TTTS Friends, help me with the delivery dilemma

I know we've talked about this a million times, but now I am so utterly confused.

My docs initially said they would deliver my Stage I TTTS babes at 34 weeks via c-section. They said it was the safest thing for my babies.

After getting to 33 weeks (tomorrow) with bedrest (in hospital now), a cerclage and babies who doing very well, the docs have said officially they will let me go to 36/37 weeks if my body can get that far, still watching the babies closely. . . and even let me go vaginally instead of c-section.

Both babies are head down and have been for two weeks. My recipient would be second, donor first. I tend to have precipitous labor (less than 1 hour labors with previous two babies). I'm so nervous, and I just want to choose, if I even have a choice, that which is best for the babies.

Sure, I'd love to have them vaginally, but well, you know. . . BTW, I've never had a c-section.

Talk to me, ladies. I wish there was more research about this with TTTS babies. I would die if something happened to them during labor after coming so far.

 

Hmmm, I don't know. My TTTS was a bit like yours. We got diagnosed at 17 weeks and then did bedrest/Boost, and things stabilized in a couple weeks. It stayed that way until we delivered. We were monitored weekly. Now, I didn't have a cerclage or any cervix problems, so I don't know about that part of it.

My babies were breech, so I didn't really have an option. I had a vaginal birth with my son, and would have loved to go that way with the twins, but then we found about the TTTS, and truthfully, I didn't care how they came out - I just wanted them to survive, so secretly I was glad to have the decision out of my hands - so c-section it was for us.

If Baby A had been vertex, but Baby B breech, my peri said she probably would have recommended a c-section anyway, but I probably could have talked her into a vaginal birth. If they were both vertex, I think she would have let me go vaginally.

I'm not sure I would have, though. I have to admit, with everything the babies went through, I'm not sure if they could have handled labor too - I was so happy to have the c-section. As it was, my donor twin was 1 lb smaller, and only had an apgar of 3. She had to be on oxygen for 9 hours and didn't have a suck reflex. This was when I delivered at 38w4d. Because of that, and because you're in the hospital anyway, I would let those babies go as far as they will let you go safely. After all, all the research shows that you should deliver at 36 weeks, and I went a full 2.5 weeks past that, and my babies still had some struggles. I am SO glad we didn't go at 37 weeks (my peri would have done it then if everything else were stable and an amnio showed lungs mature - which I guess they weren't).

So, I'm not sure if that helps. I would have a real talk with your peri about delivering vaginally and what fast labors like yours may do to the babies. Also, I would call Dr. delia and ask him. There is NOT much research - dr. delia might know the most about it. personally, i would go c-section with the TTTS risks. The recovery wasn't THAT bad. I was just happy to have two babies.

Good luck and keep us posted.

Jenny

 

We were diagnosed at 18 weeks and stayed at stage 1 throughout.

I was induced at 33w6d because of the TTTS heading to stage 2 and pre-e. They gave me cervadil and then I went into labor on my own. At one point our donor baby's heartrate skyrocketed and I was rushed to the ER but it ended up coming down so we waited it out. I ended up delivering them both vaginally with 11 minutes inbetween them. Connor (recipient) actually came out unresponsive and had to be recesitated.

I was very confidant in the care I was getting. We were right there in the OR, pretty much prepped for a C-section just in case. They had an ultrasound machine and moniters on the baby throughout the whole thing.. I went along with what they said mostly because we were taken care of by the top Dr's in canada for TTTS and I trusted them fully because they dealt with many many cases.

Even though they were born at 34 weeks, because of the TTTS causing them to slow their development a bit they stayed in the hospital for 5 weeks. If it hadn't of progressed and I didn't get pre-e, we had an induction date set at 37 weeks and looking back, that it would have been so much nicer if I could have made it to that date.

 

My TTTS was level 3 so they had to do surgery two weeks ago at 18 weeks. I have no idea which form of birth is better in your case. It is good that they think that you can hold them in for another couple of weeks the longer the better. There is a c-section book that really tells you everything about c-sections. It is called the essential c-section guide. I had a c-section with my last pregnancy and it was nothing at all to be scared of. The recovery was better then a regular surgery, I could stand up and walk as soon as the spinal block wore offf.
If both of your babies are head down then you will probably have no problem with a vaginal birth. Since they are in seperate sacs, even if they have to deliver the second baby via c-section they should both be fine. Once the umbilical cord of the first on is clamped they aren't sharing anymore.
My suggestion would be to read the book about c-sections continue to talk to your doctor about it and then decide what will make you the most comfortable.

