From the top part 2: Monochorionic Monoamniotic diagnosis

JUNE 2005

Ian took the time off work to drive me 75 miles to OHSU in Portland for my first Peri appt. on June 14th. Little did I know then, we'd be making that drive countless times. OHSU is like a Mecca. It is a teaching hospital, so it is absolutely HUGE! They specialize in many things, and have our state's best Children's hospital; Doernbecher's. That is where my new Dr. was located.

Our first appointment was extremely long. We had our ultrasound with a very good and experienced technician. She took her time looking, checking over and over for even a slight hint of a membrane. It was obvious that there was none. At that point I was just 11 weeks along, so the babies weren't very big. But you could already see so much. After about 45 minutes of the technician looking and taking pictures of the images, she then left the room to get the Radiologist. When the radiologist came in, the whole mood of the room changed. It was more sobering. She then explained that she'd like to take a look at the babies herself. After checking for a while, she then started to explain her findings. She was certain that our pregnancy was infact a mono-mono twin gestation. She also thought at one point that the twins may have been conjoined. She had to probe them several times with the ultrasound wand to make them move apart from eachother... (apparently they liked to cuddle). When she gave us her diagnosis she asked us if we knew what monochorionic-monoamniotic meant. Of course we did from having already having a tentative diagnosis, and the research that I did on the internet. We were definitely fully aware.

Two hours from the start of the ultrasound we finally met with the Peri. Dr. Tolosa. He was a very nice man. He told us in laymans terms what we were in for. He gave us a lot of statistics, percentages of success, and again told us how extremely rare and high risk this pregnancy was. He also explained how rough it was going to be to manage. He said if I could make it to 24 weeks I should be hospitalized for constant monitoring. Delivery would happen by 32 weeks gestation, which is as far as mono-mono twins can safely be carried. There were so many risks of fetal death of one or both babies, especially as they grew. The bigger they got the more the likelihood of a "cord accident" resulting in losing one or both. The cord placement in the placenta was crucial, and was monitored closesly. In mono-mono twins the cords are often implanted in a very weak area. And with the babies sharing one small planenta there may be complications with the twins being malnourished in the womb.

At the end of the initial consultation, Dr. Tolosa mentioned that we could choose to terminate the pregnancy since the risks were so high. Ian & I knew that was not an option for us. We believed that these babies were given to us for a reason. Whatever the outcome they were ours.

The pregnancy from that point was managed by my O.B. here and the team of specialists @ OHSU. We were seen every 2 weeks by one or the other. Going up north once a month for the first 20 weeks, and being seen by Dr. Hovey once a month as well. Every appointment entailed a very long detailed ultrasound checking the babies' growth & development but mostly checking their cords for tangles, and knots. The ultrasound machines could detect the blood & oxygen flow through the cord. I learned so much I probably could have used one of those machines myself. We were able to find out the sex of the babies at around 16 weeks. I was a little bit hesitant at first to find out, because in a way I didn't want to get attatched to them out of fear. We were thrilled when during the scan the tech said it's GIRLS!! My dream of having a little girl was coming true times 2. Fortunately things went pretty smoothly until about 20 weeks. That's when all the action started.