Confused and concerned

Sascha3

My twin pregnancy so far has been text book perfect except for the normal discomfort and some temporary pressure I was feeling.  At my MFM yesterday I was given some information that has me confused and upset.

First I was told the babies are starting to measure small since my appontment last month.  I am 32 weeks.  Baby A is 3lb12oz and is in the 16%.  Baby B is 3lb9oz and in the 9%.  I was told that if my next growth scan in 3 weeks shows B getting any smaller they will likely take them that week (35-36 weeks).  He initially said 4 weeks, which is one week before my Dr wanted to deliver anyways (he delivers at 37 weeks) so I asked if that was too long and he switched to 3 weeks.  We will have weekly NST scans in between, which confuses me because I had NST twice weekly with my last daughter even though I had no issue besides maternal age.  To add further to my confusion I have a friend with my due date whose baby measured 3lb14oz Monday and was told he was in the 47%.  2 oz shouldn't cause it to go from 16% to 47%.  Why would our doctors charts be so different?

Second, he mentioned that Baby B still had extra fluid in her right kidney, measuring 9mm. I was shocked, and he said, oh I didn't tell you last month? No, you definitely never mentioned that...you kept telling me they looked perfect. Now he is telling me there is a 5% chance she will need surgery to drain the fluid. It is called pyelectasis.  Not a huge deal, but highly upsetting to hear as a mother, especially when I was told everything was fine.

Third, he sent me home with the report from my scan yesterday which I scoured.  It says my amniotic fluid with A is 5cm and normal and B is 3cm and it does not say normal next to it.  I went online and saw that 5cm is the minimum they like to see and anything less is bad.  He never said a word about it yesterday and now I am wondering if he forgot, like he forgot to mention the fluid in the kidney.  Is anyone familiar with low fluid at this point in pregnancy?  I saw online that women were admitted to hospital bedrest for it so now I have myself all worked up about it.

I felt good about my care until yesterday, now I am confused and wondering if I am being monitored enough. I called my doctor within 5 minutes of them opening today and he never called me back. I called again at the end of the day and the office was already closed. My normal OB is out of town for 2 weeks. So I am feeling anxious and curious if others had similar experiences. 

aliwisewoman

That is very concerning. I would be calling again tomorrow and demanding a call from the doctor. I have a hard time being firm with a doc, but I just try to be straight to the point and not afraid to say something stupid. We pay so much money for insurance. It is the docs job to make sure everything is okay and that we are informed. I hope you get some answers soon and that everything is okay.

octbride1234

So sorry you are going through this.  I don't blame you for feeling upset, I would too.  I agree with the OP and would keep calling the doctor until they call you back.  I am not a doctor but I don't find their weight to be that behind.  When I had my first set of twins at 34 weeks one weighed 4.1  and the other 5.6.   With this pregnancy at my last ultrasound when I was 32 weeks one was weighing almost 4 pounds and the other was close to 4 & 1/2 pounds.   My understanding is that the important thing is that they keep gaining weight.  One of my babies only has one kidney which is a little larger since it is working for two.  I would really encourage you to call a Children's hospital and get an appointment with a specialist asap.  They will review your case and tell you if anything needs to be done.  I know that they want to closely monitor their kidneys during each ultrasound, sometimes wanting to see them after they are born as well.  Some time surgery is required or even an antibiotic before being born.  I don't know too much about it but I know some issues can also cause problems with low fluid and I believe you mentioned that in your post with this baby.  It is so important to watch them closely and make sure that one or both kidneys are working properly.  You will also need to watch for UTI and make sure they are producing enough wet diapers when they arrive. 

This is just some info I got on our LO that I thought I would share with you and hope it helps... good luck.

PurrCrasher

I'm sorry you're going through this! I wish I had more information to give you on how those weights fall in terms of percentiles but I don't. I wish I had kept track of what my babies were measuring at various times.

As far as the lack of communication I find that very concerning. Have you considered getting a referral to an MFM? It seems like you would benefit from someone with a little more expertise especially if there is concern for low fluid levels and potential kidney issues. Perhaps your OB doesn't have much experience with high risk pregnancies like twins. I guess that would be my only advice for you. Be proactive, advocate for yourself and your babies. Get a second opinion.

Good luck, sister.

Sascha3

Thank you guys for the information.  I am making a list of questions to ask when I call again tomorrow.  I was so shocked yesterday that I couldn't think straight.  Of course I had a million questions come up last night that I didn't get answered today.

PurrCrasher...this actually was my MFM!  Up until yesterday he has been extremely informative, talkative and always answers any and all questions that I have.  I actually prefer him to my OB who is much quicker and doesn't say too much.  But until yesterday, I had never heard that the twins had a single thing wrong.  My OB is out of town for 2 weeks so I can't even get his opinion.  If this was earlier in the game I would consider switching doctors but I am only a little over 4 weeks away from delivering, since my Dr likes to deliver at 37 weeks, and my MFM agreed that after yesterday he wants me to go no longer than 37 weeks either.

PurrCrasher

Sascha3:

Thank you guys for the information.  I am making a list of questions to ask when I call again tomorrow.  I was so shocked yesterday that I couldn't think straight.  Of course I had a million questions come up last night that I didn't get answered today.

