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Joshua and Caleb - born at 30 weeks

Pregnancy and Birth

I discovered at 13 weeks that I was pregnant with twins (my first pregnancy).  At an early ultrasound, our doctor informed us that our babies were monozygotic (identical), and we were overjoyed - we couldn't believe our luck!   Due to the higher risks a multiple pregnancy poses, I was sent for regular ultrasounds at monthly intervals. I was approximately 18 weeks pregnant when I first heard of a disorder of multiple pregnancy known as Twin-to-Twin Transfusion Syndrome.  For lack of better words, TTTS is a "deformity" of the placenta (identical twins usually share a single placenta) where blood and nutrients do not pass evenly to each baby - ie. one baby receives too much blood, and the other baby doesn't receive enough.  It is a rare but very serious complication - the bigger baby (the recipient twin)'s heart often does not cope with the extra strain and they can experience heart failure, while the smaller baby (the donor twin) is at risk of death from anaemia & low birthweight.

At our 18 week scan, we had one baby slightly bigger than the other - the first warning sign of what was to come.  My obstetrician was watchful, but not overly concerned at that stage, as there were no other signs of TTTS, such as high/low amniotic fluid levels.  My next ultrasound was at 22 weeks, where the smaller baby (twin 2) was still falling behind his brother growth-wise (we had found out that they were both boys), but was still within normal ranges, however the smaller baby now had lower than average fluid levels.  Concerned, but by no means in dire straits yet, I was sent home & told to take it easy & rest as much as I could, and my ultrasounds were moved forward to fortnightly intervals.

At 24 weeks my next ultrasound was due, and I went along hoping everything would be better this time, however things had taken a turn for the worse - baby 2's growth had slowed right down, and his amniotic fluid level had dropped as well.  In addition to this, he had an enlarged heart, which was due to the stress he was under from missing out on extra nutrients through the placenta.  Dazed, and not too sure why this was happening to me, I was ushered into my obstetrician's office along with a sympathetic look from my OB.  He gave me an interpretation of the ultrasound report - during the ultrasound I was told various things, but had no idea really what was going on - my OB told me that the baby 2 was in a lot of trouble and could die.  At this stage, baby 1 was only about 700g, and baby 2 about 400g, and the doctor thought that a caesarean section might have to be performed at 25 weeks gestation.  If this happened, he said, I should be prepared for the possibility of ending up with a caesar scar & no babies.  I was sent home to pack my bags for hospital, where I went the next day, for an appointment at the Maternal Fetal Medicine Unit, the section of the Mater Hospital that deals with problem pregnancies.

Another ultrasound was performed, things were still looking pretty bad, but the decision was made by the specialist and my OB to leave the babies in the womb until there was absolutely no other option but delivery.  I was given one lot of steroid injections to boost the babies' lungs in preparation for premature delivery.  I remember spending most of that day in tears, not sure what was going to happen.  I was admitted to the maternity ward upstairs and put on bed rest, and another ultrasound scheduled for 2 days following.  I went into that ultrasound with my heart in my mouth - if the situation was still as bad as it had been, we would be looking at a 25 week delivery.  Thankfully, the situation had improved somewhat - the flow of blood that had been travelling one way, had reversed and slowed, allowing the babies to stay in the womb for a little longer.  Twin 2's heart was still enlarged, but beating strong. Twin 1 seemed relatively unaffected by the TTTS  (which is quite unusual for TTTS - usually both babies are badly affected).

I was kept in hospital for the next 2 weeks, ultrasounds were performed every 2-3 days, and the babies' heartbeats were checked 3 times per day.  Twin 2's heartbeat, with him being so much smaller than his brother, was sometimes difficult for the nurses to find - I would start to panic, but eventually they would find it.  We took it day by day, each day the babies were growing a little bit bigger, a little bit more able to survive if they had to be delivered.  I used to study a pamphlet that the Intensive Care Nurseries had given me, and each time they grew a little I would look at the survival rates given for that weight - first 50, then 70, then 80%.  By the time I had reached 27weeks, things had improved somewhat, and the babies were growing well, so the doctors allowed me home for 2 weeks, although I still had to return to the hospital for twice-weekly dopplers (ultrasounds targeting blood flow).  I was also still on bed rest.

At 29 weeks, twin 2 was beginning to look quite stressed again, so I was admitted back into hospital and another set of steroid injections were given.  This time, I had a feeling that I would have the babies before too long, and sure enough, my OB scheduled a caesarean section for 26th January 2000 (Australia Day).  I would be 30weeks & 4 days gestation.  He told me that we had been so lucky to get this far, and he didn't want to lose the extra advantages we'd gained by waiting until the babies were too sick to survive.  I checked the survival rates again - Twin 1 (at around 1500g) had a 98% chance, while Twin 2 (at around 850g) had about a 90% chance.  That was good enough for me, at least we should come home with one baby, and if we were lucky, we would end up with both.  On the morning of the twins' birth, I was prepped for my caesarean, and at 8:10am Joshua (twin 1) was born, weighing 1560g.   His brother Caleb (twin 2) followed two minutes later at 808g.

The boys are now 3 years old, and so far, neither has had any major problems due to either their prematurity or TTTS.

©2003 Linda

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