28 Weeks

The first bumps in the road shook what seemed like our perfect world at a routine 28 week growth scan. Both boys were measuring smaller on the growth curve than in prior scans – dropping off from 35% (18 weeks) to 25% (25 weeks) and at 28 weeks, down to 15%. More alarming was that their abdominal circumference, one of the three measurements used in estimating weight (head circumference and femur bone length being the other two), was only in the 4^th %. That means that only 4% of all fetuses of the same gestational age have smaller abdominal measurements than my boys!  In addition, baby B’s heart Doppler came back abnormal – this is a special type of ultrasound that shows the volume and direction of blood traveling through the umbilical cord and is an important influencing factor on how much oxygen/nutrients (carried by blood) the baby is getting. Therefore, it could partially explain why baby B was a bit smaller than A (2lb 1oz vs 2lb 4 oz). He had what’s called Low End Diastolic Flow (LEDF). A little lesson on how the placenta works in relation to the mother’s heart:  when my heart is beating, blood is pumped to the twins’ placentas (systolic flow) and when my heart is at rest in between beats, the reserve blood that was left in the vessels continues to flow to the placentas/cords just at a slower rate (diastolic flow). Picture turning the water faucet on and off real fast – even when it’s in the off position, some leftover water will still be coming out – that’s diastolic cord flow. What LEDF meant for our baby B was that he just wasn’t getting as much excess flow in between beats as he should have been. It was an early warning (yellow flag) that something was not working as it should in the placenta.  Thankfully, my boys are di/di twins meaning they are in separate sacks and have separate placentas, so each could be treated almost as a separate pregnancy.

The doctors were trying to keep us calm about the overwhelming amount of scary and new information hitting us like ricochet bullets. I was immediately strapped on to the non-stress test machine (“on the monitor”) to see if the babies were in distress and if their heartbeat patterns were indicative of any other issues. Of course, the stress and crying brought on a wave of Brackston Hicks contractions and I felt like I was barely holding on to my sanity and could lose grip at any moment. A panel of blood tests were run to rule out preeclampsia, a high blood pressure condition during pregnancy. Everything came back normal… The doctors explained that this is a relatively new issue that they were able to identify in the last 5-10 years in multiples pregnancies, which meant they didn’t know a whole lot about root causes or how to treat it. I was sent home on strict home bedrest, with orders to start counting calories to make sure I hit 2,500 kcal a day with 150 grams of protein minimum.  I was also to return to the office twice a week for ongoing Doppler studies on baby B’s cord flow.

And just like that, 2 weeks of dreaded home bed rest went by while B’s diastolic cord flow remained low. M took care of me, the pets, cooked, did laundry, etc.  I thought back then how hard it was to be confined to a bed all day for someone who used to be so active and ran a household in perfect routine order. I had to let go of my control freak antics and get over how M folded laundry and how he loaded the dishwasher. Those little things seem so trivial now, but back then they were a total thorn in my side! I was still working from home on my laptop, so it was a welcomed distraction from googling LEDF risks.

At 29 weeks, M and I had our “practice run” to the Labor & Delivery unit due to frequent contractions that just wouldn’t slow down. We had a FFN (fetal fibronectin) test done which tells the doctors if the protein that holds the sacks attached to the uterine walls is breaking down and leaking out. This test is an indicator of whether the body is preparing to go into labor in the next 2 weeks and is 99% accurate. For me, it was negative which was good. I got a shot of terbutaline, a soft tissue relaxer, to knock out contractions + 2 bags of fluids via IV and we were back home within 4 hours.  Since that trip, frequent contractions have been the norm even with home bed rest – I just knew my small torso was struggling to accommodate 2 growing boys and every little kick from one of them sometimes was enough to trigger a wave of uncomfortable uterine contractions.