weight discordance in my mono/di girls

i'm at work monday afternoon and dr. scharf, who is dr. hurford's (my doctor) partner, called me. he said he was going through dr. hurford's files and came across my ultrasound and was concerned about the weight discordance between the twins. at my u/s last week, there was a significant difference in the size/weights of the girls. he scheduled me to see a high-risk ob-gyn on thursday and has put me on bedrest, at least until i see this other dr. to see what he has to say. i'm worried and scared.

Yesterday, I went to see Dr.Hurford for my regular appt. He said not to worry b/c he suspects that when I go to Dr. Myles, the high-risk ob-gyn, that he'll do a scan and say the discrepancy isn't as big as Dr. Huford's office thought. I asked how that could be and he said that Priscilla may have just been laying in an awkward position causing the computer to read her measurements inaccurately. Maddie's measurements are perfect, but Cilla is too big right now.

However, if something looks wrong, I'll probalby have to go for non-stress testing sooner than planned or even have an amnio, maybe other tests, i guess i'd find that out when in see the high-rish doc. It could be twin-to-twin transfusion syndrome or maybe Cilla has a chromosomal abnormality. He said he didn't want to tell me about the chromosomal thing and was probably going to regret freaking me out, but it's a small possiblity, too. Of course, I've already thought about all of those things. With TTTS, I would probably be on bedrest; w/ the chromosomal abnormality, i don't think i could do anything but prepare myself for whatever challenges that might bring. in my heart, i don't think it's TTTS b/c it's not that maddie's small & cilla's big...it's just that cilla is big.

right now, i'm just remaining on bedrest at least through thursday when I see Dr. Myles and trying to stay calm, but it's not really working. All I do is cry and look at their u/s pictures and obsess over how it's evident that Cilla is noticeably bigger than Maddie. Thursday afternoon can't come fast enough at this point.

Last week, at the time of this u/s, I was 25w 5d and Maddie (baby A) weighed 1 lb 10 oz; Cilla (baby B) weighed 2 lbs 7 oz. I don't know any of their measurements, except that Cilla's head and abdominal circumferences were significantly larger than Maddie's.

Has anyone else faced this problem - one average sized twin and one large twin - and what was your outcome?

Thanks so much!!

 

Dear Aritz,

As hard as it is when you're on bedrest and it's all you can think about, try to relax. I had mono/di boys constantly monitored for TTTS the whole pregnancy (never the same size, even from 8 wks), and who were born at 29w5d at 2#10 and 3#5 from preterm labor after 5 weeks on strict bedrest. And yes, there can be a substantial variance between u/s scan, and a difference between the scan estimates and reality. Despite their weight difference -- which exists to this day 2 years later -- they didn't have TTTS.

Here's the good news I think: your girls are a good size even though they have a discrepancy. You're well into your pregnancy and their viability, so if an emergency does happen, they are getting into good-outcome range.

Your perinatologist will give you more info, answer your questions, address your fears, and will probably increase the frequency of your u/s scans, so you'll get to see lots of the babies over the next few weeks, which may give you more assurance as you see them more. Try not to get too far ahead of yourself until you talk to him. Easier said than done, I know.

Best wishes,
Nikki

 

nikki --

thanks for reading and replying to my post. it helps to hear from other moms who have faced a similar situation. it's so hard not to think about what's going on, but i'm doing my best.

i can't wait until my appointment tomorrow to find out more about what's going on and hope & pray that the girls are okay.

thanks again,
amy

 

Hi, I know how you are feeling I have been seeing a specialist since 8 weeks. I found out at 27 weeks (now 32 weeks 4 days) that my twin B (little boy) was only 1/3% for weight he had dropped from 17% and my little girl was 27% and dropped to 19%. Anyway I had to go to the hospital to get testing and was kept for 3 days and had steriod shots and was told to be aware they may come in the next few weeks. We have made it 5 weeks since then so we are doing well; I was put on bed rest and my baby B grew to 5% in two weeks so now I get weights done every two weeks, also doplers and bio's done twice a week. We are going to get weights again this Monday and I am nervous because our little boy had dropped from the 5% back to the 1/3% again. If he didn't grow enough it is possible they may come at 33 weeks. Also I have preclampsia now. So I feel for you but just know that your doctors will do all they can to keep the babies in you before they deliver you early. It is so scary and stressful not knowing what is going to happen. Good luck with everything.

