Sunday, March 30, 2008

Identical twin girls (March 17/08)

Saint Patty's Day is suppose to be a very festive and cheerful day, however, not so much for us. We had our U/S in the Fetal Assessment and Treatment Unit, which is where high risk pregnancy's are looked after.

The resident started the U/S going over the anatomy of the babies. Lynne came in shortly after, and I could tell she had some concerns but was trying not to overeact initially.
There was definetly only one placenta. With identical twins, if the egg seperates between conception and day 4, the babies have their own placenta. It the egg seperates between day 4-8 after conception then the babies share the same placenta, and in our case they have their own amniotic sacs, however it is possible to also share the same amniotic sac. It was also very obvious from the U/S that the babies were girls!

As she went over the U/S she told us she was concerned about the difference in amniotic fluid around Baby A and Baby B, and told us that she thought the twins were showing early signs of Twin twin transfusion syndrome (TTTS). This is a disease where there is unequal sharing of the blood and nutrients between the two babies, and can occur in 10% of identical twins. The donor baby gives too much blood to the recipient baby, which is bad for both babies. The recipient who is getting more blood and nutrients, grows more, but also has to work extra hard with all the blood, and is at risk for congestive heart failure. Because it has more blood and nutrients, it's bladder is also working harder and urinating more therefore producting more amniotic fluid. The donor baby obviously is not growing as much, and if not urinating as much, then has little fluid around it to develop. That being said, the main things to look for in this disease, is the amount of amniotic fluid surrounding each baby, the discrepancy in size between the two babies, and both the bladders and hearts. Both bladders and hearts looked good, and there was a 20% difference in size between the babies, but a large difference in the amniotic fluid. However, Baby B (the donor), had enough fluid surrounding her for development. Lynne explained to us that with TTTS it is very unpredictable, and that within a couple days to a week, things could even out, stay the same or get much worse, therefore weekly U/S were necessary to monitor the babies.

She briefly went over to treatment options, but said we weren't at the stage requiring them yet. Amnioreduction is the first option, which is similar to amniocentesis, but used as treatment rather then assessment. They can drain fluid from the bigger baby's sac in hope that the pressure change will even things out between the two babies. Some people do this once and everything is fine, other people need this draining a couple times a week. The second treatment is a type of laser surgery where the abnormal vessels between the two babies are disconnected in hope of correcting the main problem which is an unequal sharing of the blood and nutrients.

This was a lot of information to take in.

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