After years of infertility treatment
and what I previously thought had been
a complicated pregnancy with my
daughter, we became pregnant with
twins in Feb. 2004 after another IVF
cycle. I'll tell you my story in much
detail, as it seems to be rarer even
than the average PPROM, I had counsel
from nearly every specialist
imaginable, and I have a happy, happy
ending.
At 9 wks, 4 days, I began to have some
light bleeding. My OB had me come in
for an ultrasound, which showed a very
small subchorionic hemmorhage that he
didn't feel was cause for alarm. The
next day (a Friday), I had another u/s
just to be sure -- same results. That
evening, in my car on the way home
from work, I felt a gush and tried to
stay together on the rest of the drive
home. When I got there, I saw I was
bleeding heavily. I was crying and
freaking out, and the doctor met my
husband and me at the hospital. When
we got there, he had a Maternal-Fetal
specialist do the u/s just to be sure
he was reading it right, and he too
saw only a small bleed that didn't
look like it threatened either baby or
the pregnancy. Even so, they told me
to stay off my feet as much as
possible until the bleeding stopped.
By Tuesday, all was back to normal,
and after the doctor examined me and
told me I could get back to normal
life. The next night, at 10 wks, 3
days, I was reading in bed, when I
felt another gush and saw more
bleeding. At the u/s the next a.m.,
the subchorionic hemmorhage was a bit
bigger, tho still not large, but the
OB put me on modified bedrest and I
had to seem him every week for an
u/s.
My bleeding lasted until 15 wks 1 day.
When I saw my OB at 16 wks, 2 days, I
hadn't had bleeding for over 1 week,
so he told me I could cautiously
resume daily activity -- no lifting,
exercising, etc.
That VERY night, my husband and I went
out to dinner with our daughter to
celebrate my freedom. Again, as I sat
there, I felt a big gush. I went to
the bathroom, but this time there was
nothing there but wetness with a
teeny, tiny brown spot in the middle.
I decided I wasn't going to over-react
since I had made it through the worst
(I thought!).
I called the OB the next morning, and
he told me to come see him in his
office immediately and that he didn't
want me to see his partner who was at
the suburban office that day. I knew
that was a bad sign.
That day's u/s showed both babies
still looked ok, but it looked to the
OB like Twin B had less fluid than the
previous day. Since he hadn't been
measuring fluid exactly but monitoring
the bleed, he couldn't say for sure
but he said this was really the first
time in my pregnancy that he was
worried. He called the Maternal-Fetal
specialist who had previously seen us,
and said I could meet him at the
hospital for an u/s that afternoon.
The OB told me to call my husband to
have him join me.
The MF specialist agreed that both
babies had enough fluid, tho Twin B
definitely had far less. Even so, at
it's level that day (16 wks 3 days),
it was fine, even if it was at the low
end of normal. My OB put me on strict
bedrest, told me to drink lots of
fluids just in case....
I continued to feel the leaking, but
no more gushes. Just over one week
later, at 17 wks 4 days, we went in
for a previously scheduled u/s test
related to genetic screening (can't
even remember what one!). One look at
the screen, and my husband and I knew
that Twin B didn't have enough fluid.
The OB who was doing the Level II u/s
turned white and when I asked if it
was really bad, he said it was and
asked us to meet him in his office.
There, he told us that Twin B's
amniotic fluid index was 0 -- no
measurable fluid. He explained the
implcations of PPROM on me and the
baby, especially with a 2nd trimester
rupture that continued to leak. He
said with a 0, it's pretty impossible
for the fluid to reaccumulate and that
reducing to just Twin A might give
that baby a better chance of survival
and reduce the risk of infection to
Twin A and me. After a long
conversation with him and then my own
OB the next morning after he spoke to
MF specialist, we scheduled a
reduction for the next week, at 18
wks, 3 days. I was sick, sick, sick
with fear and depression until that
day.
The day of the reduction, after the
counseling but before the Dr (same guy
who did Level II u/s) came into the
room, the u/s tech asked us if we were
doing the reduction to have a
singelton pregnancy. We looked up at
the screen and both of us knew right
away there was a whole bunch of
fluid. I was so scared to hope, but I
couldn't help laughing. When the Dr
came in, he was shell-shocked. He said
in over 20 yrs of practice, he hadn't
seen fluid come back from a 0 AFI.
But it was measuring at 5. He said he
needed 5 min to think, then came back
into the room after 5 min, told me to
get dressed and for us to come in his
office.
We sat there while he called our OB
(his partner) and then had another
long talk. He felt that the risk of
losing Twin A to infection or pre-term
labor was still very large w/o a
reduction of Twin B, especially since
I continued to feel the leaking. BUT
he said we were in unchartered
territory, since Twin B ruptures are
usually rare -- if it had been Twin A,
we likely would have lost the
pregnancy already, so we could take a
leap of faith.... Now, I felt even
more scared -- before the decision had
really been made for us.
Without an appt, my mom took me to my
OB's office first thing the next
morning -- I was crazed with fear and
hope. He called the MF specialist
again and scheduled us for a formal
consult and u/s with him in his office
the Tuesday after Memorial Day -- I
would be 19 wks 2 days by then, so
decisions would have to be made very,
very quickly after that.
