One modi twin is smaller than the other.

JuliaAndPete · October 2013

It's no secret on here that I am suspicious of most doctors.

Went to the MFM for the first time yesterday. The doctor told me that he was mildly concerned about baby A being significantly smaller (visually not just by measurement) than baby B. I am 19wks1day. Baby B measures @ 19wks3days. Baby A measures @ 18weeks0days

He feels better because:

1) "A" has been smaller since day 1 and nothing has changed about how she measures in comparison to baby B. In other words they grow at the same rate.

2) The fluids around them are totally fine. Also blood flow through their chords are normal.

3) A is not too small she's just smaller than her sister. And her first anatomy scan came back completely healthy. They see no problems.

His concern also includes the fact that A's chord connects to the left side of the placenta and this could cause TTTS.

He explained that TTTS is a four stage condition and he wouldn't even put us at Stage one at this point.

Oh also I have placenta previa, which a technician at my regular OB told me I didn't have so MFM dr said he'll look again next week before diagnosing me with that definitely. Now I'm scheduled for monitoring almost every week.

Does anyone have experience with this? I don't know what to think or do.

somewhereincali · October 2013

it sounds like your doctor is pretty thoughtful about the risks and reasoning as to what is going on, with a clear plan for monitoring.
what are you wondering about? are you not happy with the plan? I know its scary when there are unknows with our babies, but in my experience the very best thing is a doctor who is honest about these unknowns and does their best to look at all the evidence to decide on a treatment/monitoring plan which it sounds like your dr is doing

Mrs. Alice · October 2013

My twins had stage I TTTS and discordant growth. We didn't know until 22 weeks though. One was always just a little smaller from the beginning but it wasn't enough to worry about. Typically it becomes a cause for concern when the discordance is 20% or greater and/or one twin measures below 10th percentile (that's IUGR). I would ask for babies estimated weight in grams and their percentile for gestational age at each growth u/s. My smaller twin had marginal cord insertion too which is not uncommon with twins. Sometimes it can cause problems and sometimes it's fine. The cord insertion is not a cause of TTTS, that's from abnormal connecting vessels between twins in the placenta. It's usually diagnosed when fluid levels are at least 10 and 2. Glad to hear your under close monitoring and I hope things improve. I'd be happy to help if you have other questions.

JuliaAndPete · October 2013

I'm ok with the plan I just want to know where this is headed. Is this very common? What are the chances it can turn into TTTS? What can we do about it? How do they treat?

He wouldn't answer me because we had already been there for 3 hours. And I think he didn't want to freak me out in an uncessesary way. I told him I wouldn't and I just want to know.

kiwi443 · October 2013

It sounds like your doctor is proactive and aware of the risks of TTTS. Not every doctor is, so that's a plus for you. I believe the occurrence of TTTS is 10-15% in mo/di multiples (not exactly sure on that statistic). There is no way to prevent it, but you can educate yourself on the warning signs. Frequent monitoring is very important. This is a good website to check out:

https://www.tttsfoundation.org/

jezebel57 · October 2013

i would ask for the weight in grams of both the babies and take it from there. i have mono/di twins also (at 24 weeks 1 day today). see what the percentage of discordance is. i've read anything over 15-20% discordance could be worrisome and worth more monitoring. good luck!

Topanga · October 2013

I've got discordant growth on my mo/di twins from the beginning. I have been monitored every 2 weeks since 8 weeks. They keep telling me everything looks good but then in trade monitoring. Today they were 17% discordant. So I hope they continue to grow and do well. I think baby A is just smaller.

