Our Pregnancy Journey with TTTS

2-22-07 
5 1/2 weeks
Holy cow! Okay guys...so I just found out that I'm pregnant, and (even
bigger surprize) I might be having twins!!! Double holy cow!

So I had a sonogram because I was having some pain on my left side and the
first thing the sonogram technician says is, "Do twins run in your family?"
and I said, "Are you kidding me???". But it isn't for sure yet because they
don't have heartbeats yet. They are only yolk sacs and one could still get
reabsorbed. I'm only 5 1/2 weeks right now, but I have another appointment
on March 2nd and I'll get to find out for sure.

3-2-07
7 weeks
You know the old saying, "One if by land, two if by sea"...Well we have 2 so
I guess it's by sea! How crazy!! Today we had another sonogram (7 weeks)
and there are definitely two babies in there AND they are in the same sack
which would mean identical twins! I can hardly believe that this is
happening to me. It still doesn't quite seem real because I haven't been
really sick at all yet (knocking on wood as I type), and I can't feel them
move yet, but I love seeing the sonograms because it makes it so much more
real. We heard their heartbeats today and could see their little hearts
fluttering. They aren't doing much else right now, but they are too cute!
I have another sonogram in 3 weeks so that they can determine if there is a
membrane separating the two babies. If there isn't, then I'll be clasified
as super high risk because their cords can become entangled very easily and
they will probably do a C-section really early to minimize the risk for the
babies in the womb. However, if there is a membrane (that they just can't
see yet), then I won't be quite as high risk, but they will still do a
C-section about 2 weeks before my due date. I'll keep yall posted as I find
out more information.



14 weeks
Just wanted to give a quick update on the twins. I am currently 14 weeks
(15 weeks, on Friday), but my belly is measuring the size of a single baby
at 16 weeks. I haven't gained any weight yet, but I'm sure it will start
soon enough since I am now officially in my 2nd trimester. The babies are
definitely identical twins, and they are measuring almost the exact same
size right now. They are almost 4 inches long (or about the size of
oranges). At my last checkup on Monday, their heart rates were 150 and 140,
which is normal.

Right now the biggest concern is Twin to Twin Transfusion Syndrome (TTTS).
This occurs in identical twins that share a placenta (which mine do).
Instead of only exchanging nutrients from the baby to me and vice versa,
there can be abnormal blood vessels that connect the 2 babies. Depending on
the number of connections and the direction of blood flow, one baby can get
more blood than the other causing size discrepancies between the 2 babies.
So to screen for this problem, I will be getting weekly sonograms from 16-22
weeks (maybe more if there is a problem). My next sonogram on May 8th where
we will hopefully find out if it is boys or girls (since they are identical,
we will get 2 of something).

So far everything is going really well. I haven't been sick at all just
really tired.


16 1/2 weeks
And the verdict is....Girls! At least so far anyway. We have another
sonogram next week to check in on the girls, so we can double check then.
Both babies are measuring in at a whopping 6 oz, which is right on schedule
for ~16 1/2 weeks. Although they are measuring the same size (which is
great), they are already showing some signs of Twin to Twin Transfusion
Syndrome. One baby has more amniotic fluid than the other, so that means
that we will be keeping an extra close eye on them over the next several
weeks/months. This means weekly sonograms with the specialist for now.
I'll keep everyone posted. For now, everything is okay.

Baby B was already sucking her thumb...it was so cute!



6-11
21 weeks
My ultrasound update news is so-so. We went to the specialist (not our
regular doctor because he was out of town) on Friday and he said that the
babies hadn't gotten much worse, but not really better either. So he wanted
us to keep our appointment for Monday (today) so that we could check on them
again. Well, we just got home from that appointment (with our regular
specialist doctor) and he is going to send us down to Houston for a consult.
He didn't give us the option of going if we wanted to, like last time
though, instead he said, "What day this week is good for you?". They are
going to call me later to tell me what day we have to go down to Houston,
but the appointment will probably be Wednesday morning, which means that we
have to leave to go down there Tuesday evening. Right now it is just for a
consult because there have been lots of subtle changes that our doctor isn't
quite sure how to interpret. One thing will get better, then another thing
gets worse. Right now the donor baby (Baby B) has constricted umbilical
cord flow again and he isn't sure why. Also, at first Baby B didn't have a
visable bladder, but by the end of the ultrasound she did have visible
bladder, so that was a good sign. Baby B's fluid level measurement is down
below 2, which isn't very good. Baby A looks good today, although she has
looked pretty good the whole time. It seems to just be Baby B that is
giving us a little bit of a hard time. We aren't sure how long we will have
to stay down in Houston yet because this is just for a consultation, but
they could decide to keep us down there if they think it is bad enough. Our
doctor doesn't think they will do anything drastic yet (because I'm only 21
weeks), but he wants to get another opinion. 