After the U/S that day showed two
pockets of fluid again (this group
measure fluid differently w/multiples,
but basically we were looking for AFI
of 3 and 2 to 3 pockets)MF Dr told us
that there was really nothing in
medical literature about Twin B PPROM
outcomes -- nearly everything was
based on singletons and Twin A, and
those outcomes generally were dismal.
However, he also said we were in
unchartered territory and the only
thing a Twin B reduction would do
would be to give us CERTAINTY that
Twin B wouldn't be born with lungs
unable to support life. Nothing we
could do could protect Twin A at this
point. All evidence-based medicine
supported that. Once there is a
membrane rupture, even the reduction
of Twin B doesn't eliminate an open
membrane for bacteria to infect. And
the PTL risk also wasn't cut by a
reduction, except slightly as it
relates to the higher risk of PTL in
any twin pregnancy vs. a singleton
one. With this pregnancy, if PTL
began, there would be no stopping it.
On top of it all, even tho this was so
rare, this high risk group had another
patient with EXACTLY the same Twin B
issue right now with a rupture very
close to mine in gestation, and she
was now 8 wks further along and doing
well (her story is also on this
board!).
We talked to him for 2 hrs, and went
home having to make an even harder
decision now. We talked and cried the
whole way home and before we even
reached our house, we had reached the
same conclusion -- keep both babies
and take a leap of faith. We had
fought so hard just to get pregnant,
and now no doctor could say with all
certainty that Twin B wouldn't
maintain the fluid even at borderline
levels thru the rest of the pregnancy.
We weren't naive that we don't know
what it feels like to lose a full-term
child, but even with 50-50 odds on
Twin B, we were going to take the
chance, as those were awfully high
odds everything would be ok. At 19
wks, 3 days, at my OB's urging, we
officially moved our care to the high
risk group for the duration of the
pregnancy.
At first, they hoped we'd get to 24
wks when perhaps one of the boys could
survive... then 26... then 28 (they
liked those even numbers, tho we knew
every day counted). The leaking
stopped around 23 weeks. We went in
every 2 weeks until 26 wks for growth
u/s's, then every week, then twice a
week for NST and biophysical profile
at 30 weeks with a growth u/s thrown
in every 2 wks.
When I hit 28 wks, I cried with joy --
at 32 I wanted to throw a party. At
30 weeks, they started monitoring for
Intrauterine growth restriction, b/c
Twin B's growth had slowed. Despite
signs of IUGR, they felt it wasn't
severe and the prospect for Twin A
were best if we kept going. At 34
they actually told me I could stop
bedrest and resume moderate activity --
no work or lifting or whatever, but I
didn't need to be cooped up b/c at
this point, anything further was
gravy! We still watched the IUGR
closely.
At 35 wks, 4 days I had another gush,
and went to the hospital, but the
tests came back negative for amniotic
fluid and u/s was ok. They said I
must have mistaken my bladder for the
water breaking... ok, but it felt an
awful lot like what happened at 16.2
weeks!
At 36 wks, 1 day, my NST and
biophysical profile was fine and I was
scheduled for a c-section exactly one
week later, but a few days later I
started to worry and at 36 wks, 4 days
I couldn't stop crying with fear
something was wrong. I was so scared
that I actually thought about writing
a note to my 2-year old daughter about
the things I wanted for her in life. I
felt pretty positive something wasn't
right, and I wasn't sure if it was
with me or with one of the babies. The
MF dr told me to meet him at the
hospital -- I think he thought I was
having a nervous breakdown. I actually
drove myself since my mom was sick and
my husband was at work in the city!
Well, I wasn't crazy. When I got
there, Twin B's heartrate was down to
90. They turned me on my left side
and it stabilized at 140 after a few
min, but after I got up to to the
bathroom, it went back down to 90.
Left side did the trick again. After
an hour, I asked to move onto the
Right side for just a few minutes of
relief... HB back down to 90. Anyhoo,
things moved very very fast at that
point and my two sons were born by
emergency c-section a minute apart
within the hour. Twin A (Joseph
Fletcher) came out first and I laughed
when I heard him cry -- I was so happy
but still so nervous. I didn't get to
see him before they whisked him to the
peds team but my OB (who scrubbed in
with the MF specialist since he was at
the hospital that day) sqealed with
delight that he was peeing on him.
Then, they said Twin B (Payton
Colorado) was out and I heard him cry
out -- I think the whole room (and
there were A LOT of people in there)
cheered. A nurse brought him around
to me very quickly before running off
to the peds team, and I realized they
let me see him in case....
BOTH BOYS ARE PERFECT!!!!! Joe was 4
lbs 15 oz and Payton was 4 lbs 3 oz --
tiny but healthy. I went home after 5
days and THEY DID TOO!!! Payton (Twin
B) only had normal premie issues with
jaundice and heat retention -- but
since it was c-section those few extra
days I was there meant they could come
home with me. We had to take them to
the pediatrician the very next day and
3 days after that, but all was and is
well.
I know this scenario won't play out
for everyone on this site, and I used
to read the many unhappy endings here
as well as the happy ones just to
manage my own expectations and be
realistic. But, maybe there will be
other women in a similar Twin B
rupture situation, and I hope my story
(as well as the other one here) allows
you to hope if you decide to move
forward.
--Blair
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