Today's appointment announcement is that the girls will be arriving at 34 weeks. Given their growth restriction, this is their best chance for survival and healthy longevity. Barring any further development, we'll be delivering at 8:30a on Wednesday, Sept 9, 2009.
The vital stats haven't changed; hearts look good, lungs look good, blood flow is normal, and both girls are moving and breathing as expected for their gestational age/development. We are planning for a NICU stay of up to 2-4 weeks, though we are hoping for shorter. I am sure that this will provide additional challenges and emotional havoc as Gwynne is able to be discharged and return home sans babies 4 days post-delivery. Having a glass half-full attitude, Gwynne will be able to have her incision heal prior to the girls coming home and I will be able to focus more of my paternity leave around the girls' arrival home versus their stay in the hospital.
We're into crunch time...the nerves are peaking a bit...but we're just as excited as ever.
Thursday, August 27, 2009
Tuesday, August 25, 2009
To Admit or Not to Admit
We're still looking for our easy button with this adventure...
Yesterday's visit to the doctor started smooth as silk. Everything looked status quo with the girls' heart rate and cardiac function. Measurements were taken and they are both growing...and the first reason for pause arises.
While they are both growing, the smaller baby has slipped a bit further behind again (dropping from the 13th %ile to just below the 10th). The larger baby is now weighing in at 3 lbs 13 oz, with her smaller sister weighing 2 lbs 8 oz. Knowing that these measurements are estimates with inherent error the doctor didn't appear overly concerned. The roughly 30% differential has been relatively consistent since we began tracking their measurements. It did spark a conversation as to when we will need to pull the smaller baby from the womb to increase its chances of survival. Growth restriction of this type in the womb often poses greater risk to the fetus in utero than a prolonged stay in the NICU; especially considering the health of the larger baby. We must remember that with this type of twin all of their blood supply is connected and what happens to one directly (even if sometimes inversely) effects the other.
Long story short, the conversation ended with an understanding that the decision to deliver is more strongly a day to day decision and that 34 weeks may be as long as we can let them gestate...though the jury is still out...many conversations between the perinatologist and the neonatologist to come.
After all of this we still had to do our fetal non-stress test. Heart rates look good; uteris monitor shows steady, gentle contractions. We're not too concerned as Gwynne's fetal fibronectin test came back negative and her uteris was still long and closed. The doctor had some concern. He wanted to manually check her uteris before he decided what he let us do next (i.e. leave for home or admit to the hospital).
Going to the new exam room, our third of this visit now nearly 3 hours old, I hear him on the phone with the neonatologist discussing our case. After a short wait he performs the test. After a brief pause that felt like forever, he lets us go home because Gwynne's uteris, is indeed, still long and closed. Those girls could be dropping hand grenades and they aren't coming out through the uteris at this point.
Thursday, and each subsiquent visit thereafter, will be a constant watch for hospital bed rest and/or C-section delivery. We will just never know when it is our day. Let the fun continue!
P.S. if anyone has that easy button, we'll take it.
Yesterday's visit to the doctor started smooth as silk. Everything looked status quo with the girls' heart rate and cardiac function. Measurements were taken and they are both growing...and the first reason for pause arises.
While they are both growing, the smaller baby has slipped a bit further behind again (dropping from the 13th %ile to just below the 10th). The larger baby is now weighing in at 3 lbs 13 oz, with her smaller sister weighing 2 lbs 8 oz. Knowing that these measurements are estimates with inherent error the doctor didn't appear overly concerned. The roughly 30% differential has been relatively consistent since we began tracking their measurements. It did spark a conversation as to when we will need to pull the smaller baby from the womb to increase its chances of survival. Growth restriction of this type in the womb often poses greater risk to the fetus in utero than a prolonged stay in the NICU; especially considering the health of the larger baby. We must remember that with this type of twin all of their blood supply is connected and what happens to one directly (even if sometimes inversely) effects the other.
Long story short, the conversation ended with an understanding that the decision to deliver is more strongly a day to day decision and that 34 weeks may be as long as we can let them gestate...though the jury is still out...many conversations between the perinatologist and the neonatologist to come.
After all of this we still had to do our fetal non-stress test. Heart rates look good; uteris monitor shows steady, gentle contractions. We're not too concerned as Gwynne's fetal fibronectin test came back negative and her uteris was still long and closed. The doctor had some concern. He wanted to manually check her uteris before he decided what he let us do next (i.e. leave for home or admit to the hospital).
Going to the new exam room, our third of this visit now nearly 3 hours old, I hear him on the phone with the neonatologist discussing our case. After a short wait he performs the test. After a brief pause that felt like forever, he lets us go home because Gwynne's uteris, is indeed, still long and closed. Those girls could be dropping hand grenades and they aren't coming out through the uteris at this point.
