Anyone have twins without Sonogram? - Mothering Forums

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Old 03-16-2007, 07:28 PM - Thread Starter
 
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I am 9 weeks pregnant and am measuring about 15-16 weeks. We would really like twins and actually prayed that we would have them. We are suspecting twins. This is my 4th pregnancy but I have never measured large.
Anyways I am just wondering if any of you were diagnosed with out an ultrasound. I have been a bit cautious about them in the past and am not sure I want to have one now.
I do realize though that if we are having twins I need to know because I plan to go on the Brewers Diet for twins.
Thanks for your help.
Charlsie
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Old 03-17-2007, 01:05 AM
 
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I would say you have a good chance with how far ahead you're measuring. I suppose some people could be diagnosed without an ultrasound (like hearing two distinctly different heartbeats), but I think it's best to be diagnosed by ultrasound. Early on, they should be able to tell you whether they are monochorionic or dichorionic (1 or 2 placentas). Your monitoring will...or at least should...be different depending on the type of twin pregnancy.

Let us know what you decide!

Melissa

twins due May 07
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Old 03-17-2007, 01:09 AM - Thread Starter
 
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Thank you so very much for responding. I have been lurking for awhile since I have hoped for twins but obviously have so much to learn!!!! I will let everyone know when we have a bit more concrete information.
Oh and another question....so later on it is harder to tell if they have their own placenta?
Thank you, Charlsie
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Old 03-17-2007, 01:31 AM
 
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I think the ideal time to see if it's one or two placentas is around the 11th-12th week (if my twin-addled memory is correct). If it's one, you are at risk (a real risk, imho, not the risk that surrounds a lot of pregnancy talk in the medical world) for developing something calls TTTS (twin-to-twin transfusion syndrome) -- something like 20 percent? of all di-mono pregnancies end up with it? (hmmm... I used to know this stuff better!)

In any case, if it is one placenta, by monitoring the babes and your fluid levels, etc., they can see if it is coming on and, if needed, induce or take the babes early (otherwise, it can kill one or both babes). Also -- just knowing if it's one babe or two can impact a lot of choices -- how much you eat and drink, what kind of preparation you do before the babe/s come, lining up support (from food to breastfeeding support), etc.

I think a lot of times u/s are overused, but in this case, if you truly suspect it could be twins, I think it is a wise choice for your health and the health of your babe(s) to find out. It can provide you with REAL information and allow you to make informed choices -- not just curiousity, etc.

Just my 2cents of course And congrats on your pregnancy! LEt us know what you decide and what you find out!
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Old 03-18-2007, 01:08 AM - Thread Starter
 
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Ok well you have convinced me. I think I am going to meet with a midwife to get my measurements again and then schedule an ultrasound for 11-12 weeks since someone said that is a good time to see if they are sharing a placenta or not.
After that is all done hopefully I will be back with some good news!
Charlsie
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Old 03-18-2007, 06:20 AM
 
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I self-diagnosed at 11 weeks. Went in at 12 weeks to make sure I wasn't crazy OB said that 12 weeks is ideal to see placentas, thickness of shared membranes, etc. After that, can't really tell. Sharing the placenta isn't as big of a deal. Sharing the same sac is.

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Old 03-18-2007, 01:29 PM
 
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Actually the risk is only 10-15% but if they get it it has a high mortality rate. More serious still is if they also share an amniotic sac. The risk for Mono/mono twins to get TTTS is far greater then for Di/mono twins and the risk of death for one of more twins due to cord entanglement or compression is huge if untreated. I'd personally go for an ultrasound earlier as even at 12 weeks you can't really see the chorianic sac very well, but usually by 12 weeks you can see the membrane between the twins if they are monochorianic. We were diagnosed monozygotic at 7.5 weeks and diagnosed Di/Mono at 12 weeks. We are getting ultrasounds every 3 weeks to check the babies for TTTS.

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Old 03-18-2007, 01:57 PM
 
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Originally Posted by MamaRabbit View Post
Sharing the placenta isn't as big of a deal. Sharing the same sac is.
I have to respectfully disagree -- sharing the placenta is a HUGE deal. TTTS is a very real concern for the approximately 20% of the mono/di twins who end up with it. My twins had TTTS and the pregnancy was a nightmare. The mortality rate for one or both twins is 80%. The rate of complications with surviving twins is extremely high: cerebal palsy, developmental difficulties, mental difficulties. TTTS can go from stage 1, where its manageable, to stage 4, where one twin is dying/dead, in a matter of days. Although my pregnancy was not difficult, I was constantly worried about my babies and constantly waiting to see if today would be the day the "donor" twin would not have enough amniotic fluid for his kidneys to work; or that today would be the day the "recipient" twin would have a heart attack because he had too much blood and fluid in his sac. I am very grateful I made it to 34w before it became obvious that the donor would do better if he were no longer inside me -- many cases of TTTS are born incredibly prematurely. I just watched a show on Discovery Health where a set of TTTS twins were born at 25w because one baby was dying. An old friend of mine lost her recipient twin when he was 2 days old.

