We consulted a new gynecologist in Bengaluru for travelling reasons but were constantly in touch with our initial doctor over phone. After conducting an ultrasound, the gynecologist called us for counseling and said, “Shanti and Ravi yours are Monochorionic Diamniotic twins”. Her statements were met with the puzzled looks on our faces. No-one would have ever heard such rare words until encountering for the first time, have we? No right! We as well.
The doctor continued to explain us that Monochorionic Diamniotic (MCDA) twin babies share a single placenta, but different amniotic sacs and they are from a single fertilized egg. Boom! Which means identical girls or identical boys. We were on cloud nine on hearing that, looked at each other’s face and were trying not to show our exhilaration outside.
She also explained us the high risks and complications associated with multiple gestation pregnancy such as high blood pressure, gestational diabetes, TTTS etc. I started being apprehensive of safe delivery of our twin babies right from that moment onwards.
Later she assured us that not every MCDA twin pregnancy has to face these complications but having awareness can make us take informed decisions at the right time and asked us to be positive minded. I was referred to a specialist from Bangalore Fetal Medicine Centre (BFMC) just in case any complications arise (I don't want to take the name of the specialist who conducts the fetal scans).
Our first appointment was on 10th of July 2019. All the vitals were fine for both the babies and I was asked to come for more frequent checkups than usual as this was a high-risk pregnancy. We booked a 2nd appointment immediately for 7th of August. There's almost a month gap and Ravi had to travel to China for some onsite assessment and I had to stay alone. I denied both my parents and in-laws request to assist me by traveling to Bangalore. I somehow had that gut feeling that I can manage alone, and I did.
Ravi came back and we went to BFMC on 7th August for my 2nd checkup. I can never forget this date, the day when we had to hear that one of the twins is not growing well and the condition is called Twin to Twin Transfusion Syndrome (TTTS), it is a condition of the placenta that develops only with identical twins that share a placenta. Blood vessels connect within the placenta and divert blood from 1 baby to the other. It happens in about 3 in 20 twins with a shared placenta. Unfortunately, I was in that unlucky 3.
You can refer these links below for more detailed information on TTTS
* Our twins were diagnosed with early TTTS (18 weeks gestational age) and sFGR (selective Fetal Growth Restriction) type 3 in twin 2.
* Twin1 is the recipient with more blood and Twin2 is the donor with less blood which led to well visualised bladder in twin1 and smaller bladder in Twin2
* Fetal growth has slowed down in Twin2 with amniotic fluid less than expected for gestational age.
With all the above findings we were left with only 3 options given by the super specialized fetal medicine center.
1. Fetoscopic laser ablation - correcting the blood vessels in the placenta with a laser so that equal amount of blood goes to both twins; survival chances - 33.3% both survive 33.3% both die 33.3% at least one survives.
2. Selective fetal reduction - cutting the blood vessels going to unhealthy twin2 with a laser again, so that healthy twin1 may make it till the end of pregnancy: survival chances for twin1 - 90%
3. No treatment at all - if there's any intrauterine demise of one twin, the other twin has 25% risk of mental handicap and that could be unpredictable.
Which option we had to finally choose? Was it that easy to simply choose one and proceed further?
What factors we had to consider for arriving at the right decision?
You can find the answers in my next blog post.
Stay tuned! 😊
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