(cont)
Up until last week we were seeing the specialist for ultrasounds once a week, but last week we had to start going twice a week. There have been subtle changes that the doctors want to watch closely. The bad news first - The babies' amniotic fluid levels have been fluctuating some, but mostly in the wrong direction.  Baby B (the donor baby) is a little smaller than Baby A, and Baby B is having some
constricted umbilical cord blood flow. The good news - At the last ultrasound, both babies had visible bladders and they were both moving around quite a bit.  We are all watching the babies very closely so that if anything were to go wrong we can catch it before it gets too bad.  This week, for our second appointment of the week, we are going down to Houston to see the TTTS specialist at Baylor. They specialize in TTTS treatments like laser surgery on the placenta to correct the abnormal blood flow. Our appointment is on Wednesday and depending on how the appointment goes and how the girls look, will dictate how we proceed.  We might just continue with weekly appointments or we might have laser surgery. I'll try to update as soon as I can after the appointment.  One more good note - This pregnancy has been really easy as far as how I've been feeling physically. I love being pregnant, it is just a little stressful going to the doctor so often.


6-13

This is just a quick update from the visit with the specialist in Houston.
The girls are looking okay at this point. They are both growing and
both are within acceptable limits as far as their size goes. Their
amniotic fluid levels are still unbalanced, but physically they are both
doing okay.
Now the problem is me! My cervix length changed quite a bit from my
appointment on Monday (from 3.5cm to 2.1cm), so now I am on bed rest. I
go this coming Monday to have a cerclage, a stitch placed in my cervix, to make sure
the babies don't fall out. We are going to continue seeing our normal
specialist for ultrasounds on a weekly basis to keep a close eye on the
girls. The doctors in Houston seem to think that laser surgery is still
in our future, but not for several more weeks.



6-15
Scary part of the Houston appointment:
While the doctor was in the room doing an ultrasound to
double check the umbilical cord flow of Baby B (smaller baby), all
of the sudden the screen where it shows the heart rate (the little
up and down bleeps) changed from about 15 bleeps across the screen
to only 3 bleeps across the screen. So calmly he starts looking
back and forth from Baby B to Baby A and I ask what is on the
screen. Naively I'm thinking maybe he doesn't have a good read on
the umbilical cord (because she had been moving around like crazy),
but oh no, he says, "That is her heart rate." So her heart rate had
just dropped from somewhere around 140 to somewhere around 50. So
the doctor says, "I need you to lay on your left side", which really
starts to freak me out and when I'm on my left side I can't see any
of the monitors. So I'm facing Walt, and I start crying because I
don't know what is going on, and the doctor still has the ultrasound
thing on my belly watching her heart rate. Then after about a
minute (it seemed like forever though) he says, "okay, it's back to
normal and you can roll back over". So then he tells us that this
is actually a normal thing that babies do sometimes during a resting
period. They only worry if it doesn't go back to normal. Then he
tells us that he thinks he got a few more gray hairs from that
little experience. Good lawd! These crazy babies are just keeping
us on our toes I guess. Preparing us for life after they are born,
when we still don't have complete control over what they do. I just
want to tell them, "okay, I understand that you do what you want,
when you want. Now cut it out already!"

Also, I think we decided on names? Camryn and Kristin. We haven't decided
for sure on the spellings, but I think we are pretty set on the
names. Now we just have to come up with middle names.


