Unequal Placenta Sharing

JuliaAndPete

So we found out today that our modi twin girls probably do not have TTTS but they have "unequal placenta sharing" for sure. Baby A's cord is marginally to the left. Baby B's is right in the middle.

Growth scans today showed that baby A is measuring at 14 ounces (18th percentile) and Baby B is 1lb 6oz (56th percentile). We are at 23 weeks today. Their size difference jumped to 34% today. Last time it was 31%. Baby B grew 6oz and baby A grew 3oz from the last scan.

The MFM OB wants us to tour the NICU tomorrow and probably get used to being there.

Baby A's cord is showing a disruption in flow while her heart is at rest. This is the first time we've seen any change in the cord flow. The fluid in their sacs are good right now and everything (anatomically) looks great.

Our dr said that we need to start thinking about making a tough decision soon. Meaning whether or not we want to have a c-section soon or wait it out for the bigger baby's sake.

If baby A gets down to the 10th percentile for size she would need to come out. If that happens in the next month we might not make it past 27 weeks. Ultimately that could be bad for both girls.

He said the average gestational period for someone in my situation is 33 weeks. Which would be phenomenal at this point.

My husband and I ultimately want to do what is best for both girls.

Does anyone have any experience with this? What path did you choose?

I feel like baby A is so strong. In my heart I feel like she's not going anywhere. My husband is feeling really sad about the whole situation. I don't know how to feel.

whitehousem

I don't have any experience with this (12 weeks with mo/di), but I had a hard time reading this without getting teared up. I just wanted to offer thoughts and prayers. I hope things change for the better and you don't have to make that decision!

JuliaAndPete

I'm sorry, mama I didn't mean to make you tear up. I'm feeling more positive right now than when I wrote this. Baby A is so active and she's a tough chick. I've been playing guitar for her for the past hour and she's been dancing in there. We're remaining hopeful and logical at this point. The NICU will be rough tomorrow but hopefully we'll get some questions answered.

yinyang124

I don't have any advice, but sending up prayers for guidance in your decision and two healthy, sweet girls. 

raraavis28

My situation was not nearly as severe, so I don't have any advice, but my heart goes out to you in this difficult situation. I will be praying for your Baby A to hang in there and for good health and strength for both little girls, whenever they need to be born. Also sending T&Ps for you for peace and strength.

Mrs. Alice

I know I responded to you other posts and my boys had a similar situation. I didn't learn until later when I read their placenta pathology report that baby A had a marginal cord insertion too.


Are they going to admit you to be monitored? I would strongly push for that vs. a c-section so premature. Unfortunately statistics for micro preemies are not very good. So I would try everything to keep them safely inside as long as you can. Consult with a neonatologist as well.

I was admitted at 24 weeks. Baby A was 10% and reverse end diastolic umbilical flow. They gave me steroid shots and by some miracle the flow improved. Not to normal but to absent end diastolic which sounds like what you're describing. My Dr. let them stay inside as long as I stayed in the hospital for monitoring and he stayed out of reverse flow, above 5th percentile, and passed BPPs and wasn't in distress. That got them to 28 weeks which makes huge difference in survival and long term disability risks. I'm so sorry you're facing such uncertainty but keep faith and hope. I had a good outcome with my boys, not an easy path though. Praying for you and your girls! I'd be happy to try to help if you have any other questions too. P.S. my boys measured 30% different on u/s but were really more like 20% at birth.

24karat

My mo-dis weren't as severe (discordant growth/fluid levels 1st discovered at 16wks), but I remember how awful it was to hear my team say that they were certain I'd deliver prematurely due to my complications and it was just a matter of how early they'd come. I was 23wks when they said that. Our A lagged behind B the rest of the pregnancy but the difference stabilized (birth weights ended up only 9oz apart) so we were spared any tough decisions.

I hope that you too will be spared that decision. T&P for you and for your precious babies, especially A, to grow! ::hugs::

kiwi443

My girls didn't show signs of discordant growth until after 30 weeks. One of mine had a velamentously inserted cord and the other was marginally inserted. My dr. chose to bump up my c-section to 36w4d when the smaller baby started shunting blood to her brain (a sign that she was not receiving adequate blood flow). I ended up going into labor the night before the scheduled C-section. They were born at 4.13 and 6.2. The pathology report stated that there was unequal placental sharing (2/3 v. 1/3). They are now healthy and thriving 22 month olds.

Best wishes as you process this news and I hope that your girls stay inside as long as possible.

 

SWA80

My situation was almost exactly the same, absent end diastolic flow and 30+ discordance starting at 24 weeks. We were monitored carefully, twice a week and then three times with scans and BPPs. The way the flow measures can vary depending on who is doing it, how it is done but doctors were okay with letting me go as long as flow didn't reverse and both babies continued to grow. I was admitted to hospital at 32 weeks and made it almost to 34 before things deteriorated and they had to get them out. My B's abdomen was measuring 3rd percentile and he hung in there like a champ.

Every situation is different but I suggest you get a second opinion if possible before being pressured into a decision you're not comfortable with. So sorry you are going through this, my thoughts are with you.

