TTTS at 35 wks

We had quite an interesting day yesterday... I had an appointment with my perinatalogist who I see every three weeks for an ultrasound. When we arrived we were told that he was out that day and we would be seeing a different Peri, but I was fine with that because we've heard great things about her. So she started the ultrasound and asked me what the babies' weights were last week (from the ultrasound at my OB's office) - I told her that baby A was 4 lbs 14 oz and baby B was 5 lbs. She said she was concerned because baby A was still 4 lbs 14 oz and baby B was now 5 lbs 5 oz. Baby A hasn't grown at all in 7 days! I'm not exactly sure about everything she said after that because I started panicking. I thought we were basically in the clear for TTTS this late in the pregnancy, but she explained that it can occur at any time, even during delivery. She said she was going to call my OB and recommend a c-section at 36 weeks (next week), which is a big change of plans because my OB had been planning on a vaginal delivery (she would induce at 38 weeks if necessary). The Peri explained that she did not recommend a vaginal delivery with any twins who share a placenta because of some type of issues with the placenta after baby A is born. I went straight to my OB's office after that and she said that the Peri had called her and she was changing the plans to deliver next Friday (I will be 36 wks) via c-section. My concern is this... isn't it risky to wait until next Friday to deliver if there are signs of TTTS right now?? I am scheduled to have another ultrasound with my OB on Monday but I worry that she isn't knowledgeable about TTTS and doesn't know what to look for or what to do if baby A still hasn't grown at all. It worries me that she was planning on inducing at 38 wks when my Peri explained that that was really a bad idea. I've been up all night worrying and I know I probably need to just wait until Monday and explain my fears to my OB. Does anyone have any advice on this? Once there are signs of TTTS is it okay to wait a week to deliver?? Have there been any cases where one baby didn't grow at all in 7 days but it was not TTTS? I'm trying not to worry too much but I can't help it!

 

There are a few factors that are looked at when determining TTTS, one is growth discordance and they usually only worry if there's a 15% to 20% difference or more between the babies. The other is lack of fluid around the smaller baby and too much around the other. They also look for things like whether or not they can see the smaller baby's kidneys. It surprises me that your MD would react this way. My peri doesn't even like to compare weekly growth measurements because it's not usually enough for a significant change. It might be helpful if you can find out if the other factors are present. There are different stages of TTTS, but if it's a significant threat, the best thing to do is deliver. I guess it doesn't hurt to be cautious though... Good luck, I hope everything works out.

 

was the peri sure it was ttts, i know that growth restriction can cause size discordance which can happen at the end - if your peri thinks it's ok to wait i would say that it's probably fine...good luck!

 

I personally would be pushing like crazy for them to section me today. If they think it is TTTS, there is NO benefit to them leaving them in versus taking them in 7 days. From a NICU standpoint, the risks are almost exactly the same (and so low they are comparable to a term pregnancy --I'm a NICU nurse so I'm not making that statement uneducated) Your babies may need a little support in the beginning but they will be fine. I am VERY conservative when it comes to monochorionic twins -- if there is a suspected dangerous situation it makes no sense to me to expose the babies to that for any longer than absolutely necessary. I would really recommend you visit the TTTS site. Contact Dr. Julian DeLia (a specialist in TTTS) and get his opinion. His number is easily obtained at www.tttsfoundation.org. Talk to the women who have dealt with this. If you are unwilling to deliver now, I would absolutely push for NST's to monitor. Seriously, if your babies were born today they would be FINE. Even if there is only a 1% chance of it progressing, TTTS can progress quickly (in a matter of hours ir not minutes). Why take any chance?

 

I have no advice or info, but this sounds scary and stressful so here's all I can give: HUGS! Lots and lots of hugs! Hang in there sweety!

 

QUOTE(Momma_Mare @ Apr 26 2007, 07:43 PM) [snapback]235166[/snapback]
I have no advice or info, but this sounds scary and stressful so here's all I can give: HUGS! Lots and lots of hugs! Hang in there sweety!



I have to agree w/ pp.... If there seems to be a problem, then they should be delivering you ASAP. My peri doesn't let Mono-di twins go past 36 weeks because often times the placenta starts to break down causing the babies much more risk staying in longer. Definitely get a consult with Dr. Delia. Those babies will do absolutely wonderful if they are delivered now. Good Luck!

 

Why don't you call the peri back, ask for his nurse or one of the doctor's to call you back ASAP and start asking these questions... Since it seems like the peri is sort of pulling the strings here I think it would be best to call the peri and find out exactly why he is waiting, whether he really thinks it is TTTS.... to balance out some of these fears, I was told later on in my twin pg that size measurements are very difficult this late in the game.... they can really be off b/c the babies are so large it's difficult to view them for accurate measurements... so I agree that there must be other factors they need to look at too.. the fluid, etc. No one wants you to wait and have something horrible happen... but it could be that your peri doesn't think there is huge cause for alarm...but simply feels strongly that mono-di twins should be delivered at 36 weeks via c/s.... Please call the peri first thing in the morning and get your answers.....don't wait to see your regular OB... don't feel stupid about calling the peri back.. in the rush of an appointment it's very easy to be so shocked at something like this that you don't think of the important questions to ask... so call back and leave your questions with a nurse and request, nicely but firmly that they get back to you ASAP.... A good doc won't let you hanging over the weekend so full of anxiety. But you need to be clear with them and let them know how distressed you are about this. I think I would spend more time trying to contact your peri than talk to another outside doctor... as good as that professional is, he hasn't seen your u/s...and really can't make a diagnosis without it...

 

I know how worrisome this all can be. I think the most important thing is to get all the information you can. Email Dr. DeLia and he will call you back ([email protected]). One thing that doesn't seem right to me is that they are comparing ultrasound measurements done by two different people using different machines. The room for discrepancy can be quite large. I was having ultrasounds with both my OB and peri and they always seemed "different," sometimes making it seem like the girls weren't growing much in between those appointments (but they were). Also the measurements just by one tech can be more 'off' now that the babies are bigger. A TTTS diagnosis involves a lot of things...big fluid differences being the main symptom. Since your OB is the one doing the ultrasound Monday, find out from tttsfoundation.org WHAT your OB should be looking for...and then ask him/her Monday during the ultrasound.

BIG hugs to you! :hug99: I think we all wish this twin pregnancy thing was easier with more clear-cut answers! Keep us updated.

 

I agree w/the PP - had I carried that long, my peri wouldn't let me go beyond 36 weeks anyway, because of the shared placenta.

 

QUOTE(Evanly @ Apr 26 2007, 11:15 PM) [snapback]235430[/snapback]
I agree w/the PP - had I carried that long, my peri wouldn't let me go beyond 36 weeks anyway, because of the shared placenta.

my twins had ttts, if you do have it?! get those babies out!!!! why wait, they are safe at this point and this disease is a monster!!! call delia and he will help you with your decision. good luck and god bless.

 

I agree with pp's. It seems so many people are under the false impression that TTTS doesn't occur after 20 weeks. Wrong! My dd started showing signs late in pregnancy and was delivered (VIA C-S) at 36.1. Also, I know there is another thread about c/s versus vag for mo/di. DD's peri is one of the top in the country and she thought it was risky to deliver vaginally..
Lindy, mom to Stephanie and Nana to
Cameron and Corey

 

I'm a little surprised that they've thrown all that at you at once just simply because it was different techs and different equipment.

regardless of all of that, I'd give their office a call and make them answer all of your questions TODAY!

I wish you the best, you'll be in my thoughts!