Mrs. Alice · October 2013

I don't think there's any reason to freak out yet. Try your best to trust the experts but also ask questions until you understand. I've done lots of my own research about mo/di and ttts pregnancies after I went through it. While it was happening I was too afraid to look much up and I felt very alone. My MFM said he sees about 1 or 2 cases like mine per year. Discordant growth between mo/di twins doesn't always lead to ttts, sometimes one twin ends up with a larger placental share. However both can occur simultaneously so they should monitor as such. If you have ttts they will likely send you to a specialist to evaluate you for surgery to ablate the abnormal vessels between the twins. I didn't do surgery because the fluid levels improved with bed rest. I did have to be admitted to the hospital at 24 weeks for monitoring because they were very worried about the smaller twin and his blood flow.

raraavis28 · October 2013

My mo/di twins also had a growth discordance and hovered around 20% from about 15 weeks on. I had biweekly scans to check growth, fluid levels, and cord blood flow. They never developed TTTS, but once their growth difference surpassed 20% the MFM ordered my Csection (I was 35 1/2 weeks at this point, so it was a much safer option to get them out than keep them in). My Baby B is still quite a bit smaller than his brother, but they have both been healthy and growing consistently since birth.

It sounds like you are in good hands w/ your MFM. The most important thing at this point is that you are monitored frequently. It can be nerve-wracking, but it's also nice to know exactly what's going on with your babies. T&P that everything continues to be fine and that the worst part is just the annoyance of all the doctor visits!

JuliaAndPete · October 2013

Thank you. Starting to feel a bit better about this situation. I'm just a nervous pregnant lady.

SWA80 · October 2013

Lots of great advice here! One of my boys had IUGR, ultimately causing me to have a c-section at 33 weeks 4 days. Sounds like your Dr is monitoring fluid levels and cord flow-both are very important. Try to enjoy your pregnancy as much as possible and not worry too much. Hopefully you won't have a reason to!

babywillmake3 · October 2013

I'm in the same boat. Was going to post about it. At 20w we have Twin A 25% behind B. Even though A is within a safe range for their gestational age because B is bigger that is cause for concern. We don't qualify for TTTS or IUGR because everything else looks good. Bladder, fluid is fine. My MFM said just because they are did ordinate doesn't mean they are IUGR or TTTS, we keep an eye on them knowing we are at risk but are not doomed for a diagnosis. If they keep holding their own and stay at 25% and below but keep growing and everything else looks good we won't get a diagnosis. I'm getting monitored weekly now as of today whereas before it was every two weeks.

JuliaAndPete · October 2013

@babywillmake3 how do you deal with all this monitoring? It's very overwhelming. We have SO much going on. We're moving in two weeks and I haven't even tried to fathom registering for stuff. I don't know how I'm going to do this.

babywillmake3 · October 2013

@JuliaandPete I have a fantastic boss who has been supportive. My appts are at 7am every Friday so I'm missing as little work as possible. That is one of my biggest concerns right now. I work FT and long term disability is not an option.

As far as the actual appts are concerned, the every other week ones didn't take a toll. It was nice for my sanity. The fluid and bladder checks were a quick and I was on to work with a stop for breakfast

the weekly ones.. And the roller coaster ride of that might make me batty. Ask me again in 3 weeks

jcath · October 2013

My MFM was very concerned about the possibility of TTTS at my AS. I can't remember the girls weights but they were off, fluid was low and there was concern about blood flow to baby B. Everything turned out fine - in fact my girls both weighed 6lbs 12 oz at birth. Focus on getting lots of water and protein and get as much rest as possible.

Jenyoung5 · October 2013

Thanks ladies for all your comments. I just found this forum. I am 22w5 days with mono/di boys with a 25% discordance in growth. I am seeing a specialist weekly to watch for ttts and if my appt looks good tomorrow I will go t

Jenyoung5 · October 2013

I go to every two weeks. I've read that rest and lots of protein help with preventing ttts and weight discordance, but has anyone been told how much rest and how much protein? I am already on a gd diet and so all I can really eat is protein and veggies with very little carbs. I am just hoping the weight difference evens out. It is very stressful for me!

babywillmake3 · October 2013

@Jenyoung5 I am 22w with mo/di twins with a 25% discordance in growth as well. Welcome!

marcobonny · October 2013

I'm pregnant with twin girls, and we didn't find out until I was 16 weeks into the pregnancy. We were planning on a home birth as this is my third pregnancy. But we had to know the gender, so we found out we're having 2 girls at our elective ultrasound! At that point the babies had their own sacs but we couldn't find a dividing line in the placenta. Also the girls were measuring about a week apart. My midwife told me to increase my protein to 125g-150g of protein everyday. And really listen to my body about rest, if you're tired take a nap. Just had a diagnostic ultrasound this past Thursday (23 weeks) and now the girls are only measuring at a few days difference. I'm assuming the protein intake helped! And we still don't know if they are fraternal or identical. My OB is def keeping an eye out for TTTS as well just in case. Good luck!!