 

i went to the high risk doctor yesterday (26w6d), had a LOT of ultrasounds. found out baby a (madeleine) weighs 1 lb 14 oz & is in the 35th percentile and baby b (priscilla) weighs 2 lbs 8 oz and is in the 65th percentile. there is a 24% difference between their weights.

after reviewing everything and the ultrasounds, my doctor said that he doesn't think it's twin-to-twin transfusion syndrome and didn't want to treat it as such (i.e. removing fluid from priscilla or doing laser surgery). he's not ruling it out entirely, but doesn't think that's what it is. he said, it could be that they are attached to the placenta in such a way that madeleine is not getting enough of what she should to grow and priscilla is getting more than enough. he also mentioned that maddie may be suffering from some sort of growth restriction. finally, he said maybe the girls aren't true identicals and maybe maddie has a chromosomal abnormality. i had the sequential screen to screen for chromosomal abnormalities and the blood test results were normal, but he still threw it out there as a possibility. the length of my cervix was checked and it's great, so it doens't look like i'm in store for pre-term labor in the near future.

for now, i'll have ultrasounds every two weeks to monitor the girls' growth and to see if any sort of patterns evolve that can help my doctor narrow down why they are growing so discordantly. my hope is that they'll just kind of even out w/ one another in the upcoming weeks. if not, this is going to be the longest 2 1/2 - 3 months of my life!

i'm still very nervous for my little girls and just hope and pray that everything turns out okay! i can totally empathize w/ any mom who is facing a similar situation and pray her precious babies are happy & healthy too!

 

Keep us posted on your status and you your babies are in my prayers. I was told this will be my last weekend at home. Sunday is 33 weeks. The protein in my urine keeps tripling each week so the doctor said that even if they decide not to deliver me this coming week they will more than likely keep me in the hospital until it is time to deliver. I go Tuesday to get my babies weights measured again, and depending on how that turns out will play the biggest factor on if I deliver next week or not. If I am in the hospital I won't be able to access this site. My personal email is [email protected] if you need support on your weight issues I can offer some, because I am going through it all too.

Miranda

 

We had IUGR due to Jessy having a 2 vessel cord and both having Velamentous cord insertion. The girls always had quite a difference even at 24 weeks (when we first discovered it was twins!)

 

My mono/di girls always (and still do) had a weight descrepency. Abby was born a pound more and is still a pound more. At my first u/s at 11.5 weeks there was a difference and it kept getting bigger and bigger. I was never diagnosed with TTTS because there were no other signs of TTTS. At delivery, the MFM who delivererd my girls told me that Taylor's cord was a lot smaller than Abby's and it was attached to the side of the placenta and Abby's was attached to the thick middle. So I guess it was a matter of Abby eating more. She still eats more. Hope that is all it is! good luck!

 

thanks to all for responding to my post! hearing your stories...and positive outcomes makes me feel a lot better than i did when i left the doctor's office thursday afternoon!

you girls are the best!!

 

Have either of your doctors suggested that you drink the Boost protein drinks? When we realized at 18 wks that I was having mono/di twins my peri suggested I drink 2 Boost drinks a day and I haven't had any problems with TTTS. He said that studies have shown that drinking those drinks helps ward off TTTS.

 

thank you for your recommendation, I go to the doctor tomorrow and if I think of it I will ask about the boost drinks. The only thing is I do not expect to be able to go too much longer. The doctors have made it sound like they will come this week, unless things go really well.

 

Keep growing girls!

Not too much to share, but thought I'd tell my girl's story. They are di-di identical, with a fused placenta. Baby A always measured a little bigger than her sister, and they were born 14% different: 6.11 and 5.12 at 39 weeks. Although the weight difference meant a lot of minor differences in their looks, and they are very different personalities, both are very healthy and thriving at 18 months old.

I know there's a lot to worry about, but with so much uncertainty, I think you have to focus on how well your girls are doing. They are getting bigger just like they should, and no other concrete reasons for concern. Who knows, maybe they are fraternals after all with a fused placenta and they just have different growth curves.

Keep up the good work mamma!

 

I was on ensure with full bedrest on my left side. Only up to go to the bath room and shower

 

nobody told me about the boost drinks, but i'd be willing to drink them if it meant that my girls are going to be healthy!!

how long were you on bedrest?

