalized on bedrest. It's ridiculous.

#2 I'd request another u/s sooner than 17 weeks. Mono/di twins (identicals in general) run a higher risk of developing Twin to Twin Transfusion Syndrome, and catching this syndrome early can help in treating it. The TTTS Foundation website recommends that identical twin pregnancies sharing a placenta should start u/s by 16 weeks and have them frequently. I agree with this.

#3 Request to see a perinatologist or Maternal Fetal Medicine specialist.

#4 Ask your OB what he/she knows about TTTS. (Not that you will have this, but I think the doctor treating a twin pregnancy ought to know about this.) Personally look at the TTTS Foundation website to learn what you can about it. Don't let it scare you at this point, but it helps to know the red flags and all just so you can be educated and proactive in case. There are some questions at the site that you can ask your doctor too. (www.tttsfoundation.org)

#5 I'd start pushing for all this now instead of waiting just to give myself a piece of mind.

We did have TTTS, and I had a doc who told me, "I don't treat twin pregnancies any different than singletons." Red flag, indeed. Twin pregnancies are different.

Best wishes to you!

 

I would first get a definitive diagnosis (as much as that is possible) that your babies are truly mo/di. I was told through my whole pregnancy that mine were mo/di, but they were actually di/di fraternals.

 

QUOTE(Yusra @ Jul 9 2008, 11:44 PM) [snapback]868724[/snapback]
So I went to the OB at 13 weeks for my monthly visit and all was well. I left happy, knowing I had one healthy baby. Then, the next day, I had an appointment at a perinatal's office for a detailed ultrasound for the NTT and discovered I was actually having twins. Well, now I don't go back to the OB until the end of the month at 17 weeks. I doubt I'll have an U/S since I have to go to another office at 19 weeks to have my detailed 18-20 week U/S. Is it ok to wait this long with mono/di twins?? What questions should I ask my doctor about my care and how this changes things??

Also, my OB belongs to a practice of more than 10 OBs. I was told on my first visit that he would not neccessarily be the one to deliver me, it would just be whoever was on call. Now that I'm expecting twins, I'm even more uncomfortable with the idea of this. Should I be seeing a peri instead?? If so, then how do I go about that? Should I wait until my next appointment and ask for a referral or call now?? I've read about the risks of TTTS, but at 13 weeks they were measuring just 2 days apart... This is my first pregnancy so I'm pretty clueless and would love any advice you guys have! Thanks!!

yusra


Since there is the chance that they are mono/di, you should start getting at least bi-weekly ultrasounds at 16-17 weeks. Since you did not find get your first u/s until 13 weeks, it is definitely possible that they are not but you should assume they are for care purposes. I know that at my OBs office, they can usually schedule an u/s within a couple of days so you may want to bring that up at your next appt. and start getting those ultrasounds. With fraternals and no maternal complications, a peri is not needed but you may want to look at a peri since you might be having mono/di twins. If your OB isn't experienced with TTTS, you should definitely be seeing a peri. You should probably ask your OB for a reference.

Just remember, 85-90% of mono/di identicals do not get TTTS so don't get stressed out about it but it's great that you're already knowledgeable so that your babies can get the best care.

 

I agree with Emily.

My clinic told me we pretty much get treated the same - in fact, they didn't even really say anything about them being mo/di - in fact, they told me they could still be fraternal and we wouldn't know until they were born. NOT SO. AT 8 weeks, both babies were in one gestational sac, which makes them monochorionic, and identical.

I wouldn't have had another u/s after my NT scan at 12 weeks until 20 weeks, but they couldn't find a membrane between them ever, so we had a scan at 16 weeks, find a size difference of 20% and got sent to a peri. At 18 weeks my donor was shrink wrapped with no fluid and we had stage 3 TTTS. Frequent monitoring is key! We got so lucky in that we had a scan at 16 weeks and saw some signs - I would never have known better. I feel so stupid now. I now try to help people educate themselves so they can also catch this earlier too!

The TTTS foundation and message boards are a great resource. Use them!

Jenny

 

Hi Yusra,
I was in the same situation as you. My OB was not treating me any differently other than having u/s once a month. I did alot of research and spoke with the founder of the TTTS foundation, Mary. She recommended fluid measurement u/s every other week, growth scan u/s once a month, extra protein, and extra rest for all mono/di twins. She also suggested I find a peri who delivers babies, so I wouldn't have to deal with my OB at all. I researched peris on my own and found one at my hospital that did deliver babies also. I switched on my own without talking to my OB. I just called his office and had my records switched and cancelled my appointments. It was the best thing I ever did. My peri actually does fluid measurements u/s every week for all mono/di patients, OB appointments every other week, and grow scan u/s once a month. I wish I had switched earlier. Please start researching now and switch to a peri that will check you fluid at least every other week. The fluid levels indicate TTTS if one has a large amount of fluid and the other has a small amount of fluid and the fluid levels can change rapidly. I have luckily not develped TTTS yet, but I feel so much better knowing my doctor knows what he is looking for and is doing everything he can for me.

 

I am extremely lucky. My dr is very hands on and likes to deliver for his own patients. There are only 6 drs in the practice and I have met at least 3 of them already. I am also 1 of his 12 twin patients right now.

We found out about our twins at my 10 week ultrasound. He discovered they were mono/di at our 13w3d appt. My next appt is on Tuesday the 15th and I will be exactly 17 weeks. I have no idea what the ultrasound schedule is after this next appt. My dr is very laid back and said we will deal with problems as they come up.

I don't know about waiting until 19 weeks for your next scan. How many weeks are you now? Can you call the ob's office and explain that they discovered twins and ask about having an ultrasound at 17 weeks also? My dr does all of his patients ultrasounds himself.