6-15
All of the super scary stuff happened down in Houston, but the doctor was
super calm and collected, which made it a little better. Still not a wonderful feeling, but we made it
through. Here is the link on TTTS info that the office in Houston sent to me.
 
http://www.texaschildrenshospital.org/carecenters/FetalSurgery/twin_twin_transfusion_syndrome.aspx

  It goes through what TTTS is and how they fix it. The sucky thing
is that sometimes even when they fix it, it (the bad blood flow)
comes back. Sometimes really small blood vessels are missed or the
babies can even form new ones. So there is a chance that even after
they "fix it" that "it" can still come back. Right now the babies
aren't bad enough to risk surgery. While the surgery can fix it,
there are lots of possible complications that can occur due to the
surgery, so that's why they are going to hold off until the babies
get worse. The Houston doctor said that if these were two
individual pregnancies they would look basically normal, but since
they are in the same uterus you can see difference in them. 
Individually, the babies are good, but it is when you compare them
to each other that you see the difference in fluid volumes.


6-21
22 weeks
I had the stitches placed in my cervix yesterday
(procedure called a cerclage) and all went well. I had a spinal block
during the procedure so that I didn't feel anything. We ended up
staying at the hospital almost all day (8:30am until about 4:30pm), but
it wasn't too bad.
The doctor said it was a good thing that we did the procedure because
the outer part of my cervix had started to dilate a little. I'm on
pretty strict bed rest right now. I can only get up to go to the
bathroom and to take a quick shower. I can't even sit up in bed! So
far I'm doing good though and I'm enjoying the rest. The girls both
seem to be doing good too.
They are both kicking and flipping around like crazy.



6-25
Today I had a checkup and my cervix was measuring 2.5-2.8 depending on the
angle. Both babies seem to be doing well. Their largest vertical pockets
were 2.5 and 5.9. I'm still on bed rest, but it really seems to be helping.
If anything, I guess I am more relaxed, so maybe that helps out some.
Hopefully we won't have to go back and to Houston for a while, but we'll just
have to wait and see.



6-27
23 weeks
I had an appointment on Monday and it went really well. My
cervix was measuring about the same as last week and the stitches all looked
good. Both babies looked good also. Their fluid levels were about the same
as last week, which is good because at least they didn't get any worse. We
go back on Tuesday for one more cervix measurement and also to measure the
girls and see how big they have gotten.
I'm still on bed rest, but I can sit up some now and even get out of bed for
short periods of time. I'm not too bored yet. I've been trying to just
enjoy relaxing and not running around like crazy.



7-3
24 weeks
Update from my doctor's appointment today - The girls both look really good!
Yeah! Their fluid levels have evened out, which means the TTTS isn't
getting any worse this week. That is always good news. My cervix looked
pretty good too. It seems like the bed rest agrees with my body and my
babies. My doctor is going to keep me on modified bed rest (I can get up
for 1-2 hours a day) since it is working so well. He doesn't want me going
back to work, since it would mean being on my feet for 12+ hours a day. I'm
so glad the girls are doing well after the scare we had with them 3 weeks
ago (their TTTS was getting way worse and we almost had to have laser
surgery on the placenta).

I had my Fetal Fibernectin swab done and I should get results back on
Thursday. If I get a negative result it means I shouldn't go into early
labor, but if I get a positive test, it means that I could possibly go into
preterm labor.

I have my Gestational Diabetes screening test on Thursday, so hopefully that
will come back negative.

We got some super cute pictures and video from the ultrasound today. The
girls were facing each other, so we got some pictures of them together.
Baby B was kicking Baby A in the face, and Baby A was blocking with both her
arms. Too cute!



7-16
26 weeks
Our doctor's appointment today went very well. The girls are both
doing great! Their fluid levels have evened out (both had 6cm of
fluid) and the doctor can't really tell them apart any more; which
is a good thing! Since this appointment went so well, we won't go
back for another 2 weeks.
I also had my 3-hour glucose tolerance test this morning and should
have results back in the next day or two. Let's hope for no
gestational diabetes! P.S. That orange drink is so gross!!



7-31
28 weeks
We just got through at the specialist's office and the appointment went really well.
The girls are growing well - Baby A weighs 2 lbs 10 ozs and Baby B weighs 2 lbs 4 ozs.
Our doctor isn't worried about the small difference in their weights because it is only ~12%
difference and they don't start to worry until there is a 20% difference.
Their amniotic fluid levels seem to have stabilized also.
I've almost made it to 29 weeks (I'm 28 weeks and 5 days right now) which is
awesome! All of my doctors were just hoping that I would make it to 30
weeks, but they are all extremely pleased that me and the girls have made it
this far. I'm just trying to take it easy at this point and keep these
girls in as long as possible. As of right now, we are hoping that the girls
come sometime between the middle of August and the end of September. My
doctors won't let me go past the end of September.