JuliaAndPete · October 2013

Oh boy. Protein you say? I have not heard this from my doctor. This is a tough one for me because I'm a strict vegetarian. I do a lot of eggs, dairy, nuts, and beans. But I do not eat meat of any kind. Not even fish. I'm going to have to ask the doctor about this.

Mrs. Alice · October 2013

For TTTS it's been studied that drinking 2-3 boost or ensure shakes throughout the day is beneficial. I'm also not a big meat eater and don't eat red meat nor do I like eggs. I really had to try hard to get enough protein in. I wish I had known about Greek yogurt. The full fat kind would have been awesome since it has lots of protein. That's what I feed my kids in hopes to fatten them up!

JuliaAndPete · October 2013

Yes I'm huge into yogurt the plain full fat kind. It's not Greek but a kfier cheese yogurt it's called. I'll have to start back on the protein shakes. Still haven't gained any weight either. Really gotta work on this. Thanks everyone!

staceymack · October 2013

I don't have time to read all the great responses so forgive me if I overlap. It sounds like your perinatologist is on top of things. There is no way to know where this is heading. You just have to take it appointment by appointment. I know that is very difficult to do. You can drive yourself crazy with the what if's. My baby B was always a week or more behind, as well as less fluid. They monitor us closely and thought at one point we would need sugery to fix possible TTTS. Thankfully, we did not. I did not want to know anymore info than necessary at the time because I didn't want to dwell on scary treatments. B kept up for her normal. She barely stayed above the growth curve, but she did stay above it. Their fluids also leveled out around 31 weeks or so. They ended up coming at 33/4 because I went into labor due to pregnancy induced hypertension. They both were bigger than everyone expeted. It is very scary, and I'm sorry you have to go through this.

SWA80 · October 2013

Mrs. Alice said:
For TTTS it's been studied that drinking 2-3 boost or ensure shakes throughout the day is beneficial. I'm also not a big meat eater and don't eat red meat nor do I like eggs. I really had to try hard to get enough protein in. I wish I had known about Greek yogurt. The full fat kind would have been awesome since it has lots of protein. That's what I feed my kids in hopes to fatten them up!

I ate tons of full fat Greek and it is heaven! I switched to 2% when my weight gain began to concern. I feel a little sad that I will never again be able to justify eating the stuff

Also the Bolthouse protein drinks are great.

kgs0505 · October 2013

If the fluids are good, don't worry about TTTS.

That is Stage 1 - when the donor's fluid (most vertical pocket measurement) is less than 2, and the recipient's is greater than 8. My twins had TTTS. It only happens in 10% of identicals. So not very often. We ended up having surgery to correct, which was successful. Not sure about cord placement being an indicator, that's the first I heard of it. TTTS has to do with shared blood flow within the placenta. ID's share blood vessels. Most of the time (90%), they figure out the balance. 10% of the time, they don't, and one tends to give it all up (donor), and the other takes it (recipient). It's good for neither. At any rate, TTTS would see grow discordance along with the issues in fluid, lack of a visible bladder (Stage 2), and cord flow issues (Stage 3). And let's just not discuss Stage 4. My girls didn't really show any growth discordance before surgery. The donor just started to slip behind the recipient when we had surgery, and she was only 3 oz less than her sister at birth (5.1 and 4.14).

BTW, my surgeon said that all the protein drinks in the world wouldn't correct a chronic TTTS like I had. Protein is definitely important, but don't kill yourself over it. I tried upping my protein too, and it didn't make one iota of difference.

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