XP from Multiples: Confused and concerned

Sascha3 · June 2013

Sorry so long. 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.

CNYBride05 · June 2013

Sorry you are feeling anxious.

Our girls have always measured pretty close in size and are now getting a bit further apart. Most recent discordance was 12% or something. I wouldn't worry too much - those measurements are so subjective a d it could be that the tech got a bad angle or something.

I don't have any experience with the rest.

Best of luck with the end of your pregnancy!

NiksMama · June 2013

Fluid in the kidneys is quite common and only VERY rarely is surgery needed. My son was one of those rare cases, so I've been through all the scenarios and what ifs.

In the vast majority of cases, the fluid releases naturally once LO is born, the first time they pee. If your doctor was concerned, he would be sending you to talk to a pediatric urologist. If baby is retaining fluid in her kidney, it is not surprising that her amniotic fluid is low.

Even if it does not self correct when she's born, surgery is not the next step. There is no immediate concern and you'd start working with a urologist to monitor the kidney and run a couple simple tests to determine the cause.

I know how stressful it is when you think there might be something wrong with your baby. Please feel free to PM me if you need to chat more about this. At this point, I would try not to worry. ::hugs::

Sascha3 · June 2013

Niksmama...that is pretty much what he told me so I am trying not to freak out too much, although it is hard to think of your baby possibly having surgery. I am more concerned that I am not having more monitoring, or the 3 week wait to check growth this late in my pregnancy and mostly the fluid levels which he didn't even mention to me, and I only noticed by scouring the report.

I'm sorry that you went through this with your son. I will definitely PM you if I have any further concerns after speaking with him tomorrow. Thank you:)

Courtimilk · June 2013

Positive thoughts and vibes your way honey.

I was 36 weeks when they discovered that LO1 had 5.1 cm of AF. Had it been just 5, I would have had been induced or CS'd within the next 24 hours. Perhaps at 32 weeks you still have time to up the AF levels.

Sascha3 · June 2013

Courtimilk:
Positive thoughts and vibes your way honey.
I was 36 weeks when they discovered that LO1 had 5.1 cm of AF. Had it been just 5, I would have had been induced or CS'd within the next 24 hours. Perhaps at 32 weeks you still have time to up the AF levels.

Wow...that is so concerning. Especially because he never mentioned the fluid and I read it on the report he gave me. I was just told to up my protein for the growth and to lay on my side for 20 minutes of every 2 hours minimum. I will definitely be calling at 8am and getting some answers. Thank you.

Jasmineeelizabeth · June 2013

I have low fluid, it's at a 6.2, one doctor told me that if it stayed the same or dropped lower he would want to induce me at 37 weeks. I talked to my MW and consulted with a different OB at a high risk clinic, they said that as long as the baby is moving, and everything looks good from the NST's and BPP's the risk of induction is higher than the risks associated with low fluid.

I will be monitored more closely for the remainder of my pregnancy and now have a lower threshold for when I choose to go in for reduced movement.

The tests are extremely inaccurate, as are growth scans. I'm guessing it would be even more inaccurate with twins. If you're really worried are you able to get a second opinion?

Jasmineeelizabeth · June 2013

https://www.scienceandsensibility.org/?p=5294

This article may be helpful.

As long as you and your babies are being monitored frequently, you're watching out for movements, and drinking at least 2.5L of water daily, you will be just fine.

Step away from google.

Sascha3 · June 2013

Jasmineeelizabeth:
https://www.scienceandsensibility.org/?p=5294
This article may be helpful.
As long as you and your babies are being monitored frequently, you're watching out for movements, and drinking at least 2.5L of water daily, you will be just fine.
Step away from google.

Thank you so much for this article! Not only is it a great source, but it mentions that there are two different methods to obtaining fluid measurements. The AFI method has the lower parameter listed as 5cm and that is what every single article I read talked about. But the pocket method has a lower parameter of 2cm, so hopefully that is what the report is referring to, and it is not a critical oversight by my doctor! My doctor isn't open yet, but this helped me relax until I am able to hear from him. Still nervous about the other issues but at least they aren't something that needs immediate attention like very low fluid would. Thanks again!

leahaustin · June 2013

I don't have any experience in this but sending many T&Ps your way!

Sascha3 · June 2013

Ok, I got a hold of them.

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. I got them to up my BPP/NST appointments to twice a week.

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.

Thank you for the responses and well wishes!

[Deleted User] · June 2013

I don't have any experience with this but wishing you the best.

Sascha3 · June 2013

dani_brewer:
I've always been confused about the whole growth thing. Why is it that they induce when baby isn't growing as fast as they should. Shouldn't that mean leave them in longer (go to full term) and give them a chance to catch up?

I guess that when the baby isn't getting everything they need on the inside, it is actually safer to deliver them where they can be completely monitored and given everything that they need.

Sascha3 · June 2013

jenny5o5:
I'm a Sono tech and we do not measure fluid levels on multiples in my practice because it is very difficult to measure the 4 quadrants of fluid. The membrane in between the babies more around and causes an inaccurate measurement! If you are really nervous, give your doctor a call

Oh I definitely called! I mentioned in my op that I was waiting for a call back and in my follow up post that I finally got in touch with them. That is similar to what they told me...they just measure a single pocket so the parameters are different. They worry if it is under 2mm rather than 5mm in the traditional measurement method. They said my fluid will be monitored in bi weekly BPP tests.

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