A Change

Today there was a change, not earth-shattering, but not particularly positive either. My fluid levels have continued to go up surrounding baby A, this time more rapidly. Baby A is only just within normal fluid range - by about a quarter of a centimeter. This excess of fluid, if the Maximum (also referred to as Deepest) Vertical Pocket (MVP) measurement is greater than 8,  is referred to as polyhydramnios. This is a condition affecting about 1-2 percent of pregnancies and can be caused by several different issues. Of course we have been monitoring this because one cause is TTTS, though Baby B's fluid levels have also continued to increase, where as in TTTS the donor baby's fluid levels get dangerously low.

**Allow me to interject here and say that I am so thankful that Baby B continues to have adequate fluid surrounding him! I was feeling him less over the past few days and sometimes that is indicative of a problem, as it turns out, it is simply because he flipped to a breech position so I am just feeling his movements differently - no biggie!**

While there are plenty of cases of babies with polyhydramnios that are perfectly healthy, many have this condition as a result of some defect that may restrict their ability to swallow the amniotic fluid surrounding them, keeping the AFI at normal levels. Another explanation would be that I have developed gestational diabetes, that'd be a fairly simple fix so I'm almost hoping for it at this point??? As this is, and has always been, a waiting game, we will simply see how things are next Thursday at my next appointment. The next appointment will be more in depth and the boys will have full anatomy scans again to check for abnormalities and see how they are growing. I don't have any indication right now of what caused this fluid jump (it was rather rapid since it has been less than a week since my last check), but seeing as we are still flirting with the normal range we should be okay to wait.

The "good" news about finding this information today is that explains my feeling significantly worse rather suddenly. Somewhere around Saturday evening my ability to breathe became much more restricted and my heartburn came back (after a blissful 3 week lull) with a vengeance despite taking medication for it. Beyond gestating multiples, higher fluid levels cause quick compression of the lungs and stomach in the mother which can cause these issues. In addition to these symptoms, the stomach/abdominal area is, once again, stretched too quickly and becomes increasingly painful. While I was definitely larger in my pregnancy with Audra at full-term, I never experience this level of abdominal pain. In short, it sucks, and there's nothing I can do about it.

If polyhydramnios does progress, it puts me at a much higher risk for pre-term labor, placental abruption, and uterine rupture. This is without factoring in that there are two lovely young men that are growing inside me right now.  Bedrest is pretty common in these cases, in order to keep pressure off the cervix and keep things still since it all gets too tight and heavy in there. Bedrest scares me to death. Audra is sooooo 3 and she is soooo not okay with Mommy's slowing down right now.

Seeing as we may all be on borrowed time, I am trying my hardest to get things a bit more organized day by day. While physically taxing, it does help me to feel more prepared in the event that we experience a drastic change. Okay, now I am laughing..of course we are going to experience a drastic change. Life with twins. Yikes. We have been rather focused on things on an appointment to appointment basis, along with some other things that have come up in our family, that time to actually think about what life will be like with the little ones is pretty much nil. Then again, perhaps it is better that way. This entire experience is one great exercise in surrendering control and trusting that God will provide, but it isn't easy, it is definitely exercise. I hate exercise. Also a bummer today, NO PICTURES! The perinatal center has been remodeled and they are moving out of their temporary location this week back into the new digs for next week so they are on a time crunch, and obviously it was more important to spend time determining how serious this new development was than to get cute pictures. *Sigh*

Alright, well I have a toddler in bed, laundry being laundered, and a kitchen to clean, so I am signing off. Thank you for your prayers - and please keep them coming!

The power of prayer...

...is so apparent every time I go in for another appointment. The sonographer I had today was the same one that was at my initial follow-up with the perinatologist after concerns of TTTS arose. When looking over my numbers for the past two weeks, and confirming AFIs and dopplars today, she remarked how shocked they had been at that follow-up that the boys' fluid levels have remained within the normal ranges, and that the umbilical flow is remaining healthy enough and steady. We knew that the doctor was pleased at the lack of progression, but this shows that it is not medically the norm. So, I thank you for your continued thoughts and prayers, and thank God for being the penultimate Creator/Doctor/Anatomical Programmer, etc. He truly has His hand on these fine young gentlemen...Whom - YES MOM - we hope to officially name soon so as to avoid the Baby A/Baby B confusion. With Audra, we kept the name to ourselves and publicly referred to her as Bean, and in fact, we still call her Bean or subtle variants of that nickname to this day.

