Twins measuring small...

snoangel79 · December 2011

So on top of some cardiac issues that will force me to deliver before 35 weeks (she want's me to at least get to 28) which should be good (knock wood). Anyways, my two are measuring on the small side (25.2 weeks today, one is 1lb 7 oz, the other 1lb 9oz) I'm eating a ton also!! Anyone have any reassuring advice? My high risk doctor will be doing the next U/S in two weeks.

tootlebug · December 2011

first of all let's alert Dr. Lukes ; )

those sizes dont seem that small to me though....i-am-pregnant.com, which im sure isnt the most credible website albeit, not the worst, indicates that at 25 weeks the baby weights about 1 1/2 pounds....which is right where you are. perhaps it's possible they just grew a little more slowly this time around but will have a growth spurt? did the u/s tech tell you this? what percentiles are they in? im not a doctor obviously but they dont seem that small...and cant there be some fluctuations as well in terms of percentiles every few weeks?

snoangel79 · December 2011

It doesn't make sense because according to even Dr. Lukes book they are close to normal. The girl is measuring in the 5th and the boy in the 12th, normal fluids levels, obviously di-di. I'm not too smart on this and I do not know what BPD (little c) and BPD mean but Baby A the bigger one has a BPD (lil c)- 25.3 GA, and BPD of 26.0GA, FL- 24.4, Baby B BPD (lil c)24.4, BPD 23.9 FL 24.4. I have no idea what these mean!! Even when I look at What to expect it says they should weight around 1lb and 1/2-2 lbs entering week 26 and they fall right in there!!

tootlebug · December 2011

so did the tech tell you they were measuring small, or the OB? or are you just going off of those weird letters with the gestational ages (that's what im assuming GA means) behind them?

snoangel79 · December 2011

My OB told me and put IUGR in my chart for the girl. The tech told me they were smaller also. The boy is still in the really low normal according to everything I read being in the 12th precentile! For her it says 679gms +_115gms, and for him it says718gms +- 122gms so with that input it seems they are figuring the grams minus the number above (which would be lowest possible weight they are at this point I think) and also considering abdomen measurements which look a little smaller then the week they are in. If I put those numbers in 679 and 718 without the - number they seem normal range.... I guess I need more protein?? With everything that is going on with my heart also I just hope they will be almost 3lbs or more when they come out...

Edited to add: She asked me if I was a small baby and I wasn't but I think she keeps forgetting these two are donor egg. Even though my husband is a big guy 5'11", 215lbs. Our donor was tiny 5'2" 105lbs. So maybe this also plays into it all.

tootlebug · December 2011

ok not gonna lie - you lost me on some of the number speak.

but im sure the genetics of your donor plays a huge role in this!!! this was kind of my point in earlier posts about weight gain.....sometimes it just comes down to genetics.

maybe try and get in to see your MFM earlier? or give your MFMa call and ask for further clarification?

jcath · December 2011

snoangel79:
Even though my husband is a big guy 5'11", 215lbs. Our donor was tiny 5'2" 105lbs. So maybe this also plays into it all.

I think that could totally play into. Birthweight is somewhat genetic. I wished that birthweight had been in our donor information. Sounds like they are being very cautious which isn't a bad thing.

I do think foucsing on eating lots of protein - cottage cheese, protein shakes, put cheese on everything - helped me.

snoangel79 · December 2011

tootlebug:
ok not gonna lie - you lost me on some of the number speak.
but im sure the genetics of your donor plays a huge role in this!!! this was kind of my point in earlier posts about weight gain.....sometimes it just comes down to genetics.
maybe try and get in to see your MFM earlier? or give your MFMa call and ask for further clarification?

Yeah sorry for going on! hahaha I'm all over the place. This is my MFM btw. I don't have an OB anymore because he broke up with me when I had my lung collapse at 14 w. So she is taking care of me well and hopefully these two will grow in the next two weeks!

Jcath- I plan on eating a whole chicken tonight... <:

Mrs. Alice · December 2011

My twin A was being watched for IUGR from 22 weeks. They were mo/di and thought to have mild TTTS as well. Any how, he started having intermittent absent end diastolic cord flow (big fancy word for, the blood wasn't flowing well through his umbilical cord) at 24 weeks. His estimate at 26 weeks was 1lb 8oz, I think right around 10th %. We were trying to get past 28 weeks and fortunately we did. The MFM decided it was time to deliver when twin A's cord flow got so bad it was in reverse and he dropped to 7th %. He was larger than expected at 2 lbs when he was born, about 20% smaller than his brother.

I would ask if they are doing cord dopplers on the u/s and when you should start NSTs. I started drinking boost/ensure and a high protein diet. Also resting most of the day and lying on my side to improve blood flow to the uterus.

deutschefairy · December 2011

I just had my u/s at 25w5d and mine measured 1lb, 15 oz, and 1lb, 11 oz so not that far off. My MFM seemed to think those sizes were good so I would try not to worry too much. Just keep eating FWIW, my MFM doesn't even have me coming back for another growth u/s for another 4 weeks. I see OB in 2, but only for a cervix check (and regular check-in).

