Ultrasounds to monitor for TTTS

I've been reading alot, and it seems everywhere I look is says weekly ultrasounds are started at 16 weeks (until like... 20 if they are measuring the same, I believe?) I was wondering if this is the case for all monochorionic/diamniotic twins? I just switched doctors and he said to schedule my next ultrasound for 20 weeks. My last ultrasound was at 14 weeks. Not normally something I'd waste my time worrying about but it seems like alot of ladies have them much more often than I have. I've also been feeling the babies regularly moving everyday for about 3 weeks now, and baby B moves wawwaaayyy more than baby A. Baby A seems pretty content right where he/she is I guess. Just kind-of strange that I can actually se baby B rearraging himself in my belly and baby A is contantly still.

 

We didn't know ours were mono/di until the 18 weeks u/s. After that we had u/s every 3 weeks to monitor for TTTS and then at 32 weeks we had NSTs twice weekly until delivery at 37 weeks. I also drank Boost protein drinks twice daily throughout the pregnancy and never had any signs of TTTS.

ETA: I also felt one baby more than the other, my doctor said that's common in twin pregnancies and is usually due to the position of the babies.

 

Well, I'm a stickler for being an advocate for your babies due to my own experience. Somewhere between 10wks and 15wks we developed TTTS. By 18wks Eve was "stuck" and we were Stage III. We had surgery to correct it and were fortunate to be survived by both babies.

We would have lost at least one had we not been monitored before 20wks. Then when that was corrected, Eve developed SIUGR unrelated to the TTTS. Because of frequent monitoring (daily for the last 4 days due to signs of oxygen deprivation) they were able to deliver them both before it became fatal.

I know it's scary and that's not my intention to do so, but I feel so strongly about MOMs being an advocate. I was even going to a high risk facility run by Dr. Quintero but the majority of his staff didn't take me seriously. It was all his doing and my fighting when he transferred away to Miami. I would not have my girls otherwise.

That being said, the risk of TTTS is low. You're probably going to be fine

 

I highly recommend weekly or at least bi-monthly scans to check for TTTS. TTTS typically strikes between week 16-24.

My peri's office wanted to scan me every 2 weeks but I insisted on weekly visits just to check fluid (they can't do growth measurements every week or they will be inaccurate).

TTTS occurs in 15-20% of identical twin pregnancies. Though most pregnancies are not affected, this is not a small number. I can tell you that even if growth is the same for both babies, it doesn't mean that TTTS won't occur- a girl I met was pregnant with ID twins as well and we chatted throughout our pregnancies in the beginning. Her twins always measured exactly the same or within an ounce of each other. Mine were always 15-20% discrepant. Shockingly, I did not develop TTTS but she did- the twins were delivered at 27 weeks.

We are dealing with sIUGR with one of our twins but I am still pregnant- hoping to make it to 34 weeks.

I definitely don't want to scare anyone but being pregnant with IDs is NOT the same as being pregnant with fraternals and it frustrates me that many OBs/peris seem to balk at the extra monitoring. It is there for a reason!

Best of luck to you!!

 

My DD was monitored every other Friday her entire pregnancy by her perinatalogist and opposite weeks by her ob.

 

I had biweekly us at the peri's office every 2 weeks beginning at 18 weeks, but prior to that I had seen them at 7 weeks (to rule out mo/mo) and then again at 11 or 12 for my NT scan. Then again at 17 for my level 2. It's true that 15-20% of mono/di pregnancies develop TTTS, but that also means that 80-85% of them don't. Try not to worry but definitely make sure that you are getting the level and frequency of care that you are comfortable with. Good luck and congratulations on your twins!!
Oh and I always felt baby B more than baby A. It could have something to do with their positioning..

 

As I am sure you know, the recommendation is weekly after 16 weeks. I never even heard of ttts until I was diagnosed with it at 20 weeks. Luckily my boys stayed in stage 1. I had twice weekly ultrasounds to monitor the condition. You should get them weekly because it can develop quickly and without warning. I was lucky that mine never progressed, however I have heard stories similar to mine where the conditions in utero became fatal within a weeks time. You can never be too careful. Please urge your doc listen to the recommendations of the TTTS foundation.

 

We're mono-di, as well, at 24 weeks. I've been having bi-weekly ultrasounds to look at fluid and growth since 18 weeks. We're also seeing the high-risk specialist once a month for another ultrasound. When we reach 28 weeks we'll be bumped to weekly, then twice weekly monitoring. So far all is great, no sign of TTTS! I enjoy the ultrasounds, if for no other reason than for how fast they're making this pregnancy go! I feel like the girls will be here any day now! The ultrasounds are incredibly reassuring, I'd ask for more frequency, starting now, just for peace of mind.

 

I had mono-di twins 9/1/09. My OB suspected mo-mo at one point, but that was ruled out around 22ish weeks. I had ultrasounds at least every three weeks from 12-24 weeks, every two weeks from 24-32 weeks, then weekly until my scheduled c-section at 38+5. I went to an OB who specialized in high risk pregnancies and had fluid levels, etc. checked at each visit. I only had two NSTs - once when one baby randomly (or not so randomly - I'll explain later) measured significantly less than the other around 34 weeks, and a second when I had dilated to 2 cm at 36 weeks.

