A New Day

This morning, our ultrasound revealed two heartbeats and stable condition in both babies. There was no real improvement in blood flow or heartbeat, they were at least surviving on their own. Praise God that they made it through the night. That is a great first step. This morning's ultrasound also revealed that Siska's cervix is 100% efaced. Not a man reading this, knows what that means, but it basically is the point before the the cervix dilates which allows the baby to come out...along with the membrane breakage. They are watching that closely, and cannot stitch it together because it is to far along. We are prayerfully and anxiously awaiting tomorrow's ultrasound for good news. Every day they hang on now, is so important. The reality is that the kids could be born now, as they are viable, but the womb is the safest and best place for them to grow. Your love and prayers are precious to us. Until next time!

Decision and Operation

The doctor asked, what do you want to do. It all seemed to come so fast. We asked for some time, prayed, met with the doctor again, prayed some more... Then Siska knew for sure that she wanted the surgery. That was confirmation to me, and we were in total agreement. Siska was truly a hero. I was amazed at her courage, and the way she walked through all the pain, both physical and emotional. They prepared the OR and took her into surgery.

During the operation, the goal was to coagulate all of the shared blood vessels in the placenta forcing each baby to rely only on their individual vessels. The probem is really not with the babies, the problem is with the placenta and the sharing of the vessels in the placenta. Essentially, they are now more like fraternal twins in the way they recieve their blood. During the operation, the doctor found a tear in the membrane dividing the two babies. Noah's amniotic fluid had increased so fast that it tore the membrane seperating the two. Some of the amniotic fluid leaked from Noah to Matthew. That is not a serious issue as long as it does not continue to tear and the outer membrane stays intact. During the operation, the doctor also removed 3 liters of amniotic fluid.

That was a difficult 2 hours. Siska came through the surgery well, and the doctor felt it was a success. Both babies still had a hearbeat, and both had not digressed in their bloodflow, but now we had to wait till morning to see how the babies were still responding. Please keep praying...

A Difficult Day

As I shared, this all happened so fast. We found ourselved in a hospital in Tampa on Thursday morning, given a choice to make on what gives the best chance for survival of our boys. It seemed that on our way to Tampa, it was clear that we would do the surgery if we were allowed. But, as we faced the decision, we realized the impact of either decision we made. The main issues we faced as they were being examined, Siska was experiencing contractions every four minutes. They were worried that she could go into labor at any time. The donor (little Matthew) had absent blood flow, with potential of reverse blood flow. The recipient (Noah) was getting was getting too much and his heart was enlarged. Neurological damage and heart failure were concerns for both. The amniotic fluid level at normal at 3 to 8 centimeters. Noah was measuring at 20 entimetes(was the largest our nurses has ever seen). Matthew was 2.4 centimeters. Because of the amniotic fluid in Noah's sac, Siska was measuring at 44 weeks. This issue had pushed Matthew deep into Siska's lower belly and they could not get any good ultrasound pictures. After discussing the issues we faced with the doctor, he would not and could not tell us what we should do. We just prayed, and we knew you were praying too. We told ourselves whatever decision we made, we would not second guess.


I felt like the Psalmist when he penned, “Yeah though I walk through the valley of the shadow of death, I will fear no evil for, Thou are with me.” Although, my heart felt, "Yeah, though I walk through the valley of the shadow of death, I am so afraid, but I know you are with me."

To be continued...

What is Twin to Twin Transfusion Syndrome?

Twin-to-twin transfusion syndrome (TTTS, also known as Feto-Fetal Transfusion Syndrome (FFTS) and Twin Oligohydramnios-Polyhydramnios Sequence (TOPS)) is a complication with high morbidity and mortality that can affect identical twin or higher multiple pregnancies where two or more fetuses share a common (monochorionic) placenta. Severe TTTS has a 60-100% mortality rate.

Etiology

As a result of sharing a single placenta, the blood supplies of monochorionic twin fetuses can become connected, so that they share blood circulation: although each fetus uses its side of the placenta, the blood vessels connecting the twins allow blood to pass from one twin to the other. Depending on the number, type and direction of the interconnecting blood vessels (anastomoses), blood can be transferred disproportionately from one twin (the "donor") to the other (the "recipient"). The transfusion causes the donor twin to have decreased blood volume, retarding the donor's development and growth, and also decreased urinary output, leading to a lower than normal level of amniotic fluid (becoming oligohydramnios). The blood volume of the recipient is increased, which can strain the fetus's heart and eventually lead to heart failure, and also higher than normal urinary output, which can lead to excess amniotic fluid (becoming polyhydramnios).
In early pregnancy (before 26 weeks), TTTS can cause both fetuses to die, or lead to severe disabilities. If TTTS develops after 26 weeks, the babies can usually be delivered and have a greater chance of survival without disability.

How it all started

Our twin pregnancy has been an amazing journey. Up until 21 weeks, every test came back perfect. The weights of the babies were 801 (Little Matthew) and 809 (Noah). We were shocked when 4 weeks later, the boys had gone from equal weight to 29% discordance (difference in weight). After that appointment, we were told by our Ob/Gyn that although it was serious, we should be hopeful (up to 20% discordance in twins is fairly normal. Siska was put on bed rest and was told that she would be seen again in 3 weeks. I began doing some research and was concerned that TTTS was a possibility. Needless to say, I was not really satisfied with the lack of monitoring. I convinced our OB to see us again in one week and he made a specialist appointment for for 2 weeks later. At our visit with the OB after a week, he told us that although there was still the discordance, things looked good, heartbeats solid, etc... We were somewhat relieved. That was until our specialit visit which was this past Tuesday (June 3). At the ultrasound, I knew by the look on the nurse's face, we were in trouble. She would not tell us anything. The doctor told us it was Twin to Twin Transfusion Syndrome. I will share in a later blog the details of what that is. He told us there is a procedure that a couple of doctors do in the US for us to consider. The problem was, that we were outside the timetable to perform it (only up to 26 weeks). We were already 27 and one day. They called one doctor somewhere up north, and he was not willing to do it. They then tried Tampa and the doctor here said that he would be willing to see us and perhaps would be willing to do it. After our specialist tests were finished we went home, packed out bags, and drove to Tampa. We arrived at our hotel after midnight and tried to get some rest for our 5:30 AM ultrasound.
To be continued...