A twin pregnancy; my experience of twins with an IUGR

The following is a guest post from Alan Langdon, fellow father of twins.

Beyoncé, Ronaldo and Ross Kemp are all famous celebrities that have recently became twin parents.

Becoming a parent to twins is an amazingly scary but exciting thing. Like the aforementioned celebs, we weren’t aware just how much the risk increases to the mother and babies throughout a twin pregnancy.

Some of the risks include; Pregnancy induced hypertension otherwise know as high blood pressure during pregnancy, Vanishing Twin Syndrometwin-to-twin transfusion syndrome (TTTS) and Intrauterine Growth Restriction (IUGR)to name a few.

There have been plenty of standout moments for me during the pregnancy of our twins. One being when my wife and I attended a routine scan. We had been unsure if she was even pregnant, only to be told to wait while the sonographer got a second opinion.

At that point we thought there were serious complications, maybe an ovarian cyst something of that nature.

A few moments later a second senior sonographer checked. Five minutes of silence later we were told that there wasn’t one baby, but two.

Shocked is an understatement.

We had a million things flowing through our minds. How are we going to cope with twins? could we afford them? Are we able to provide for them etc.

A strong coffee and some tears later we started on our journey to becoming twin parents.

Extra checks are normal

The first 16 weeks flew by, apart from the all day morning sickness from hell, my wife’s words not mine, the pregnancy went smoothly.

We found out that the twins were identical twins. We quickly found out the difference between identical twins (monozygotic) and non-identical twins (dizygotic/trizygotic) is that identical twins share the same placenta. Non-identical twins have their own placenta.

With identical twins there is an increased number routine hospital checks required. This is to ensure the babies keep growing fine without any complications. We ended up knowing all the staff on a first name basis due to spending that much time in hospital.

Its not twin to twin transfusion syndrome

Routine checks were scheduled every two weeks with our specialist. Each scan the babies head circumference (HC), abdominal circumference (AC), femur length (FL) and teh fuild around each baby was taken and plotted on a chart.

During the pregnancy one of the twins was growing slower than the other. With each visit the difference in HC, AC and FL size difference grew greater between the two babies. However, we were told each visit that both babies are doing fine and its not twin to twin transfusion syndrome (TTTS).

Twin to twin transfusion syndrome (TTTS) is a rare condition that occurs in identical pregnancies. Simply put, twin to twin syndrome causes the blood to flow unevenly between the babies.

Having TTTS, while rare, is dangerous for the babies. There is some fantastic information on twin to twin transfusion syndrome on the TTTS foundationwebsite. I strongly recommend checking it out.

What the hell is IUGR?

We attended our 24 week routine appointment as usual. Our specialist noticed that the size difference between the babies had gone above NHS guidelines. There was an immediate concern for the babies.

It was Tuesday.

We had an emergency appointment to go the regional multiple birth specialist hospital to see their top specialist on Wednesday. At this point we were still unsure what, if anything, was wrong.

During the appointment we were informed that we have a suspected Intrauterine Growth Restriction (IUGR). What the hell is IUGR? We didn’t have a clue.

We were informed that IUGR is were one of the babies has slower growth within the womb. This has a risk to the health of the baby effected. In our case, this was being caused by a failure in the placenta.

With our twins being identical, a placenta failure would cause disastrous consequences for both babies. The smaller baby was receiving less blood flow than the other twin.

Due to both babies being feed by the one placenta there was a risk that the smaller twin could die in the womb. The larger twin would attempt to revive the other by transferring blood to the smaller twin causing the other twin to die in the womb.

It was had to comprehend just what we were being told.

The options

Due to the gestation age (24 weeks) we were told that only three options existed.

  1. Deliver immediately, but at 24 weeks the chance of one or both twins surviving would be 40–70% were at 26 weeks chances of survival increase significantly to 80–90%.
  2. Do nothing and let nature take it’s course and be monitored weekly with the aim to get to 26 weeks and deliver.
  3. Go to Kings College in London on Thursday and have pioneering laser surgery to split the placenta by the world’s leading Professor Kypros Nicolaides.

So that was our three options. With the sobering possibility of losing one or both the twins at any time we only had one option. Option three, but we had to act fast as option three couldn’t be performed after gestation week 25.

By Thursday we were in London.

A date with destiny

Thursday was a long day filled with worry as we spend the whole day waiting to see the Professor to get his decision if the surgery was feasible or not.

Professor Nicolaides was a fantastic person that made us feel at easy, he explained the surgery potential outcomes and chances for success.

We were scanned for the second time that day. IUGR type 3.

Type 3, we were told is were the blood from the placenta to the baby is either positive (normal), absent (like a hick up; some blood goes through) or reverse (blood flow goes away from the baby to the placenta).

This means that absent flow is to be monitored closely but if the flow goes into reverse. Both babies would be deliveries within 24 hours. Reverse flow indicates the baby is struggling, spontaneous death within the womb becomes a very real possibility.

The result of this scan my the professor resulted in devastatingly bad news for us. Due to the position of the placenta, the laser surgery was not possible.

We had no option but to let nature take it’s course with bi-weekly scans until we reached 26 weeks then decide if to delivery early or not.

Every day mattered

We had scans twice a week at least. For us if we got to the next day without any issue or there was no change it was a good day.

Every day that passed was a win.

We met up with another couple that were going through the same IUGR issue. It felt electrifying to just sit and chat about our worries with someone going through exactly what we were.

Week 28 came and went.

The days snow balled and we raced towards 30 weeks. We had made great progress and the goal of 32 weeks was set to deliver. Routine appointments were bi-weekly. Each scan the blood flow in the umbilical cord was absent. This was great.

The end was in sight

One Tuesday morning in January we had the usual scan. We were at 31 weeks and four days and hoping to get our delivery date.

The babies had other ideas.

The flow had reversed.

The countdown began.

The specialist informed us that we won’t be leaving today and my wife were sent up to the labour ward to get monitored, the babies we going to be born within 24 hours.

The feeling of excitement and worry came and went throughout the night. Monitoring of the twins continued and the delivery was scheduled for Wednesday morning.

That Wednesday morning the sun was shinning down on us. My wife and I welcomed into the world our twins girls. Both alive and well, all things considered.

The next chapter in our lives was just about to begin.

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