 

QUOTE(Emily@Home @ Jun 4 2008, 04:33 PM) [snapback]810196[/snapback]
I know we've talked about this a million times, but now I am so utterly confused.

My docs initially said they would deliver my Stage I TTTS babes at 34 weeks via c-section. They said it was the safest thing for my babies.

After getting to 33 weeks (tomorrow) with bedrest (in hospital now), a cerclage and babies who doing very well, the docs have said officially they will let me go to 36/37 weeks if my body can get that far, still watching the babies closely. . . and even let me go vaginally instead of c-section.

Both babies are head down and have been for two weeks. My recipient would be second, donor first. I tend to have precipitous labor (less than 1 hour labors with previous two babies). I'm so nervous, and I just want to choose, if I even have a choice, that which is best for the babies.

Sure, I'd love to have them vaginally, but well, you know. . . BTW, I've never had a c-section.

Talk to me, ladies. I wish there was more research about this with TTTS babies. I would die if something happened to them during labor after coming so far.


Emily, are they at all worried that accute TTTS could be a risk during delivery?

Because I had the surgery I have been told that I am not at risk for this. You have stayed stable at a stage I but because you did not/have not needed the surgery are they concerned at all that this could affect your babies? If so, I've been told that a c-section is the safest form of delivery.

My doctor has told me that they will probably not let me go past 36-37 weeks. I guess we'll see how that goes. She also told me that unless I am much closer to my dute date and unless both babies are head down that I will need to have a c-section. I've had one before and really it was not that bad, so try not to worry if that's how it ends up being.

 

How big are your babies? How well are they doing otherwise? I would think that will play into it a lot. Our girls were Stage 1, and had IUGR, so were tiny at 35 wks and my OB did the c/s to save them trauma. Like you, I had a quick and (relatively) easy vag birth with DD, so was disappointed and scared of the c/s. But it went well and all's well that ends well! :hug99: You've done a great job; hang in there!

 

I was in stage II from 14/15 weeks until I was induced at 36 weeks. I was scared of making it that far and risking acute ttts during a vaginal delivery but I felt if my doctor thought it was ok vaginally I would try for that.I had researched as much as I could and ultimately left it up to the doctor. I trusted my doctor completely and the nicu staff if needed. I too had precipitous labor with my first but I was induced and it took all day long. When I was finally pushing out A (recipient) B flipped and wrapped herself in the cord so I immediately needed a csection and that took care of any worries I had it had all worked itself out. My babies were 4 lbs and 5.5 lbs. After everything we went through they needed no nicu and came home from the hospital with us.The csection was no where near as bad as I had anticipated. I definately know how worried you are because it is such a monumental decision. I hope it all works out for you.

 

QUOTE(ButterflyKisses @ Jun 4 2008, 04:12 PM) [snapback]810270[/snapback]
We were diagnosed at 18 weeks and stayed at stage 1 throughout.


This was our situation too. I was being cared for by two doctors and one said let's get to 34 weeks and talk about delivery sometime between then and 36, the other said I could go as far as 38. I really wanted 34 since that is the date I focused on as being safe from the moment we were diagnosed. I just wanted them out and to stop having to worry that we were going to get a sudden onset of Stage 3 or 4 and not be able to get them out in time.

At my 32 week appointment the doc that originally said let's go to 38 suddenly said let's get to 34 and then do an amnio for lung development and if they are good let's get them out. It was one of the happiest moments. The delivery option was left up to me...c-section or induction. I had a natural labor with my son so knew it was okay and I was scared of the c-section, but ultimately I just did not want to take that chance, however small, that my babies would have acute TTTS at birth and I would lose one of them. So when the amnio came back that my girls lungs were mature we decided to go with the a c-section. I had a very good experience with the section and the only downside was that I didn't get to see my girls for 8 hours after they were born because they were in the NICU and I had to wait until I could get out of bed and into a wheelchair. But the peace of mind of knowing they weren't going to have any issues from acute TTTS was completely worth it. My girls were out of the nicu in 24 and 48 hours and came home with me right away.