Both babies had measured within a day and a few ounces of each other the entire pregnancy. My final OB visit - at 38 weeks - they measured 6 lbs. 10 oz. and 6 lbs. 12 oz. As I said, they were delivered at 38+5 and A was 5 lbs. and 19 inches, B was 6 lbs. 11 oz. and 18 inches. They did, in fact, have some mild TTTS going on - in addition to the weight difference, B had been hogging the blood as well and much pinker than A. A ended up in the NICU for 4 days because he was anemic and could not regulate his body temp. DH and I decided that the weight guesses were off because femur length and head circumference were very similar for both babies - the only potential (fat) difference would have been abdominal circumference. That's our best guess.

Both babies are great now and have no ill effects from the disproportionate sharing of groceries before birth.

Good luck with your pregnancy!!

 

I am being monitored for TTS and have bi weekly scans done sine about 24 weeks. Good luck

 

Thanks for the responses everyone. I called to make my first appointment with my peri-thought maybe she would go with more frequent U/S's. My OB apt. isn't for 3 more weeks-same day as my U/S (which will be 7 weeks from my last) The receptionist told me she'd like me to schedule my apt. with her for twenty weeks (which is actually 21 weeks because they are going by U/S measurements for due date when we know the conception date) I asked about the possibility of having visit sooner and my peri's nurse called me back and told me it was unneccessary this early in the pregnancy... Interesting.

 

We're expecting mono/di twins and the peri has wanted to see us every 2wks from 18-26wks for USGs of babies and cervix. A few of those weeks we have gone in weekly because of my cervical length. Once you see the peri, I would definitely clarify frequency of visits and your concern about TTTS monitoring.

 

Don't know how relevant this is, but I thought I'd share. We found out I had twins at 19 weeks. I was surprised that my peri (loved by me and all of his patients) only needed to see us every 4 weeks. I asked him about it, and he said it was a good thing. Every four weeks meant things were going well. I could worry if he wanted to see me more.

I was carrying identical girls, but they thought they were di-di. One placenta came out, and I strongly suspect mono-di. If my peri missed that, I'm not sure how useful the rest of his advice is.

Anyway, my point is: if you have a good peri, and he only wants to see you every few weeks, that could be a good sign.

Then again, as PP point out, you've got to be the best advocate for your babes.

Finally, feeling one more than the other is totally normal! It's a positioning thing. I felt Baby A way more than B, but once born, B is the feistier one!

Follow your instinct, but try not to get too worried by what you read. Congrats and best wishes!

 

Gena- I agree that every 4 weeks is pretty standard for di/di (since that is what they thought you had), but every 4 weeks for mono/di is extremely risky in my opinion.

TTTS can strike in as quickly as 4 days...I was not comfortable even going every 2 weeks and insisted on every week for fluid check between week 16-24.

I don't think it is worth the risk- if my peri recommended every 4 weeks and wouldn't budge, I would find a new peri.

It's also not just TTTS that can complicate a mono/di pregnancy- we developed sIUGR in our baby B due to unequal placenta share. Mono di pregnancies are very high risk and it just frustrates me that doctors use the same protocol for di/di twins...the pregnancies are incredibly different!

I apologize for preaching...I just have had a hellish pregancy and I would hate to see someone go through the same thing and not have it caught for 4 weeks.

 

Gena- I agree that every 4 weeks is pretty standard for di/di (since that is what they thought you had), but every 4 weeks for mono/di is extremely risky in my opinion.

TTTS can strike in as quickly as 4 days...I was not comfortable even going every 2 weeks and insisted on every week for fluid check between week 16-24.

I don't think it is worth the risk- if my peri recommended every 4 weeks and wouldn't budge, I would find a new peri.

It's also not just TTTS that can complicate a mono/di pregnancy- we developed sIUGR in our baby B due to unequal placenta share. Mono di pregnancies are very high risk and it just frustrates me that doctors use the same protocol for di/di twins...the pregnancies are incredibly different!

I apologize for preaching...I just have had a hellish pregancy and I would hate to see someone go through the same thing and not have it caught for 4 weeks.

 

Are you seeing a peri or an OB? If OB, immediately switch to a peri! Also, you should make sure that whoever is taking care of you has mono/di experience. As you know, there are a lot more things you need to worry about in mono/di pregnancies- placentas are meant for one baby...when you have two babies sharing, there are a lot of increased risks.

I think you are in Madison, WI? I am sure there are plenty of peris who would monitor you more often. Have you considered switching?

If you are spotting and contracting at 18 weeks, it's good advice to slow down. Also, definitely monitor baby movements and if you feel something isn't right, go in ASAP! Always better safe than sorry even if it's inconvenient for your doctor's office.

Lastly the ttts foundation (www.tttsfoundation.org) has a great list of questions to ask at every ultrasound. You should print it out and bring it with you to appointments. Mary is very helpful there. They are adamant about weekly monitoring for fluid.

 

I was seeing an OB. After going in with more spotting and contractions he got me for another U/S yesterday. It was only suppose to be to measure cervical length though. Th last measurement was at 4.7 and it is now at 4.4 but the OB said not to worry until it gets to 3. (couldn't convince her to take measurements of the babies because my OB didn't order them but she said they look about the same size and we got to see their little hearts beating so that was reassuring.)They've been moving a lot less for about a week now. The ultrasound tech was going to try to tell us the sexes but she said they were both breech and didn't want to move to let us peek. She said I'm probably feeling less movement because they're both frank breech and they are getting bigger. My placenta is also still completely covering the cervix which is disappointing. I was hoping that it has at least changed to marginal placenta previa by now. So the good news is my cervical length is nothing to worry about (yet) and hopefully at my U/S 2 wks. from now placenta will move, length will stay the same and babies will have moved. Nothing to do now but wait and see I guess..

 

4.2 is a great cervical length!