Update! prenatal care for twins, how is it different?

12bailey18 · May 2014

I mentioned in my intro post that our twins were discovered at 17 weeks at an elective ultrasound in town. I called my doctor's office today to let them know and to schedule an appointment. They can't get me in until 20 weeks but I do have my anatomy scan and OB appointment both scheduled for that week. Because I can only see OB's now and not the midwives who also rotate they weren't able to squeeze me in sooner.

I guess my question is, have I missed much as far as twin prenatal care goes? I'd love to get everything looked at today but I know that's not possible, LOL. I just don't want to feel like I'm behind in my prenatal care. How are appointments for twins different? Or have I really not missed much? We did get to hear the two heartbeats and see them on ultrasound at the elective ultrasound so that does ease my mind.

Thank you! And I hope this post makes sense, LOL.

Update: I called the office back this morning and was a little more....assertive

And they're getting me in today with the on-call doctor and the ultrasound tech! Thank you guys so much for all the feedback. It really wasn't sitting with me well having to wait 3 weeks to find out anything. I appreciate all of the info and advice.

24karat · May 2014

In many cases it doesn't vary too much prior to 2nd Tri and, believe it or not, it's not uncommon to not find out twins till th a/s. A lot of the care depends on the type of twins you're having and if you were already high risk. Di-dis are the lowest risk and seem to be treated similar to a singleton early on. Mo-dis and mo-mos are riskier so, depending on the OB, you will likely have more appointments. Mine are mo-di so we had appointments every two or three weeks for the first 20wks, then multiple weekly appts for the rest of my pregnancy.

Expect to have more u/s, NSTs, cervical checks, BPPs, and earlier GD testing once you hit 20-24wks. That's when the monitoring steps up. If you have mo-di/mo-mo twins you'll feel like you basically live at your doctor's office in 3rd Tri. You should also be offered an MFM consult sooner rather than later.

shaunah816 · May 2014

Do you know what type of twins you're having? Mo/di (meaning only one placenta) or di/di (meaning two placentas)? If mo/di, I would be banging down the door to get in ASAP, because the doctor should be making sure there aren't any growth issues due to the babies sharing a placenta (just in case). If di/di, there are fewer worries. I didn't find my twins until my a/s at 20 weeks, and because they were di/di it wasn't a big deal. I was also seeing a midwife up to that point, and they started rotating me in with an OB after that (so I'd see my midwife on our regular check up schedule, and then see my OB in between those visits). After 32 weeks (I think it was) I only saw my OB, since we were in the home stretch before delivery. You'll get more ultrasounds and growth checks with twins, just to make sure everyone's doing OK in there. I went to weekly visits at 34 weeks (instead of 36 weeks with a singleton).

Congratulations on your little bundles!!

carrotcake06 · May 2014

PP covered it. A multiple pg is similar to a singleton in the beginning. If yours are mono/di (id that share a placenta), increased monitoring starts sooner than if you have di/di (two placentas). That would be my only concern in weeks 17-20.

Other than that, increased monitoring will ramp up in the 3rd tri.

Congrats!

lynnyrd80 · May 2014

I have my OB appointments on the regular schedule. The only difference I had was ultrasounds with my MFM every 4 weeks until I hit 32 weeks, then it will be weekly. I have di/di twins.

2momsinCA · May 2014

I second everything everyone has said so far. It all depends on if your twins are mono or di. I have di/di twins, I'm 24 weeks and so far I've only seen the MFM (high risk doctor) 3 times. Two of those times had nothing to do with them being twins- the nuchal translucency scan and an anatomy scan. He said if my twins were mono/mono or mono/di then he would have been seeing us every 2 weeks starting when the twins were identified at my initial 7 week ultrasound. There are just more complications that can arise from mono twins. Like everyone says, if your twins are di/di the big difference is more in the third tri where I've been told I'm going to have more growth scans and lots of non-stress tests.

Congrats on your twins!

