21 weeks 1 day

This is the first blog of what I'm sure will be many.  Hopefully they will remain simple as no news is good news in our case.  Ill give a little background about what we have been going through in the last 5 weeks.

The Latham twins are monochorionic/ diamniotic twins.  We found this out about 14 weeks into our pregnancy.  This simply means the girls share a placenta (monochorionic) and each have their own sac (diamniotic).  The most common type of twins are dichorionic/diamniotic.  This means each twin has their own placenta and their own sac.  Mono/Di twins as we have in our case are a bit more high risk.  A single placenta is meant to nourish and house 1 baby and we are asking it to do the job for 2 babies.

10% of mono/di twins develop a serious condition called twin to twin transfusion syndrome(ttts).  This is where one baby becomes a donor twin and one baby becomes the recipient twin.  Since they share a placenta and all that comes with it, one baby gets too much nutrition and oxygen (recipient) and the other gets too little (donor).  In severe cases the donor baby can become dehydrated and anemic.  The recipient baby can get so much that she could go into heart failure from the excessive blood.

At week 16 we got the most exciting news, we were having 2 baby GIRLS!!! We were over the moon.  What I thought would be a very exciting visit quickly became overshadowed by the news we might possibly have ttts.  There are a few ways doctors diagnose ttts.  The amount of fluid in each babies sac, the bladder of the smaller baby, kidney function of smaller baby, size of babies, heart function of both babies, and brain function of both babies help to determine a diagnosis of ttts and the stage in how severe your case is.  There are 4 stages of ttts.  1 being the least severe and 4 being most severe where intervention needs to take place in order to save the babies.

The main things that are looked at in weekly ultrasounds of mono/di twins is the fluid in each sac, the size difference from baby A to Baby B and if the babies have normal size bladders.  They also use doppler to look at blood flow in the umbilical cords of each baby through the placenta.  The normal range for amniotic fluid in each babies sac should be between 5cm and 15cm.  The size different in the twins should be < 20%.

This background brings us to where we are today.  We have been monitored with weekly ultrasounds in the past 5 weeks alternating with high risk perinatologists in Roseville and the Fetal Treatment Center in San Francisco.  UCSF is one of the few places in the entire US that has experts in this condition and the means for surgical intervention to treat it.

So far, we have been told that we are in a "stable" place.  TTTS can occur at anytime and can happen quickly.  Thus the reason for weekly ultrasounds to identify a problem before it becomes too severe.  We are lucky in the fact that we currently do not meet the technical criteria for TTTS to be diagnosed.  Each of our babies is holding steady with Baby A (our bigger twin) who has amniotic fluid in her sac measuring between 8-10 cm in the past 5 weeks.  Baby B (our smaller twin) has been measuring right about 3cm of fuid in her sac.  As you can see with the technical criteria for tts being that one twin HAS to have >8cm fluid AND the other twin HAS have <2cm fluid to be diagnosed with ttts stage 1, we are borderline for that diagnosis.

We also have a issue with the growth of our girls.  The normal  is anything <20% difference in size.  Our girls as of last Wednesday  were 25% different in size.  Baby A being 1 lb and Baby B being 12oz.   This is also something to watch carefully.  Since our girls are sharing a placenta they each have their own cord attached to it.  As our doctor explained in layman's terms, a placenta is like a snowflake.  Each one is completely unique and develops in its own way.  Therefore the umbilical cords can insert in any given place.  Ideally they would both insert centrally so they could get the most nourishment and oxygen possible.  We initially were told that we had 2 central cord insertions.  Unfortunately, at out last appt we were told baby B (smaller baby) had a more peripheral cord insertion or closer to the edge.  This is called "unequal placental sharing."  This split can be varying from 70%/30%, 80%/20%, or any combination you can think of.  This is the reason for the discrepancy in the size of our girls being 25%.  They are not sharing the placenta equally. 

So what does all this mean?  Basically we sit and watch and hope they do not need intervention before they are able to be ok out rather than in.  As long as the fluid remains stable, they are growing, and the bladders are visible be will continue to be "stable" and hopefully can make it into the safe zone of delivery.  If things do not stay stable there are possibilities for amnioreduction ( drain fluid from the sac) or laser ablation (cauterize the blood vessels that the babies share in the placenta, basically creating 2 placentas.)  Hopefully with prayers and time we wont need any intervention.  Tese can be very risky and do not always work.  I will hopefully not have to elaborateon these procedures in the future.  If in time we do need to go down this path i will explain them in more detail.

We want to be able to keep everybody who has been thinking about us or praying for us in the loop about what is going on with our girls.  Sometimes its hard to talk about and telling the story over and over is tedious at times but I know it is just because you all care.  That means so much to our family and we cannot thank you enough.  I will try to update as we continue on this journey.  Please continue to pray for our girls and think good thoughts.  I know I try everyday but this process has been so overwhelming and scary that I though blogging about it may help me and all those thinking of us.