8-15
30 weeks
Not too much going on this week. We go to the specialist on Monday for the first biophysical profile on the girls. This will just check to see how they are doing and to make sure that they are not struggling.
They both get the hiccups pretty regularly now, and it is the funniest thing! Baby A's hiccups are really low on my tummy and Baby B's hiccups are right under my ribs.
I've started having some Braxton-Hicks over the past week or so, but no real painful contractions yet. 



8-20
31 weeks
So today was our first biophysical profile/non-stress test and things went pretty good. The babies get a score on a scale of 1 to 10 (10 being the best) and the girls got a 10. So that is the good news. The bad news is that their weights are getting further apart again. Baby A's estimated weight is 3lbs 14ozs and Baby B's estimated weight is 2lbs 15ozs. They are both still growing, but Baby B just isn't growing as fast. Baby B also has a little bit of a problem with her umbilical cord flow again, but the doctor isn't too worried yet because it could just be because she is so active. Just to be on the safe side though we are going back on Thursday for another biophysical profile to make sure that they aren't deteriorating any. At this point, if anything looks even a little bit worse, the doctors will deliver them. So for now we will be going to the specialist twice a week to check on the girls.


8-23
The biophysical profile testing today showed that the girls are doing better than Monday, so they get to stay in my tummy for a while longer. Baby B (the smaller baby) had better blood flow in her umbilical cord, so the doctor was very pleased to see that. We go back on Monday morning for more testing to try and determine what "normal" is for the girls. Right now the doctor isn't sure if this past Monday was just a bad day, or if today was just a good day. So we will have more information on Monday! 


8-27
32 weeks
The appointment went good today. Everything is basically the same, but not any worse, so my doctor is okay with the babies staying inside for a while longer. We are going to continue monitoring them twice a week for now, and hope for the best.
Baby B still has some absent blood flow in her umbilical cord, but for the most part her blood flow is normal. The good news is that the blood flow isn't backwards (that would be a reason that we would deliver immediately). Everything else looks good - they are both moving around, practice breathing, and their heart rates look good. Today during the sonogram we got to see Baby B yawn! It was so cute! Baby A was raising her eyebrows and then scrunching up her face...too adorable! It is amazing how much they can do already.
They were both head down today, but they are pretty acrobatic though so I'm sure they won't stay that way.



8-30
33 weeks
We are officially 33 weeks today. The appointment today went really well. The girls both looked good today. Baby B still has some absent blood flow in her umbilical cord, but when she is active the blood flow is normal and she is very active.
We scheduled our C-section for September 19th, so unless something looks bad between now and then, that will be the babies' birthday! We are going to continue seeing the specialist twice a week until then though.



9-3
Today's appointment was very uneventful. Both babies looked very good when they were on the heart monitors and neither one would hold still during the ultrasound either. So basically that means that they are doing good. Since they were both so active we didn't even see any absent blood flow in Baby B's umbilical cord. Yeah for active babies!
We are still going to continue with the twice a week appointments, but for now we are still on for the 19th. Only 2 1/2 weeks to go!! Can you believe it?? Wow...it has gone by so fast. 



9-7
34 weeks
At today's appointment the girls were both looking good (they scored 10/10 on their biophysical profiles), but Baby B (the smaller baby, Camryn) didn't have any amniotic fluid so my doctor decided that we would deliver them today. I had a c-section and here are the babies stats:

Baby A: Kristin
Time of birth: 8:29pm
Weight: 3lbs 13ozs
Length: 17 1/2 inches
Apgar score: at 1 minute - 6, at 5 minutes - 9
She had some trouble breathing due to some fluid in her lungs, but now she is breathing room air with the help of CPAP.

Baby B: Camryn
Time of birth: 8:30pm
Weight: 2lbs 15ozs
Length: 15 inches
Apgar: at 1 minute - 8, at 5 minutes - 9
She came out screaming and already had a bottle this evening. I was able to hold her for a few minutes tonight.

Both babies are in the NICU right now, mostly because they don't weigh very much.