12bailey18 · May 2014

Thank you, everyone for the helpful information! We have no idea what kind they are. The tech was pretty certain they were fraternal but since she's technically not a medical professional she couldn't really tell us much more than that. So, we are left pretty clueless at this point!

MrsP419 · May 2014

12bailey18 said:
Thank you, everyone for the helpful information! We have no idea what kind they are. The tech was pretty certain they were fraternal but since she's technically not a medical professional she couldn't really tell us much more than that. So, we are left pretty clueless at this point!

If she was pretty sure they are fraternal, that means she most likely thought she saw a membrane and a division of placentas, which would mean di-di (lowest risk). But without being officially sure, I would be bugging your ob to either bring you in for a non-elective u/s to determine type, or to refer you to an MFM. It is really essential to your care to know for certain what kind of twins they are. If for some reason the elective tech you saw was mistaken and they are identical, there are more risks and should be monitored more closely.

24karat · May 2014

12bailey18 said:
Thank you, everyone for the helpful information! We have no idea what kind they are. The tech was pretty certain they were fraternal but since she's technically not a medical professional she couldn't really tell us much more than that. So, we are left pretty clueless at this point!

Do you have a pic with both in it? We're not medical pros, but most of us have seen so many twin u/s that we might be able to give you a guess depending on how clear the pic is.

Manada · May 2014

What the PP said

I'm having di/di twins, and the low-key approach of our MW was actually a bit worrisome to us at first (having come from a fertility clinic where they were all over us for tons of procedures). We've gotten used to it though. For us we graduated our fertility clinic at 12 weeks, and will have a MW appt and ultrasound this week (15 weeks), will see them again in 3 weeks to a month, and will also start seeing the MFM/Twin-Specialist sometime in the next month, and I assume he will follow us in addition to the MW until we hit about 33 weeks. After that the MW will be the primary care provider until we deliver, unless we have to transfer care for the birth.

12bailey18 · May 2014

I called the nurses line to let them know and to see what they thought. I figure the receptionist may not really know. She's putting in a message to the providers to contact me about if I need to get in sooner than 3 weeks. Yes! I have a 3D ultrasound pic and a 2D. Let me see if I know how to post them, LOL.

12bailey18 · May 2014

I got it! So, what do you think?

photo b0151dd0-82a5-4169-8597-551469ef12e4.jpg

photo cffcd856-8a70-4167-a7ae-eab255bd9405.jpg

Rannndi · May 2014

Ummm....if that's their heads in the bottom ultrasound picture, my guess would be mo/mo (MAYBE mo/di)...I'm not seeing any way a membrane could be in there to make them mo/di. They just look VERY close. I'm also not seeing ANY space that would make me think they have their own placentas (di/di). Again, NOT a medical professional and I'm honestly not able to see the picture very well.

However, I would be calling an MFM. I'm having mono/di girls and starting at 16 weeks, they've seen me every single week for cervical length checks and amniotic fluid measurements. The risk of Twin-Twin Transfusion Syndrome is greatest during weeks 16-24, and that's why they need to measure amniotic fluids to ensure they're close to equal. We actually had several concerns discovered between weeks 16-20, so I'd be looking into that.

Like PP said, I wouldn't worry because many aren't discovered until the A/S, but now that you know, I'd be looking into your care more.

24karat · May 2014

The angle of those pics makes them look more like mo-di or mo-mo (that means identical, not fraternal). It could just be the angle, but those pics aren't clear enough to tell for sure and it' entirely possible the tech saw something more obvious (2 distinctly separate gestation sacs, the black areas) that wasn't captured in these pics.

I would push to be seen earlier (can they schedule a separate u/s with a follow up appointment with the midwife? I wasn't forced to switch from midwives but every practice is different) just to be on the safe side. If they don't have an appointment open, ask to be put on the waitlist in case of cancellations. Also ask about that MFM (basically the high risk specialist) consult because those sometimes take a month or so to schedule with the referrals etc.

katekat8721 · May 2014

Congrats on your twins! What a surprise!