Thursday, and each subsiquent visit thereafter, will be a constant watch for hospital bed rest and/or C-section delivery. We will just never know when it is our day. Let the fun continue!
P.S. if anyone has that easy button, we'll take it.
Friday, August 21, 2009
Negative Test
The fetal fibronectin test is negative...smooth sailing continues...until Monday's visit. We'll see what's in store for us then.
Thursday, August 20, 2009
Aug 20th Dr Visit
Today's visit was more of the same, which is to say that the girls are looking good. According to the ultrasound images things appear to be progressing as we should expect. As Gwynne elaborated on in the last post, we are now in a process of have fetal non-stress tests done on each visit. This means being hooked up to the monitor for Gwynne and a 20-minute nap on the couch for me.
Today's monitoring kept our attention as we were convinced the uterine contraction numbers couldn't possibly be correct. They were hovering in the 40s and 50s with spikes near 80. We were 5% worried and 95% sure the pad was placed in the wrong spot, especially since Gwynne couldn't feel anything contracting or otherwise. When our doctor came in she indicated that the numbers themselves didn't hold any meaning as pertaining to intensity, rather just the stability/volitility of the uteris.
Great! Smooth sailing we laughed and joked. As it turns out, it appears that Gwynne has an irritable uteris with one sustained contraction. So she was off to her OB, with whom she had an appointment anyway, for a fetal fibronectin test. Basically, if the test comes back positive, then there is a 1:5 chance that she will begin labor in the next 1-3 weeks. If it comes back negative, then there is a 1:50 chance of early labor; we'll repeat the test in a couple of weeks if we receive a negative result. Not really sure what will happen if we get a positive result.
Friday, August 14, 2009
August 14
Ahhh... So another week goes by! Things this week were a bit anti-climatic, which is probably the best thing we could ask for given our circumstances. We started a new process with our monitoring program/regime. Now in addition to doing ultrasounds to monitor heart, fluid, and fetal movements (including practice breaths) we are now also being hooked up to fetal heart monitors each visit. The heart monitors are these round discs that get placed on my abdomen (one above each baby) that are then held in place by velcro straps. In addition to those 2 discs they also place another disc on the remaining free space of skin to monitor contractions.
So far so good! The babies are always moving around so their heart rates go from 130 to 140's and then 000 because they have moved away somehow. The hardest thing about the whole process is breathing. This is because they have me in a reclined position each time. On Thursday I had Kevin move my chair more up-right and it was far more bearable. Kevin's enjoyment out of the fetal heart monitoring on Thursday was that he got to lay down on a couch and get a catnap for 20 minutes or so.... that is after he breezed through the interesting magazines in the room.
We asked our perinatologist this week if there was any indication of when the babies would arrive. He said that there was no way of knowing, but that doing the monitoring multiple times per week would improve our chances of both of them making it as far as possible. So right now we have little goals make is to 32 weeks. Tuesday will be the mark of 31 weeks... so we are looking like we will make it to our first goal ok, provided I can lay-low.
On another note, this weekend is my first real weekend away from the Tri races. I'm not use to being home when it comes to these summer weekends. So I feel a bit tense not being at race site even though I know the staff is doing a killer job without me there. Titan is kind of bummed too... he misses being race dog and snaking a few rogue bagels that the athletes tend to disgard on the ground. Atleast we have each other to keep company with... as well as some awesome neighbors and friends who have been so very kind in helping us out now that I am on lock-down.
That is all the news for this week :)
So far so good! The babies are always moving around so their heart rates go from 130 to 140's and then 000 because they have moved away somehow. The hardest thing about the whole process is breathing. This is because they have me in a reclined position each time. On Thursday I had Kevin move my chair more up-right and it was far more bearable. Kevin's enjoyment out of the fetal heart monitoring on Thursday was that he got to lay down on a couch and get a catnap for 20 minutes or so.... that is after he breezed through the interesting magazines in the room.
We asked our perinatologist this week if there was any indication of when the babies would arrive. He said that there was no way of knowing, but that doing the monitoring multiple times per week would improve our chances of both of them making it as far as possible. So right now we have little goals make is to 32 weeks. Tuesday will be the mark of 31 weeks... so we are looking like we will make it to our first goal ok, provided I can lay-low.
On another note, this weekend is my first real weekend away from the Tri races. I'm not use to being home when it comes to these summer weekends. So I feel a bit tense not being at race site even though I know the staff is doing a killer job without me there. Titan is kind of bummed too... he misses being race dog and snaking a few rogue bagels that the athletes tend to disgard on the ground. Atleast we have each other to keep company with... as well as some awesome neighbors and friends who have been so very kind in helping us out now that I am on lock-down.
