Pregnancy Story Part 2: Twin to Twin Transfusion Syndrome Diagnosis

After finding out we had two littles on the way, my OB requires an ultrasound with every visit because twin pregnancies are inherently higher risk than singleton ones. At that first appointment, we learned that there are three types of twins (not just identical or fraternal). Listed in order of lower risk to higher risk, these include twins that have a separate amniotic sac and separate placentas (Di/Di), those that each have their own sac and share a placenta (Mono/Di), and those that share both a sac and placenta (Mono/Mono).

Mono/Di Twins

We had the second kind called mono/di that share a placenta but each have their own sac. This type of twin comes with some risks including uneven sharing of their resources (blood and fluid) and selective growth restriction which is how much of the placenta that are naturally allotted.

Over the next few weeks we were monitored as the babes grew. Thankfully, I didn’t have horrible first trimester sickness. Though, I would get bouts of nausea daily and was exhausted by 6 PM and ready to go to bed at 7. I was able to keep my food down and continue working out in the mornings, and stay active, which I am grateful for still! 

Twin to Twin Transfusion Syndrome

As the twins were continuously monitored, the doctors discovered that twin A was growing larger and had more fluid in their sac than twin B.This is a sign of one of the previously mentioned risks called Twin to Twin Transfusion Syndrome (TTTS). In short, vessels from each twin grow across the placenta and intertwine with each other. In about 10% of cases, some of these veins allow the transfusion of fluid from the donor twin (my twin B) to the recipient twin (my twin A). This leads to twin B not getting enough fluids, therefore decreasing the amount of fluid running through their system and in their sac, and twin A having too much fluid run through their system and in their sac. Twin A’s heart becomes overworked and twin B doesn’t have enough nutrients and becomes dehydrated. You can read more about the syndrome here.

The Official Diagnosis & Monitoring

With this finding, we were sent to a high risk doctor for closer monitoring. We were officially diagnosed one week later at 15 weeks pregnant, requiring us to start with weekly ultrasounds for further monitoring with an even higher risk doctor and team to take over our monitoring. We are beyond grateful to have had access to a nationally recognized care team for specially this twin diagnosis and only two hours away in Baltimore.

For two weeks, from week 15 to 17, the team kept a close eye on the twins every 5-6 days. They were holding steady and the TTTS was not progressing. Our goal was to get me to 18 weeks before performing the treatment surgery (a fetoscopic laser surgery) as it would lower the risks to me and the twins. 

Same day hospital admission & next morning surgery

At our regular check in at my 17 weeks and 5 days pregnant, we found out that my cervix had shortened by more than half, and I had been contracting at home without feeling it. This could have been due to the extra fluid in baby A’s sac putting pressure on my cervix and/or me just having a weak cervix. Regardless, the team decided that I needed to go in for my surgery the next day. I was admitted to triage directly following the diagnosis and wheeled up for surgery first thing the next morning. 

Until Next Time,
Sam

Read part three for a recap on my surgery and hospital stay.