Based on the u/s I'd say they're most likely mo-something. I don't see the membrane separating them in either pic. I think you're being nice and proactive right now, so I'd wait and see what your OB says and then go from there. If they are identical then you will need a bit more care than fraternal pregnancies. But I'd say you probably haven't missed much from BFP to current as far as care goes!

carrotcake06 · May 2014

Stupid question: did you find out the sexes at your u/s?

Also: the farther along you are, the harder it is to tell mo/di from di/di bc babies take up more room and placentas grow and can fuse. I have di/di and have an u/s pic from 19w w their heads touching. Regardless, I still think you should get a medical professional's opinion.

ETA: just read your other post that they're both girls. Sorry I didn't see that post earlier.

erinwithtwins · May 2014

Most have covered it.The other question is whether or not they want you on any other supplements. I'm DI/DI and they have me on extra folate and vitamin D but I also have MTHRFR gene. I'd call every couple days to see if there's a cancellation. Good luck!

Rannndi · May 2014

I'm so glad you called back to advocate for you and your babies! If they tell you that they look identical (one placenta), continue to ask what their plan of care is. My initial OB said he wasn't going to do anything different because everything "looked good." That is NOT standard protocol for an identical twin pregnancy. Just remember to keep advocating! Good luck today! Keep us posted!

manateeliz · May 2014

So glad you will be getting in sooner! Good luck!

24karat · May 2014

Glad they got you in sooner! I reread your other post about the 9wk u/s...it made me even more curious as to if you have di-di vs mo-di. To me it makes more sense when a baby is hiding that they're in the same sac and missed vs the two separate gestation sacs and completely missing one. But it's possible and happens. Guess you'll find out soon enough.

12bailey18 · May 2014

Thanks everyone! They determined they are mo-di; two sacs, one placenta. They moved my anatomy scan up a week so we'll know more details in two weeks. She said because we found out later, the placentas could have grown and fused. They're treating it as mo-di, though. Thanks again! I'm SO glad I got in today...and so was my OB!

Rannndi · May 2014

Thanks everyone! They determined they are mo-di; two sacs, one placenta. They moved my anatomy scan up a week so we'll know more details in two weeks. She said because we found out later, the placentas could have grown and fused. They're treating it as mo-di, though. Thanks again! I'm SO glad I got in today...and so was my OB!

Thank you for updating us! Now that they're treating you as mono/di, did they tell you how often they'll see you? Remember, mono/di is more complicated and requires more monitoring than di/di. I only ask because my regular OB refused to see me more, and I had to switch providers for our care.

ETA: mobile bumping sucks

12bailey18 · May 2014

She only said "more frequently" but we didn't discuss specifics. I go back in 2 weeks for my anatomy scan. I will making an ongoing list of questions to ask when I get there, lol.

megknyc · May 2014

Welcome!!!! I was afraid of looking like a crazy preggo and was quiet at first about my care - then I realized that I was putting both myself and babies at risk. Glad you called. The care is definitely different and it is important to get your cervix length checked amongst other things as you progress. I quickly realized that twins/multiples is a very different experience than a singleton (at least for most). Good luck at your appt - you are already a great mom!

Rannndi · May 2014

Rannndi said:

Thanks everyone! They determined they are mo-di; two sacs, one placenta. They moved my anatomy scan up a week so we'll know more details in two weeks. She said because we found out later, the placentas could have grown and fused. They're treating it as mo-di, though. Thanks again! I'm SO glad I got in today...and so was my OB!
Thank you for updating us! Now that they're treating you as mono/di, did they tell you now often they'll see you? Remember, mono/di is more complicated and requires more monitoring than di/di. I only ask because me regular OB refused to see me more, and I had to switch providers for our care.

Wow- mobile bumping completely didn't work when I was replying to your post LOL

Get those questions ready and do your research beforehand so you know what the answers should be! I'm so glad you got in sooner for them to confirm!

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