 

did the dr think they were mono/di initially? the high-risk doc mentioned that maybe they weren't true identicals and perhaps baby a had some sort of chromosomal abnormality which could be why she was so small. i don't understand why they couldn't, maybe, be di/di twins and madeleine (baby a)is just the smaller one? i should have asked, but it had been such a long day and i'd gotten such an information overload that i was brain dead.

i've just got to keep hoping and praying that everything is going to be okay. i am so anxious for my next appointment!

 

I was on bedrest from the day they found I was carrying twins until the day they were born(24-34 weeks). They say laying on the left side gives them more nutrients. It prevents one of the major veins from being constricted

 

wow!! i try laying on my left side as much as possible. it's my least favorite side to lay on and sleep on, but i'll do anything i can to make sure that the girls are doing the best they can!!

 

I there's a good chance my girls may have been mono-di. Normal pregnancy and the twins were only discovered at the routine 19 week u/s. Apparently it can be hard to tell whether a placenta started out as one or two at that point. It can be done, they look for a delta where the sacs meet the placenta rather than a T intersection, but there's room for error. No pathology done on mine after their birth, because we assumed they were fraternal. DNA tests later proved they were identical. Which got me obsessed about figuring out the weight discordance. How could identical girls weight 14% different if they didn't share a placenta, one getting more nutrient than the other?

So, the point of this is that there is some room for error in fused placentas. Plenty of fraternals have them! If your girls are BOTH growing, on their own curves, and healthy, and if your doc questioned whether they were "true" identicals, maybe they're not. That seems like the most likely case.

In case your girls are identical, maybe something strange is happening like with my girls. Both healthy, both growing, no TTTS, just one more than the other for some reason.

Sending all my best wishes to you three!

 

Good luck! I hope you can make it a few more weeks.

My boys are identical, mono/di (Oh gosh, I think - I need to look up the defs and make sure). Anyway, they had TTTS and when born, were about 10 ounces different.

We found out after they were born that Boden had a velamentous cord insertion. He is almost 2 pounds lighter than Jacob, and they are 2 years old. He has always been smaller. Other than that, healthy as can be.

 

Definitely hoping they can hold out as long as possible. My next appt is this Friday and I cannot wait to see how they've done these past couple of weeks. Hope we hear some good news!!

I'll post whatever new info we find out at the next u/s!! Keeping our fingers crossed!!

 

Thanks for the post and all the info about your twins! My next u/s is this Friday. I'll let you know what we find out and so hoping that it's all good! Trying to stay positive!

 

Can you post a pic of your earliest ultrasound? That way we can see if we know if it's di di or mono di. Just a thought!!

Good luck!!!

 

I hope your ultrasound is great on Friday!

Looking at my first ultrasound photo - there was no visible membrane and all the twin mommies that saw it were convinced I had mono/mono babies. That was at 9 weeks. At 14 weeks the membrane was barely visible.

 

Hi! Just wanted to add my story too.
My mono/di twins were born at 30 weeks. Griffen had velamentous cord insertion (like a lot of others here) and was 1.15. Banjo was right on target at 3.4. Close to 40% size difference. Drs said at the start Griff might have a chromosonal abnormality, but the specialist reassured us this was highly unlikely. How sure are you on your dates? Is it possible that Maddie is small, rather than Cilla being big?
BTW, my boys are doing great at 21 weeks old. 97 days in NICU and SCBU, but now 5kg and 8kg (still a huge size difference!)
At least the drs are keeping a close eye on you. I agree that is the maturity and not the size that makes the biggest difference. Glad they are doing lots of doppplers, they are looking out for reverse end diastolic flow, then it is time to get those babies out! Griffen had absent end diastolic flow since 20 weeks, and he is spot on developmentally, except for the fact that he is tiny you would never know he had reduced blood flow.
Good luck!

 

Well, had my appointment today and they're both growing, which is good, but Madeleine still isn't growing enough. Two weeks ago there was a 24% discordance between their weights; today it is a 21% discordance. Another good thing is that they aren't MORE discordant, but the gap hasn't closed by much.

The doctor said the next few weeks will be critical weeks to watch them because, as of last week, their growth spurt started and it will be important to monitor their growth to make sure the discordance doesn't get out of control. Again, the doctor mentioned that he doesn't think it's twin-to-twin transfusion syndrome and suspects it could be "location, location, location". His words. It could be that Madeleine is attached to the placenta in such a way that she isn't getting enough nutrition and Priscilla is getting a little more than enough. He also said we're not out of the woods yet.

