Premature Labor and Size Difference Questions

Hi All,

Please help! I ended up in L&D today after several hours of on/off Braxton Hicks contractions and accompanied back pain. Because of how small the twins are (I'm only 24 weeks) they had to do an u/s to locate the heartbeats. The nurse took one look at Logan (our Baby A) and pronounced him a good size and then looked pretty taken aback by Aiden (Baby B ) saying that he was quite a bit smaller. I asked her if that was normal considering the last u/s tech we had said the same thing. She said that it can be, but now I'm worried. Have any of you had twins that were considerably smaller or larger then one another? Do I need to worry about twin to twin transfusion? At our last u/s the tech said that Aiden was measuring about a week smaller then Logan.

Also, I've been put on Procardia to stop the contractions. Has anyone else gone through this? What types of side effects did you experience, if any? Did it help?

Any advice/information you can send my way would be greatly appreciated.

Thanks!

 

My Twin B was born 1.5 lbs smaller than my Twin A. I didnt have to worry about TTTS because they were def frat.. (bg twins) Even now my twins are almost 9 months old and they are 7 lbs apart.
Twin B was always measured about 2 weeks behind and they said that they werent going to worry unless she stopped gaining weight or the gap got bigger.

im pretty sure if the Dr's were worried about TTTS or something else they would have said something and done some tests.

Goodluck!!! Eat lots of protien!! and drink lots of water!

 

Mine were frats, but my girl was always measuring smaller than my boy. Even now, at 4mos old, she is almost 5 lbs behind him. She is just built smaller.

Also- I was on Procardia for almost 12 weeks. It did help tremendously at first (even when Mag didn't stop the ctx), but eventually I contracted constantly anyways. I guess I'll never know if it would have been worse if I had stopped taking it. Side effects- I know I would bottom out on my BP sometimes, But I was on the highest dosage possible.
Hang in there, I so feel for you, but the time will pass and looking back, you won't believe how fast it went

 

Are you having identical twins? If yes then the answer to "should I worry?" is YES!

Size difference in identicals is a big deal. It is ALWAYS ALWAYS ALWAYS best to err on the side of caution in this area. If ANYONE is looking "taken aback" by a size difference"-- I'd be freaking!

I had ID's and was VERY well monitored and I mean VERY. TTTS is no joke as you've seen f/ some Moms on this board.

If your docs are acting nonchalant about it- PUSH THEM. Be sure you are seeing a Perinatologist who is SKILLED in TTTS.

Good luck and I'm sure it's nothing BUT it's crucial to be on top of this.

 

Hi! First let me say congratulations to making it to 24 weeks. That is the viability milestone and you've done a great job. A major part of brain development is at 28 weeks. It is very surprising that your OB didn't have you go get u/s more frequently as a high risk pregnancy, that way they wouldn't be surprised by the size discordance. Small differences in size are common and not concerning, but my specialist said that when there is a 20% difference in their size or about a pound or more, then they get very concerned.

My boys (we think fraternal) were born at 28wks 6days because of IUGR blood flow complications for Baby B because he had a small blood clot during early placenta development. Baby B was born at 1lb 7oz while Baby A was born at 2lbs 1oz. We knew this was going to happen and that they would be preemies because we had an awesome Perineonatologist - Maternal Fetal Medicine specialist working with our OB.

Did you have a peri-MFM specialist doing your u/s?? If not, request a referral to a specialist. Also, ask if they are checking the blood flow with a doplar ultrasound scan. THis was they only way we knew what the problem was for Baby B and we monitored it closely because we knew his little heart would go into distress eventually and we would have to deliver early.

Also, did they give you the steroid shots to help with lung development yet? If not, demand that they talk this over with you!!! Two rounds of this really made a big difference in my boys development.

Lastly, the only thing that I could do was be on bed rest and eat tons of protein rich foods and drink protein shakes. This was to make the boys grow bigger faster since the bigger the baby is the more successful they will be after birth. There was nothing I could feel to indicate a problem, just an excellent peri-mfm specialist.

I would suggest you get the book "Preemies: THe essential guide for parents of premature babies" and read ONLY the sections of the book that apply to your situation. Do not read beyond that!! It's a great book that even the nurses in our Level III NICU use as a reference to help parents understand what is happening to their babies. And also ask for a tour of the NICU so that you know where your babies will be and what they will do to them so that when you see them for the first time it won't be unexpected. (I wish I could say it won't be as scary but nothing I say can make you not scared.) I was on bed rest at home for two weeks, then hospital bed rest for 9 days before delivery. Take each day on bed rest as an amazing achievement. THey say one day in the belly equals leaving the NICU three days early. Think of your next goal in short bursts; long goals like three weeks away are too hard. Take it in three day increments.

My boys were born 10 weeks premature and are now 7 weeks old today. They are still in the NICU and are doing really really well with minor and typical preemie hiccups they have managed to over come easily (luckily). We are thinking they will come home by their EDD of June 16 or there abouts.

Good luck, I hope this helps.