That is all the news for this week :)
Monday, August 10, 2009
August 1-10
...after receiving the two steroid shots and further conversations with our physicians, Gwynne was released from the hospital on the 1st to go home to continue her bed rest. We were also leaving with a much more relaxed about the context within which the previous two days had transpired. It was true that the smaller baby was nervously small and low on the percentile growth standards. It is also true that the smaller baby was still growing and that all heart and lung function looked good. As it turns out the steroid shot was a precautionary measure should we get into the need to delivery earlier rather than later. All of our doctors were surprised that we hadn't been admitted to the hospital up to this point, let alone only for a precautionary series of injections and fetal monitoring. During today's appointment, one of our specialists indicated that the odds of Gwynne and the twins progressing to their current state given where we started is about 5%. In that sense I suppose we are very lucky.
We had another round of fetal growth measurements today, Aug 10. Both babies are still growing with the larger weighing in at 3.5 lbs and the smaller at 2.4 lbs. The smaller has moved up to the 13th percentile in the last 10 days. The doctors are increasingly optimistic compared to just ten days ago.
Now you must be wondering how Gwynne is coping with the bed rest issue.?. She is moderately misbehaving within the loose parameters of her imposed restrictions. She is still working feverishly on the computer preparing for the races each weekend. Though she broke the rules this past weekend, she will no longer be traveling to events on the weekends. She is rarely driving, really only to come into town for her doctor's appointments. Other than that she is pretty much on home confinement.
The term bed rest has also been loosely interpreted within our house. She does spend most of her timing sitting in a chair or on the couch. Some time is spent truely in bed, but more realistically laying on the couch has been her primary mode of bed rest. Though the doctor's orders were no cooking or cleaning, one shower a day, and one trip up and down the stairs per day they express their pleasure with her "compliance" thus far (only off the record, of course).
How have the twins been responding to the bed rest restrictions. Well, I've already indicated they have experienced strong growth over the last ten days. Her stomach has also grown exponentially. This has been attributed to the lack of physical stress she has been under lately, which has allowed her abdominals to relax enough to stretch to meet the added requirements for space. Her lower caloric expenditure also reduces her body's leaching of nutrients from the twins to allow them to better support themselves.
Thank you for reading thus far. Now that we are all caught up with this blog page, we'll try to keep updated after each visit each Monday and Thursday. Stay tuned.
July's Developments
Not much to report for this month. The doctors visits were allowed to be seperated by 7-10 days and everything looked as it should be for the first time in the entire pregnancy. It was, perhaps, the first time that we were able to enjoy the experience for the sake of the experience.
To this point Gwynne has still been able to swim 4-5 days per week, lift weights on occasion, and spend some time on the stationary bike. The most enjoyable workout she was able to do each week was ride her road bike with me when I did my long runs. We were able to talk and catch up/reflect on the happenings of the week...a bit of rare time for just the two of us. We knew the time for these ride-runs together was drawing short as her knees were hitting her belly and it was getting increasingly difficult to reach the handle bars. We didn't know that time would run out with a screaching halt on the 31st.
We went to the perinatologist appointment as regularly scheduled; both of us taking the usual 1.5 hour break from the work week to get the latest pictures and check the health of the girls. During that appointment we noticed that the smaller baby had fallen below the 10th percentile for fetal growth development. We were instructed to keep the OB appointment we had later in the day, but Gwynne was then to be immediately admitted to the hospital for a steroid injection and fetal monitoring. We were also instructed that bed rest would be immediately implamented.
Here we go again...more stress...more worrying...and extreme changes to our work/workout/life schedules. Talk about major freak out moment! We didn't really know what was going on. Leaving to be admitted we were thinking that an emergency C-section could be immanent at any moment. Trying to put on a strong face for our friends, family, peers, and staff the usual pins and needles were quickly becoming daggers and spears.
The hospital room was humble by today's standards, but clean and sufficient. We had no complaints. The nursing staff was exceptionally friendly, attentive, and at times entertaining. They stopped in just enough to get the jobs done the nurses were required to do, but left Gwynne alone enough to allow her to work on the computer, watch TV, and sleep soundly. We were left looking forward to being cared for post-delivery.
Catch up with the remainder of the story in the first August update...
To this point Gwynne has still been able to swim 4-5 days per week, lift weights on occasion, and spend some time on the stationary bike. The most enjoyable workout she was able to do each week was ride her road bike with me when I did my long runs. We were able to talk and catch up/reflect on the happenings of the week...a bit of rare time for just the two of us. We knew the time for these ride-runs together was drawing short as her knees were hitting her belly and it was getting increasingly difficult to reach the handle bars. We didn't know that time would run out with a screaching halt on the 31st.