I, too, have heart issues, but hopefully won't have to deliver early because of them. Our boy has velementous cord insertion, which could cause us to deliver early though. I've started feeling like I should be eating more lately also.

Fancy3Face · December 2011

I replied on your PAIF thread on accident. Woops!

JenLC99 · December 2011

You DEFINITELY have to take the donor's size into account! Birth weight is highly genetic, in my experience. I weighed 10 lbs 6 oz at birth and my younger brother was 10 lbs 15 oz. As an adult I am 6'1" and let's just say I'm not petite. DH and I used donor sperm due to azoospermia as a result of XXY (though he does not have Klinefelter's, just the extra X). Our donor was 6'3" and between 190-210 lbs; our first DD was born at 37w6d (induced labor) and weighed 9 lbs 2 oz, and our second DD was a whopping 10 lbs 15 oz at 39w6d (spontaneous labor). Our twins started measuring ahead right around 7.5 weeks and have been gaining ever since; at 13.7 weeks they were measuring 14.4 weeks. Genetics account for a LOT!

tootlebug · December 2011

LGLDVM:

I would call and ask for more information. My understanding (which is limited) is that BPD is biparietal diameter (basically the distance from one side of the skull to the other). It is only one way of measuring gestational age. My MFM told me that it alone is not the best measurement later in pregnancy. I'm honestly not sure what 'later' means though (third tri maybe?). I would think that they would have done other measurements for growth like head circumference (that could be the BPD(c) if they calculate a circumference from the diameter, but I'm honestly not sure), abdominal circumference, length of one femur and one humerus. Generally all of this should be compared for any discordance in growth and then averaged to get an idea of baby size.

Regardless, your babies don't seem that small if the GAs were all within a week of your actual gestation. One of my babies was measuring 2 weeks behind at 24 weeks and they calculated her in the 18th percentile. I would push for more information, particularly if they are talking about IUGR and early delivery as a result. Good luck and keep us posted. None of this is ever simple, right?!

ETA: I just went back and reread. They did do a femoral length (that's the FL) measurement. Honestly, seeing those numbers does not freak me out. I know when I went in at ~24 weeks, the doc I had scared me a bit and wanted me back in 3 weeks for a recheck and at the recheck the babies were both growing well, even though Scrappy is still behind. I think progress is more important that the actual percentages. But again, I would check with your MFM for some reassurance.

this is right here is so helpful and informative, it should be pasted into the Multiples page for further clarification re: the 20 week u/s. i had my "20" week u/s at 21w2d and noticed that some of the head stuff for one twin measured between 20w4d-20w6d and the abdomen was around 21 weeks and the femoral length was 21 weeks and 21w2 days respectively. i was kind of wondering why some of the measurements were in the 20s but just figured that not everything is going to be right at my GA age.....and they were good sized babies for where i was at and the MFM said that they both looked great.

missfire · December 2011

One of my babies was IUGR and weighed less than 1% when she was born, and she is a chubby healthy baby now. She had a velamentous cord insertion also, but they didnt know until the placenta pathology was done after they were born. I ate a ton of protein and never saw her percentage go up, always down. But everything else in her BPPs always looked great. She did practice breaths early, had great heart rates and movement, etc.

snoangel79 · December 2011

missfire:
One of my babies was IUGR and weighed less than 1% when she was born, and she is a chubby healthy baby now. She had a velamentous cord insertion also, but they didnt know until the placenta pathology was done after they were born. I ate a ton of protein and never saw her percentage go up, always down. But everything else in her BPPs always looked great. She did practice breaths early, had great heart rates and movement, etc.

Thank you very much!! I am just so scared that keeping them in especially her will cause more harm. Considering they have no health issues. This is either a cord/placenta issue or my health issues affecting them, or even the size of the donor. This has only been going on for a few weeks so I'm hoping either in the next few weeks this will stay stable or get better! So I can hold them in for at least another month!! I will be asking about steroid shots and also they are doing a doppler cord study in less than 2 weeks. Other than that I just need to keep eating really health high protein, calcium and hope it makes a difference!!

It's calming to me that your lil one and other LO's in this type of situation are thriving now!! This is really what I've needed to hear as the internet (google) is making things worse for me...

erinruns · December 2011

I was monitored for IUGR/TTTS as well. From what I remember, anything under the 10% is considered small. I would agree that you should ask for doppler readings since those will tell you if there are cord flow issues.

When I delivered at 31w6d, my littlest one's belly was measuring 25 weeks. When they are growth restricted, their belly shows it the most. If all of their measurements are consistent, the baby may just be small, but if there are inconsistencies there may be issues.

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