With subsequent pregnancies, I will always have a quick u/s just to make sure that if I am having twins again they are not sharing a placenta. I would want to know so that I can make informed decisions (as someone before mentioned).

There is also someone on this forum who has mono/mono twins and that is a whole other set of complications too.

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Old 03-18-2007, 02:49 PM
 
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I know it's not good at all. Just from what I've studied, it seems that while shared placentas is a big risk, it just seems that shared sac (mono-mono) is more. I do understand where you're coming from though!

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Old 03-18-2007, 03:06 PM
 
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The reason mono mono twins are higher risk is because not only are their cord dangers but there is also a higher risk of TTTS. Both have high mortality rates. The thing with TTTS is if caught early enough it can be treated with laser treatment to sever the connections between the two sides of the placenta, or to do amnio on the recipient twin. In either case the babies usually need to come early to save their lives. I believe mono monos usually need to come no later then 32-34 weeks and usually by c-section because the risk of pulling a knot tight on the second twin's cord is so high.

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Old 03-18-2007, 04:01 PM
 
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Originally Posted by fyrebloom View Post
The thing with TTTS is if caught early enough it can be treated with laser treatment to sever the connections between the two sides of the placenta, or to do amnio on the recipient twin.
This is a gross over-simplification of chronic TTTS -- and you haven't even mentioned accute TTTS.

First of all, not all cases are candidates for treatment. My twins stayed in stage 2 for my entire pregnancy, and although it was serious enough to warrant bedrest and a bio-phys u/s twice a week, it wasn't severe enough for any treatment. Also, catching it early is usually not a good sign -- typically, the earlier it is diagnosed, the more severe it becomes. And then there are some cases that, even when diagnosed early, are too severe for treatment. There's a whole range of chronic TTTS.

Now, accute TTTS happens right before birth and is very serious, and there is no treatment except for birth. I believe the statistic from Dr. De Lia is that chronic TTTS leads to more deaths and accute TTTS leads to more developmental disabilities.

TTTS is almost only in mono/di twins. There are a zillion other issues with mono/mono twins, but TTTS is rarely an issue in mono/mono twins. More info on mono/mono twins.

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Old 03-18-2007, 06:27 PM - Thread Starter
 
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Wow ya'll have be a bit nervous! But I think it is better to be informed than not. We lost our last baby 9 months ago at 32 weeks. I contracted Hep A and then ICP and the combination left untreated because of an incompetent Dr. caused our baby to die. We want to be as informed as possible this time so I really appreciate your input!!!!!
I guess by force there has to be a bit more intervention in twin pregnancies than in singleton ones.
Like I said we will get the ultrasound in about 2 weeks and then go from there. I look forward to lurking and learning till then!
I am really excited about the prospect and can't wait for it to be confirmed by ultrasound
Charlsie
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Old 03-18-2007, 06:32 PM
 
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Mono mono twins happen in less 1% of monozygotic twins and this the vast majority of cases of TTTS are found in mono di twins which is the largest percentage of identical births. I'm not trying to make light of TTTS! I was just on http://monoamniotic.org/public/welcome.shtml and I was mistaken. Mono monos are just as likely to get TTTS as mono di's, but since they share an amniotic sac they have to rely on size discrepency to diagnose because the donor twin still gets amniotic fluid (and so by the time it's diagnosed it's become more severe ttts). My OB said that it is more common with mono monos because the splitting is less complete and thus more likely to cause more connections between the two sides. This would mean a higher incidence of TTTS but I haven't found anything online to substantiate the claim.

ANYWAY this is really off topic so mexicomommy I appologise for hyjacking the thread. Yes get the ultrasound JIC. I think we've illustrated all the nasty stuff associated with with twins, esp if they go undiagnosed.

Lucia , Poly )O( Lactation Counseling mama lady.gifvbac.gifto 5 yo Goobersuperhero.gif and 3 1/2 yo MZ twins twins.gif Peanut and Sweetpea and 1yo Pumpkinbabyf.gif mmm placenta.gif
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Old 03-18-2007, 09:08 PM
 
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I have opted not to have an ultrasound, and I'm 22 weeks along. The primary reasons I opted out are because a) I felt myself ovulate from both ovaries (thank you, mittelschmertz + charting), b) I felt where the implantation was 10 DPO. I knew that whatever eggs my ovaries released would be fertilized (intuition), and I knew from the implantation pains that, if there were only two eggs that were fertilized, they were dizygotic.