It's a tough decision and I know exactly where you are coming from as I agonized over it for a very long time. It's a lot to consider - safety of your babies, your own safety, complication that can arise from a c-section. Whatever you decide I wish you luck and a speedy, complication free delivery.

 

Thanks y'all!

The babies were est. 3#12oz. and 4#15oz. at the 32 week BPP. Donor would be first out vaginally.

Last night, DH and I talked about why the docs would change their minds and say suddenly, "Vaginally is fine too." So we asked my OB and MFM docs today about that. . .

They said that the TTTS in our case has not affected the babies from both functioning on target gestationally, both are head down (whereas before the recipient was breech or transverse), the heads are only 3mm different in size according to u/s, and that they felt comfortable with the vaginal since we would be monitored so closely from here on out. They felt the babies were a good size and were continuing to do well. They said, of course this would all change if they saw something risky. They also said precipitous labor was on my side.

I'm still weird about it all.

Now, the plan is: 34 weeks - I get out of bed more here at hospital
36/37 weeks (July 2) - If we haven't gone by then, my doc will take out my cerclage, see what happens, and start induction if necessary

MFM docs do not really believe I am going to make it that far because of the stress on my uterus. We are guessing 35 weeks, if I am lucky. Who knows?! The MFM doc today tried to encourage me that I had exceeded expectations as no one thought we'd get to 28 weeks with my horrible cervix.

When L&D time comes (now or later), I will be prepped/taken to the OR, given an epidural, be monitored, etc. and accordingly will have a vaginal or c-section (or both) as necessary.

I'm getting very anxious.

 

I had my TTTS survivors vaginally at 35 weeks. IF your Baby A is head down and IF both babies will be monitored very closely throughh out labor and delivery, I would try vaginal. Babies born C Section can have problems with breathing and transitioning. I know either way is a risk when dealing with TTTS. Do what your gut tells you and best wishes!

 

QUOTE(jillangel @ Jun 5 2008, 08:02 AM) [snapback]811417[/snapback]
I was in stage II from 14/15 weeks until I was induced at 36 weeks. I was scared of making it that far and risking acute ttts during a vaginal delivery but I felt if my doctor thought it was ok vaginally I would try for that.I had researched as much as I could and ultimately left it up to the doctor. I trusted my doctor completely and the nicu staff if needed. I too had precipitous labor with my first but I was induced and it took all day long. When I was finally pushing out A (recipient) B flipped and wrapped herself in the cord so I immediately needed a csection and that took care of any worries I had it had all worked itself out. My babies were 4 lbs and 5.5 lbs. After everything we went through they needed no nicu and came home from the hospital with us.The csection was no where near as bad as I had anticipated. I definately know how worried you are because it is such a monumental decision. I hope it all works out for you.



Hi,
I'm on my 20th week and still don't know if I'm dignose with TTTS. My baby A is 15 oz and my baby B is only 6 oz. My doctor said Baby B is not getting enough nutriunt and I might have TTTS. Why can't my doctor tell me if my babies have TTTS now? Not sure if I have fraternal twin or identical because my doctor is not sure. I am so lost and scared. All I know is that the weight difference is dramatic and I can't stop crying every night not know what can happen to my babies.

Since you found out you were in stage II in 14/15 week. Did it stay that way at 36 week? Do you have to do any laser surgury on your placenta?? I read some of the artical and if the baby do have TTTS, and if I don't do the laser treatmenet, my babies might not make up. I'm so scared!!!

 

Firsttwin I sent you a pm so I don't take up space on this post.

 

(Jill, I don't mind if you reply to her here! This TTTS stuff isn't talked about enough to make moms and OBs aware. . .)

Firsttwin, not to scare you, but I hope you will seek a second opinion ASAP. I will be thinking of you. . .

Thanks for the responses, ladies! I still haven't a clue what will happen. They are continuing to watch my babies closely, plan on a vaginal in the OR with an epidural, will moonitor closely ans perform c/s if necessary and best.