JuliaAndPete

Wow. These stories are unbelievable and very reassuring. Thank you all so much for sharing. Please feel free to update me on how everyone's twins are doing now. Did your smaller twin catch up after they came out? How long were they in the NICU? How long did big baby stay in the NICU?

My husband and I are absolutely terrified about losing our little Eve Marie. I pray for her every second. She is SUPER active which helps me feel more positive through all of this. Our hospital is amazing and I know our girls will be in good hands.

Another thing that has changed since this diagnosis is that I have been eating NONE stop. For the first time in this pregnancy I cannot stop eating. Is it possible that this last measurement was right before a huge growth spurt? And our next scan in two weeks could show major improvement. I have increased my caloric intake by 500 a day in the past two days. It's crazy!!

Am I being too hopeful or is this possible?

marcobonny

I found out today I'm in the same situation as you. I had a diagnostic ultrasound at 23 weeks and Baby A weighed 15oz and baby B weighed 1lb 4oz. We have an urgent MFM appt on Monday. I don't know how I'm going to get through this weekend...I feel like I need to know what's going on with my little girls.

24karat

I didn't include this in my original reply, but mine didn't end up in the NICU. Despite everything, and to the surprise of everyone on my medical team, we made it to my scheduled c/s date (37wks exactly) with the boys weighing 6lbs and 6lbs 9oz. One of my midwives actually told me that she couldn't believe we made it past 30 weeks, let alone to 37. 

Even though we didn't have a NICU stay the boys did have a hard time gaining weight after birth. We were almost readmitted to the hospital because they each lost over 10% of their birth weights (C, our baby A, had latch and suckling issues plus my milk came in late). The first time C passed his brother in weight was at their 2 month check up and now, at 4 months, they're almost exactly the same size.

When is your next u/s and have you been admitted for observation/hospital BR yet? Hang in there!

Mrs. Alice

That's great you're able to eat so much now, it definitely won't hurt. I think it's very possible for your little one to continue growing. There may be a discordance but as long as things keep stable, I think it's a fine balance of benefits vs. risk decision between you and your Dr.

My boys were in the nicu for 10 weeks and amazingly came home together. My little guy was super active and feisty like your little girl. They are 2 now and are still pretty different in size. I don't know if he will ever catch up. He has struggled with weight gain since forever and he's never been on the growth chart but he's pretty healthy otherwise. He's definitely the quirkier of the two and has always been a little more behind developmentally. It makes me sad that things are harder for him and he may have more long term delays and issues than is brother. But considering everything they went through they are amazing and happy boys. Super active and full of life.

Mrs. Alice

And because I'm in a sharing mood, here's a recent pic of my guys. You can probably see the size difference here...

SWA80

My boys are only 2.5 months old and there is still quite a big difference in size but they're both doing great. The bigger one is really chubby. Little guy doesn't make as much eye contact, etc. as his brother yet.They did two and three weeks in NICU. We were very lucky.

kiwi443

Mrs. Alice, is your smaller guy on the right? It is honestly hard to tell! I know the size difference between my girls seems obvious to me (though their gap is constantly lessening) but others have difficulty seeing it.

JuliaAndPete, mine didn't need any NICU time so we all came home together.

Jenyoung5

I just passed 25 weeks and my mono/di boys were 28% difference this week measuring 1lb 9 and 1 lb 2. At 23 weeks they were 1lb 2 and 13 oz. 26% discordance. My mfm isn't too concerned because blood flow is still good to both babies. He hasn't said anything abt really early delivery, except that no longer than 36 weeks they will deliver.
I have read however that horizontal rest and protein shakes also help with size discordance. I actually talked to Dr. De Lia who invented the laser surgery for ttts and he sent me some articles to read abt his study on rest and protein for size discordance. I am doing all I can with that even though my doctors have not told me to do so. I figure the more I can feel like I can do the better I feel. You kind of feel helpless otherwise. I don't know if it will help, but worth a shot.
Good luck! Keep us posted on what happens with your babies. It is very stressful!

JuliaAndPete

So glad to read I'm not alone. My husband and I have done a lot more research the past week and we're starting to feel better about our chances of keeping both of our girls. These posts you are all sharing mean SO much to me. No words could ever describe my gratitude. I'm so sick of hearing how small I look and having to explain my situation to people who are not going through this. Thanks for making me feel in a group here. The pictures and stories are so great. Thank you all.

We have a fluid scan tomorrow. Hopefully we'll get more info and a Doppler.

SWA80

Julia, Hope your appointment today goes well, keep us posted! I remember being in tears after Mrs. Alice responded to a post about my situation. It felt so great just to have someone understand what we were going through.

Most people just don't get it and all the comments about how lucky I was to be carrying twins made me crazy.

24karat

@juliaandpete let us know how it goes today! Best wishes and keeping you guys in my thoughts and prayers.

JuliaAndPete

Our scan today was to check for fluids. Their fluid looks good for both babies. We ruled out TTTS. Baby A however still has cord disruption and depending on our growth scan next week we could all be hospitalized. Staying positive and praying everyday. Thanks everyone

Mrs. Alice

I'm glad fluids are stable!  Stay positive!  While hospital bed rest sounds daunting it's really not THAT bad once you get settled. Sometimes it's the very best place to keep those babies safe.

JuliaAndPete

@Mrs. Alice thank you so much for everything.