I decided to wait it out, and at 10.5 weeks, I felt them kicking and could pinpoint where they were from that (on completely opposite sides of my uterus, correspondant with where I felt the implantation pains).

They have been palpated, and there are only two definable bodies in there.

Because my body gave me lots of different signs that all added up to biovular dz twins, I was 99.9% certain that there was zero risk of TTTS. I feel comfortable with opting out of the u/s because of this.

IF I hadn't had these signs, and the only thing I had to go on was weight gain or early showing (this is my first pregnancy, and those tend to show later than earlier), I would likely have gotten an ultrasound to rule out mz twins and TTTS.
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Old 03-19-2007, 12:23 AM
 
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Wow ya'll have be a bit nervous! But I think it is better to be informed than not.
I think it's good to know you're having twins because then you can change your diet accordingly.

Quote:
I guess by force there has to be a bit more intervention in twin pregnancies than in singleton ones.
BUT, I totally disagree with this. You have a choice with what tests, U/S, if any prenatal care at all. It's up to you.

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Old 03-19-2007, 01:01 AM - Thread Starter
 
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Mamarabbit I see we have the same occupation! I guess I say "more intervention" as in a few ultrasounds and things like that. I have never had anything besides very basic midwife care so any intervention, even an ultrasound is a lot. I still definitely plan to refuse tests and such, maybe get bloodwork done. We will see.
This is a bit hard for me because while I really dislike most intervention we lost our last baby for lack of care from the dr/midwife I was seeing. So I do want to err on the side of caution but not to far. I feel like I am walking a fine line while still trying to be true to what I believe about pregnancy and birth. I am still trying to figure many things out. At this point we still do not have a midwife, because it is hard to trust people after what happened before, and we also do not know if we will have this baby/babies here in Mexico where we live or in the USA.
Ok sorry to get off on all of that, I really do appreciate all of your opinions and guidance, and support!
Charlsie
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Old 03-19-2007, 01:13 AM
 
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My grandmother had my dad and uncle in 1954- no sonograms back then. The story goes that no one had any clue she was having twins until they were born. It must have just been assumed she was having a large baby, or they didn't know fundal height measuring ahead meant twins back then. Grandpa says the nurse came out and said "come and see your SONS" And they were born vaginally as well, C-sections were extremely rare and dangerous back then ( but they did happen, MIL was born c-section in the 50's )
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Old 03-19-2007, 01:29 AM
 
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I decided I would not be classified as "high risk." I had a quick u/s at 12 weeks to make sure I was having twins (self-diagosed at 10-11 weeks). Did not do another appointment until last week at 20 weeks. Did all of the blood work that I specifically asked for, and I did want to know gender while he was doing a quick u/s. Other than that, I'd done all of my own prenatal care anyway. And will do. For me it's checking my own blood pressure, heartrates, urine, weight (I have a hard time gaining), fundal height. I do want my iron checked a couple more times, but I can go to a clinic for that.

I refuse to do any other test because there are so many false positives AND even is something is "questionable" that could change the whole standard of care. So far, my OB hasn't mentioned I've skipped appointments, but he does know that for me, "less is more." I highly doubt he would drop me from care... he'd only do a C-section anyway, which pays him a lot. So he's there if I need one... which I highly doubt.

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Old 03-19-2007, 01:44 AM
 
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TTTS is harder to diagnose in Monoamniotic pregnancies, but it does happen and some studies say it happens at the same rate as MoDi twins. In Monoamniotic pregnancies you can't monitor for TTTS as easily, so that's why it wasn't thought to be as common.

My first daughter was an unplanned section after 32+ hours of laboring with ruptured membranes. When I got pregnant again, I was very set on delivering at The Farm in Tennessee and likely would not have had a single ultrasound. However, my DH requested that I just check out the VBAC friendly OB in town first since I liked the interaction with him at the birth of our first.

I was breastfeeding and had not gotten my period back, so I was unsure of dates and agreed to a quickie dating ultrasound in the office. Shocker of all shockers, there were two babies and they could not find a dividing membrane with their machine.

From there, we were sent to the head of maternal fetal medicine at our university hospital and confirmed Monoamniotic at about 14 weeks. The rest is a long story, but indeed one that has cemented in my head that in the case of twins, a quick ultrasound to determine placenta sharing and a membrane (or lack thereof) is beneficial, and not a just another meaningless medical intervention.

If there is a suspicion of twins, I urge anyone to go for at least one ultrasound. After the all clear, go for an unassisted, home, VBAC birth if you wish and I'll be cheering you on! I'm a very staunch supporter of women's rights in childbearing, but I do think there are times that the medical community has something of great value to offer us.
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