PurrCrasher...this actually was my MFM!  Up until yesterday he has been extremely informative, talkative and always answers any and all questions that I have.  I actually prefer him to my OB who is much quicker and doesn't say too much.  But until yesterday, I had never heard that the twins had a single thing wrong.  My OB is out of town for 2 weeks so I can't even get his opinion.  If this was earlier in the game I would consider switching doctors but I am only a little over 4 weeks away from delivering, since my Dr likes to deliver at 37 weeks, and my MFM agreed that after yesterday he wants me to go no longer than 37 weeks either.

It even said MFM in your original post. Sorry, I obviously need some sleep! That is so strange. I hope that he calls you back tomorrow and you can get some answers. I would be so frustrated. Good luck to you!

Sascha3

PurrCrasher:

Sascha3:

Thank you guys for the information.  I am making a list of questions to ask when I call again tomorrow.  I was so shocked yesterday that I couldn't think straight.  Of course I had a million questions come up last night that I didn't get answered today.

PurrCrasher...this actually was my MFM!  Up until yesterday he has been extremely informative, talkative and always answers any and all questions that I have.  I actually prefer him to my OB who is much quicker and doesn't say too much.  But until yesterday, I had never heard that the twins had a single thing wrong.  My OB is out of town for 2 weeks so I can't even get his opinion.  If this was earlier in the game I would consider switching doctors but I am only a little over 4 weeks away from delivering, since my Dr likes to deliver at 37 weeks, and my MFM agreed that after yesterday he wants me to go no longer than 37 weeks either.

It even said MFM in your original post. Sorry, I obviously need some sleep! That is so strange. I hope that he calls you back tomorrow and you can get some answers. I would be so frustrated. Good luck to you!

Aww, haha, it's ok! Thank you and I will update when I hear from him:)

kellibelle0417

Sacha, I'm so sorry you are so concerned! Please do update us. 

I am now having an ultrasound 1x/week and NST 2x/week (Tuesdays and Fridays). Yesterday was my first NST and also a growth scan. They are going to remeasure my boy next week because they couldn't get a good shot of his head measurement. His fluid level also seemed a little low, but I guess he had a good size pocket. Not sure what that means. Our girl estimates 4.5. Our boy 4.3, but he has always been bigger. So, I'm thinking the measurement may have been off which is why I'm having his measurements done again. This is all a bit stressful.

Also, on my NST I was having contractions every 6 minutes. But, I couldn't feel them. My cervix is still closed. They consulted with MFM and they aren't concerned since the contractions aren't causing active labor. We will see what happens on Fridays NST.

I will be thinking about you!! 

katiebenes

That's so strange that they didn't talk this over with you better! T&P

staceymack

I'm sorry you're having to go through all of this. I hope you get better answers today. My girls fluid levels are measured twice a week. I've always been told as long as it's 3 or above it's fine. Baby B has had many appointments when her fluid levels are right at 3, and she's been doing well. 

Sascha3

So someone on another board sent me a link to an article about fluid levels and I guess there are two different methods to measuring, so if they used the pocket method only, which kellibelle mentioned, then I am within a normal range.  So I feel relieved, as every article I saw only mentioned the AFI method which has the parameters I mentioned.  Still worried about the rest, but a big relief if my fluid is indeed ok!  I am west coast so the Dr isn't open yet, but hopefully he will confirm that soon:)

Sascha3

Ok, I got a hold of them.  The doctor is at the hospital today but I had a nurse stay on the phone with me for 20 minutes answering questions.  And I will have more for him when I see him Monday.

The growth is their main concern. The percentages are low because they are based not just on weight but ratios. I mistyped...A is actually the smaller one, and the one with the kidney issue is bigger. A is in a survival mode right now where her growth is directed to her head and her body and limbs are small. Hence, the 9%. B is small but proportionate. She said A will be born skinny but will plump up after. But we need to watch her closely to make sure she isn't having any distress. And I need to eat as much as I can, especially protein and lay down as much as possible (not easy with a 17 month old, haha)   I got them to up my BPP/NST to twice a week, so I have much more peace of mind with that.

As far as the fluid, they use a different measurement for twins, so 5cm is not the benchmark. It is not wonderful, but not dangerous at this point. If I go below a 2, I would be admitted. B is at 3cm right now. My fluid will be checked at the twice weekly BPP.

The kidney issue is the same as I was told, that is what we mostly talked about in the office. I just have to wait and see and hope the odds are with me that it resolves itself at birth.

Strudel, he did do a doppler of their cords Tuesday and said they looked great.  I will definitely ask Monday if that is to be done with each BPP and make sure that it is done.  Thank you for that.

Thank you for the responses and well wishes!

staceymack

Thank you for the update. I'm glad you got some answers. I started adding protein shakes in addition to my meals and snacks. Drinks like Boost and ensure just run right through me. I'm doing better with the Naked brand protein drink, and my favorite is Odawalla mango protein drink. This wasn't any recommendation by my doctors, but found it on the twin to twin syndrome foundation website. I figured it couldn't hurt. Your LO's will be in my prayers. 

kellibelle0417

I'm so glad you got some answers!! Thinking about you and those babies!

google123

Sorry ou are finding all this out now.  The kidney issue is something that you need to be aware of as baby might need surgery after delivery.  My coworker had this with her twins, baby had surgery after birth, and then at 9m.  So you should consult with a pediatric nephrologist or neonatal nephrologist if they have one.

 

i don't know what normal fluid is at this stage, but if you are low, you should immediately drink more water (if you aren't hitting that 80oz) per day.