 

We've been in Stage 1 TTTS since 21 weeks with our ID boys. Size discordance can indicate TTTS, but it can also indicate other things like placental share issues or cord insertion anomalies. But I think you do need to push for your doctor to look into this closer. . . get to a specialist. Yes, it's scary to deal with, but it's even scarier to do nothing about it and know that you might've been able to.

The TTTS Foundation has a website with great questions to ask the specialist. Our TTTS was indicated by a size discordance of 20% at 19 weeks. Then by 21w, they noticed the fluid on our donor baby was getting low (below 2 cm). My cervix was also funneling, dilated, etc. That's been almost ten weeks ago, and we are still amazingly in Stage 1, our donor has 6cm fluid, recipient has 11cm (too much) and the sizes are est. 3#1oz. and 4#10oz. at 30 weeks. But they are both still growing and being monitored closely.

I've had a cerclage, bedrest at home and hospital bedrest now. I've been drinking Ensure 3X day since 21 weeks and eating lots of protein. I have not had laser surgery or amnio reductions. But those are things to consider should your case necessitate such measures. (I think we also have placental share issues.)

Do take this size issue seriously. It may turn out benign, but better safe than sorry.

 

I also agree with the pp. You need to find out is it is a TTTS thing or something more like IUGR (Interuterine growth restriction). I am pg with b/g twins, so I know they are fraternal. My little girl has IUGR and blood flow problems. I was taken out of work around 27 weeks and told to eat more and rest. Since then she has been holding her own. Growing slowely, but her blood flow is no worse. We belive all the rest is really helping the issue. If you know what is wrong, or why your twin B is growing slowly, then you can try to help the issue more. I know that I gave myself goals (ex. 25 wks, then 28 weeks, then 30 weeks.) My goals now is to make it week by week. I was already told that I will be delivering by c-section before or at 34 weeks. My ob today told me just to rest and he really believes that the babies will be fine!

Lillywhite~ I am happy to hear your little ones are doing well. I was wondering about that!

 

From what I know so far, there is a high probability that the boys are identical. They are each in their own amniotic sac but share one placenta. I don't have a perinatologist and unfortunately, the nearest one is about an hour and a half away (the curse of living in a small town). Thankfully, I have an appointment w/my doctor tomorrow to discuss what happened over the weekend. Thank you for all your advice and I'll definitely have more questions for him.

 

Did they tell you how much smaller one baby is than the other...I am nervous about TTTS too...My twins share a placenta and I just got back from a doctor's appt. today and asked her what is the difference they can be before we start to worry and she said a pound difference..Mine are not at a pound yet baby A is 13oz and baby B is 11oz....Baby B is another oz smaller than A from last appt. where they were 6 and 5oz...But she said is is very normal for one to be smaller than the other...Hope all goes well for you and your babies!!!!

 

QUOTE(Cali Mom @ May 19 2008, 05:02 PM) [snapback]781804[/snapback]
From what I know so far, there is a high probability that the boys are identical. They are each in their own amniotic sac but share one placenta. I don't have a perinatologist and unfortunately, the nearest one is about an hour and a half away (the curse of living in a small town). Thankfully, I have an appointment w/my doctor tomorrow to discuss what happened over the weekend. Thank you for all your advice and I'll definitely have more questions for him.



If they share one placenta, then they ARE identical. And yes, with a size discordance sharing one placenta, you SHOULD take it very seriously. TTTS can come on quickly. You should get on the TTTS foundation website, write Mary an email and get her to send you some info. She will also help you find doctors and get treatment. Get on the message boards and ask questions. If you can get another u/s - GET ONE - find out about fluid levels, (if one has too much and the other has too little), have them check cord dopplers (blood flow through the cord - is it normal?), can you see both babies bladders. If those things are not normal, then you may have TTTS.

Like others said, it could also be IUGR or placenta share issues, but many times, sharing a placenta, size discordance is the first sign - the other things may follow - or may not.

I would be prepared to drive to get treatment - it's worth it. Also, go on as much bedrest as you can. Boost your protein intake, and drink lots of water and eat plenty of calories.

Mine had TTTS, but also a 2 vessel cord and cord insertion into the membranes - the smaller one ended up with IUGR at the very end - at 38w4d she was only 5.2 pounds.

Very serious indeed. Find someone that will help you get some answers - drive to get them if you need to. Get that u/s and get those answers, that will help you determine what to do next!

PM me anytime if you need help
jenny

 

We had a difference of over a pound. My girls shared a placenta but not a sac. Jessy has a cord defect only having 2 vessels instead of three

 

We found our size difference around 24 weeks also.. and now I see a peri every week. Baby A measured 1lb 3 oz at 24 weeks. and Baby B was 1 lbs 7 oz.. At 26 weeks.. baby A was 1 lb 7 oz. and baby B was 1 lb 13 oz.. both grew.. but baby A is just not growing as nicely. So far they show no signs of TTTS as far as fluid levels, blood flow and such goes.. but we are keeping an eye on them because we know how fast it can show up.

I think that it would be a good idea to ask to see a Peri. If for nothing else but to ease your worries a bit.