We went to the perinatologist appointment as regularly scheduled; both of us taking the usual 1.5 hour break from the work week to get the latest pictures and check the health of the girls. During that appointment we noticed that the smaller baby had fallen below the 10th percentile for fetal growth development. We were instructed to keep the OB appointment we had later in the day, but Gwynne was then to be immediately admitted to the hospital for a steroid injection and fetal monitoring. We were also instructed that bed rest would be immediately implamented.
Here we go again...more stress...more worrying...and extreme changes to our work/workout/life schedules. Talk about major freak out moment! We didn't really know what was going on. Leaving to be admitted we were thinking that an emergency C-section could be immanent at any moment. Trying to put on a strong face for our friends, family, peers, and staff the usual pins and needles were quickly becoming daggers and spears.
The hospital room was humble by today's standards, but clean and sufficient. We had no complaints. The nursing staff was exceptionally friendly, attentive, and at times entertaining. They stopped in just enough to get the jobs done the nurses were required to do, but left Gwynne alone enough to allow her to work on the computer, watch TV, and sleep soundly. We were left looking forward to being cared for post-delivery.
Catch up with the remainder of the story in the first August update...
Friday, August 7, 2009
March to July
We found out early on that we were having identical twins (at approx 8 weeks) - YIKES, there's 2!!!. Our twins share one placenta (that's one of the markers for them being identical), that makes them extra special and considerably more "high-risk" because they are sharing the same blood/nutrient source. As such, we started seeing a perinatologist at 14 weeks to monitor the babies closely.
From the get go things have been on high alert. At first the doctors thought that there might be twin-to-twin transfusion where one baby basically steals from the other baby's blood supply. There were talks of a possible surgery to reverse it but it would not be done until at least 18-20 weeks. When the time came to make the call on surgery the diagnosis changed to un-equal placental share. While the diagnosis was slightly better it still left us in a very high-risk category. This new diagnosis also allowed the doctors to relax a bit with the idea that one baby was markedly smaller than the other so long as the rest of them was functioning normally.
At the end of June we had the echocardiogram done to check the heart function of the twins. Upon first glance we had a potential hole in one heart (VSD) and a slightly enlarged heart on the other. We met with the top neonatal cardiologist based out of UVA that same week to get his opinion. After monitoring our ultrasounds for 2 weeks he was happy to say that VSD issue had been resolved on its own and the slightly enlarged heart was not getting any worse so he wasn't worried enough to change our existing plan of monitoring.
The month of July brought us elation and relaxation... thank goodness! We feel like we finally could relax a bit and wait for the belly to grow. The month also brought us the first movements of the babies, at around 25 weeks. They are now laying Yin and Yang to each other - so while one likes to wiggle her toes in my ribs the other likes to soccer kick me in the lower left corner of my stomach.
Keep them wiggling and kicking we say!
From the get go things have been on high alert. At first the doctors thought that there might be twin-to-twin transfusion where one baby basically steals from the other baby's blood supply. There were talks of a possible surgery to reverse it but it would not be done until at least 18-20 weeks. When the time came to make the call on surgery the diagnosis changed to un-equal placental share. While the diagnosis was slightly better it still left us in a very high-risk category. This new diagnosis also allowed the doctors to relax a bit with the idea that one baby was markedly smaller than the other so long as the rest of them was functioning normally.
At the end of June we had the echocardiogram done to check the heart function of the twins. Upon first glance we had a potential hole in one heart (VSD) and a slightly enlarged heart on the other. We met with the top neonatal cardiologist based out of UVA that same week to get his opinion. After monitoring our ultrasounds for 2 weeks he was happy to say that VSD issue had been resolved on its own and the slightly enlarged heart was not getting any worse so he wasn't worried enough to change our existing plan of monitoring.
The month of July brought us elation and relaxation... thank goodness! We feel like we finally could relax a bit and wait for the belly to grow. The month also brought us the first movements of the babies, at around 25 weeks. They are now laying Yin and Yang to each other - so while one likes to wiggle her toes in my ribs the other likes to soccer kick me in the lower left corner of my stomach.
Keep them wiggling and kicking we say!
Monday, August 3, 2009
First post...
So as we all know now, 2 little ones are on the way! Our technical due date is 10/20/2009. They are identical twin girls. We hope to make it as close to our due date as possible - but the doc's have informed us to anticpate going earlier than the due date. So much for planning this all for a post tri-season birth.
More information will be posted in the coming weeks... and maybe even some pictures too!
More information will be posted in the coming weeks... and maybe even some pictures too!
Subscribe to:
Comments (Atom)