The boys remain head down and crammed right next to each other. This is no surprise to me as I feel them hanging out and hanging low. I think they are having a "how often can we make Mom pee" contest. Let me tell you, they are winning. Both kids have been super active this past week which has been reassuring since feeling movement is an indicator of appropriate fluid levels. Baby A is inching up with fluid levels, which while still in normal range ( <8cm), is causing me more discomfort. My body is simply stretching much more quickly than it was meant to. Another indicator of our special situation is that, while many twin moms' uterus measures 4-6 weeks ahead due to the extra baby, I am measuring a whopping 10 weeks ahead....and I definitely feel like I am rocking a baby belly that looks 31 weeks along instead of 21 weeks. Ah, which brings me to my next point - I gained 4 pounds this week! This is great news since weight gain has been a huge struggle throughout and the twins are growing rapidly at this point. Any fat on them is a huge help in their success outside of the womb, so bring it on! According to this, the boys are supposed to be about 10.5 inches long and just under 13 ounces each. I didn't get any official indication of their size today, but Baby B does still appear to be a smaller than his brother just by seeing them on the ultrasound. I will have another full anatomy scan of both boys in 2 weeks which will give us a clear idea of if Baby B is growing on track, just smaller, falling further behind, or has caught up.

And now - what you have all been waiting for...pictures!

 Here we have Baby A kissing his brother's head. Adorable much?

Here is Baby B's face,  lower right, with the back of Baby A's head, top left.

And here is Baby A's face, lower right, with the back of Baby B's head, top left, and hand resting on top of Baby A's head.

A First.

We had another appointment today and for the most part, it was uneventful. This. Is. Great. While Baby B is still measuring 20% smaller, he hasn't fallen back any further. He also even had a bit more fluid around him today, although the tech did tell me not to get too caught up in that number with such a small gain, it is still a step in the right direction. Keep peeing little man! The umbilical dopplers were also stable and within adequate range, although it did take a LONG time to get a reading. The boys were very uncooperative today, but that means they are able to move around in there freely and feeling good. Something that has never happened to me before happened, I totally teared up seeing them on the screen. I've never cried at an ultrasound before. I wasn't anxious going into the appointment, so it wasn't tears of relief. I was just really, really happy to see my boys today. I also really loved today's sonographer; very peppy, explained everything she was seeing and how it related to where they were in my body. Speaking of which, they are both now head down with Baby A on my left and Baby B on my right. Their little faces are smushed right next to each other. Another first was that the machine I was on today had 3-D capabilities, either that, or the sonographer just likes to treat her patients (reeeeaaallly hope to see her again). Baby A adamantly refused to show his face, but we did catch quite a bit of Little Man B bringing his hands to his face and "smiling". Honestly, they look creepy when they are so little. They probably are rocking an average of 10 or 11 oz a piece. Still, it was great to see them . Hopefully you can figure out what you are looking at below:

Friday Follow Up

We had our follow up appointment this morning and it went really well! The twins are still doing great with good heart rates and appropriately sized bladders. The test that we will be having done regularly, and that was completed this morning, is called an Amniotic Fluid Index (AFI). It does exactly what it sounds like, measures the deepest vertical pocket of amniotic fluid. The results today were very consistent with what we saw on Tuesday. Still just within the ranges of "normal", but stable. They also performed dopplers on the umbilical cords to track the blood flow in and out of the babies. These tests are giving us a good baseline to with which to compare future tests in order to determine if intervention is necessary. Because the AFI was favorable, I will not need to continue appointments every three days, but can stick with once a week appointments at the perinatal center. Dr. R. was very pleased to see no change and mentioned that it had been a very rough week, so this bit of good news went a long way for her too. She also let us know that she spoke to the doctor down at University of Maryland Medical (UMM) about our case so they are aware of us and ready to step in should we need that extra care, but for now we can stick to being monitored at SJMC,which is great since it is so incredibly close by and I am familiar/comfortable with the campus.

We are so thankful for your thoughts and prayers. Please continue to pray that AF levels remain adequate and that Baby B is getting enough nutrients to develop properly. Survivors of TTTS do have an increased risk for neurological problems. Also pray that when they check the babies' growth in a few weeks that Baby B will have had some gains and that Baby A continues to grow on track. For now, we have so much to be thankful for - like, no bed rest yet! The thought of being on bed rest, especially for an extended period of time is extremely daunting to me as we try to prepare for these little guys. I am also trying to shower Audra with lots of physical attention when I can as it is already very difficult for me to pick her up or have her as close to me as she'd like when she requests a cuddle.  She is definitely aware that this is a change and it frustrates her.  I am hoping that we can continue to enjoy this summer time with friends and outdoor activities since it is inevitable that she will have quite a shock whenever the babies arrive whether it is in September (crazily a possibility at this point!) or November.