Lucas and Cole Merriam

First post: Oct 19, 2017 Latest post: Apr 13, 2018
Back in June Mike and I found out we were expecting our first child. At our first ultrasound we were beyond thrilled to find out we would be having identical twins. 

On September 5th when the babies were diagnosed with Stage 2 Twin to Twin Transfusion Syndrome. 

Twin to Twin Transfusion Syndrome (TTTS) is a disease of the placenta that affects identical twin pregnancies. The shared placenta contains abnormal blood vessels, which connect the umbilical cords and circulations of the twins.

The transfusion causes the donor twin to have decreased blood volume. This in turn leads to slower than normal growth than its co-twin, and poor urinary output causing little to no amniotic fluid.

The recipient twin becomes overloaded with blood. This excess blood puts a strain on this baby’s heart to the point that it may develop heart failure, and also causes this baby to have too much amniotic fluid from a greater than normal production of urine.

These cases are the most serious because the babies are immature and cannot be delivered. In addition, the twins will have a longer time during their development in the womb to be affected by the TTTS abnormalities. Without treatment, most of these babies would not survive (85-90% mortality rate) and of the survivors, most would have handicaps or birth defects.

Stage 1: There is an imbalance of amniotic fluid, with a small amount (8cm). The twins are often more than 20% different in size.
Stage 2: The bladder of the donor twin is not visible or it does not fill with urine during an ultrasound exam.
Stage 3: The imbalance of blood flow starts to affect the heart function in one or both babies. This is seen in abnormal blood flow in the umbilical cords or hearts of the twins.
Stage 4: The imbalance of blood flow causes signs of heart failure in one of the twins.
Stage 5: One or both of the twins has passed away from severe TTTS.

In cases of TTTS of Stage 2 or higher, at approximately 16-26 weeks of gestation, surgeons use a laser to block the blood vessels that communicate between the two fetuses. The surgeon inserts a pencil-tip-sized fiber-optic scope in the mother’s uterus and examines the entire placenta to find the crossing blood vessels. Once these are all mapped, a tiny laser fiber is inserted and laser energy is used to stop the blood flow between the twins. Separating the twin blood flow is like functionally separating the placenta, allowing each twin to develop independently.

The survival rate for this surgery is 60% for both twins and 80% for one.

I had my inter uterine laser ablation surgery to fix the issue on September 7th down at the Mayo in Rochester. All looked good going forward.

On Monday, October 16th we had a routine ultrasound scan. The care team noticed that the water of Baby A broke at some point in the last week.

I am now on hospitalized bed rest for the next 12 weeks at the U of M Children's Hospital in Minneapolis where I will hopefully get too 34 weeks (Jan 8 delivery) if all goes well.

The milestones we need to hit are 24 Weeks, 28 Weeks, and so on, but every day is a day closer which is huge in terms of growth. Regardless of when the babies will be delivered the boys will be in the NICU.

We have been surrounded by such a wonderful support system, and I will continue to update this as the days go on. 

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