I have another appointment with the high-risk doctor on the 21st for another ultrasound and on the 26th for an ultrasound and a biophysical profile (also called a non-stress test) where they will measure the babies' heart rates, muscle tone, movement, breathing, and the amount of amniotic fluid around them.

I feel better today than I did when we left the doctor's office two weeks ago, but wish they were doing a little better. Of course, I'm still happy they're doing a little better than they were doing two weeks ago.

So that's the story for now…

Thanks again to everyone for your thoughts, prayers and concern!! I know I said it before, but Leonard, Maddie, Cilla and I really appreciate it!

♥ ♥

 

thanks for your sharing your story! i love reading about everyone's individual experience...and feel more and more reassured by all of the positive outcomes!!

currently, priscilla is a bit bigger than average & madeleine is a bit smaller than average. maddie and cilla are both vertex and it was funny, at today's u/s, maddie had her knee right in cilla's face!! it made me laugh a bit b/c i got the feeling that maddie's trying to 'get back' at her sister for hogging the nutrition!! they're constantly moving, letting me know they're there. i just hope and pray that my little fighters hang in there as long as possible and are as healthy as they can be when they make their grand entrance into this world!

 

i tried scanning it, but it just looks black -- you can't see anything. all signs point to mono/di, though. and, the membrane between them is very thin.

 

Amy,
I think you are going through exactly what Bruce and I went through. My specialist said she was going to pull my file and look back at all the ultrasounds she said that Zander's cord must have been on the side of the plecenta instead of the middle which would cause him to be almost 1/2 the size as Zoey. I think 21% is really good and do not panic because mine were 4.6 and 2.11 so my discordinace was even more than yours and both our babies are doing well! Zoey is in open crib as of yesterday.

I also was suffering from preeclampsia so be thankful you do not have to deal with that as well. Also our fluid levels where very low only 2.5 and 3.5ish. So I know what you are going through and I hope this helps put you at ease. We will still have you in our prayers.

Miranda

 

Both girls had their cords attatched off to the side and not at the center. They had an extremely thin memebrane which was at some ponta not even really visible between them.

 

miranda --

it's great to hear that zander and zoey are doing so well! aside from maddie & cilla not growing properly, i don't have any additional medical issues, like you did, further contributing to complications. i just have to keep my fingers crossed that it stays that way.

thanks for all the advice & updates. it makes me feel so much better. i still have your family in my prayers, too!! keep me posted!

amy

 

Glad to hear about Friday's u/s. It would have been nice to find out that it was just a fluke, but it sounds like you have really good HCPs. Wow, I can only begin to remember and imagine how stressful this might be. But it sounds like you're focusing on the positive, which is great. Your girls are coming right along, and both growing!

Paraphrasing my MFM specialist, Dr. McDreamy as we called him, he'll tell you when to worry. If he thinks things are OK, you have nothing to worry about.

All our best!

 

now i have a new issue...

this weekend i had a slight bit of brownish discharge. i called my dr. yesterday and he said to take it easy, if it got worse, to go to the hospital and he would see me this morning (b/c i already had my bi-weekly appt scheduled).

he checked it out and said that my cervix was a little soft, hence the discharge, but i'm not dilated at all. i have an appt for an ultrasound on thursday and another appt next monday to see him. he said there's no need to freak out or anything right now b/c i have no other signs of pre-term labor, but he doesn't want to take any chances, and prescribed bedrest. he said, at the very least, he wants to get me to 33 or 34 wks; currently, i'm at 29w3d. i told him that i had already put my notice in at work and that aug 28th was my last day...he said, no - friday was your last day. i was surprised b/c he really isn't the biggest advocate of bedrest, and although bedrest is boring, it makes me feel a lot better to be on it for the babies sake b/c i think it might also help w/ the discordance.

i guess it's just another joy that comes along w/ a multiple pregnancy!! if these girls cause me as much grief after they're here as they have these past few weeks, i'm really in for it...but i can't wait to meet them!! of course, i don't want to meet them for several more weeks! i guess we'll have to wait and see!

 

I'm glad to hear your doctor is proactive and has put you on bedrest. You are doing a great job - keep it up!!

 

Sounds very smart. Rest up and stay positive! You might want to reach out to your local twin club. Mine has a lot of good support for moms on bedrest.

:youcandoit:

 

thanks!! i recently joined my local mothers of multiples club...maybe i will give them a call! i appreciate the advice!

:thanks: