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Motherhood TTTS Pregnancy

TTTS Pregnancy Update: Week 25 + Second Amnioreduction

April 16, 2018

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Another whirlwind week! I’m well into my 25th week in this complicated pregnancy and of course, the further along I get, the better I feel about things (survivability should anything go wrong, etc).

Having a high-risk pregnancy like this can be so stressful and this one truly is, especially as a first time mom who doesn’t know what to expect at all! But, I’m also glad we don’t have other kids that need my attention and care and that I can solely focus on healing and growing these 2 babies for now.

AND of course our amazing MFM team at BC Women’s Hospital who go above and beyond.

TTTS Pregnancy Update Week 25 - Amnioreduction

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TTTS Pregnancy Update: Week 25 with Mono Di Twins

Another rollercoaster week! Both twins continue to develop well, though an echocardiogram at the beginning of this week showed “some concern” to the doctors that my TTTS recipient twin (B) was beginning to show signs of heart stress (which leads to fetal heart failure in TTTS).

I was so worried of course, but my main doctor put my mind at ease that it was just in the high end of normal for now. Fingers crossed it stays that way!

I had my first amnioreduction on March 29th to treat the symptoms of TTTS. Amnioreduction does not cure or treat the disease, only relieves symptoms. The goal of amnioreduction is to prevent preterm labour (from distended uterus due to fluid imbalance).

It’s commonly used in people like me who have Stage 1 TTTS and are nearing the Week 26 cutoff time for the TTTS laser surgery. Most surgeons will not perform the laser surgery after 26 weeks as the risks outweigh the benefits at that time, though each case is different.

In my case, with a tricky anterior placenta, unusual membrane location and marginal cord inserts, they felt laser would not be successful for me and that amnioreduction was the best course of action.

Oh, just for fun, here is a comparison photo of my belly taken just ONE DAY apart. On the left, the morning of the procedure. On the right, the day after the procedure with fluid removed!

TTTS Pregnancy Update Week 25 - Amnioreduction

So anyway, my first amnio took off 2.1 litres of fluid from Baby B, reducing his DVP (deepest vertical pocket) from 14cm down to about 10cm. (Once again, normal range is anywhere from 2-8cm.)

A week later, it was back up to 12cm. A few days later, 14cm again. A second amnioreduction was brought up and scheduled for this past week (April 12th – 2 weeks exactly from the last one).

When I showed up for my second amnioreduction and got admitted, they did an ultrasound and found a DVP of 19cm (!!!) on Baby B. This was only 2 days after the last scan showed 14. Yikes.

The Second Amnioreduction Compared to the First

I will say my experience with this amnioreduction was a little different than the first. Not necessarily better or worse, as both teams of doctors were excellent, but just different.

I did very much appreciate that my main surgeon adjusted her schedule to do the procedure as she said she wanted to do it this time. I feel very comfortable with her so it was nice to know she’d be the one doing it.

The pain was about the same – I mean, it’s a needle going all the way into your uterus, so yeah, that sucks.

This time, however, we drained 4.2 litres – DOUBLE the last one!! So, the pain near the end got to be quite a bit from all the contractions my uterus was doing (the procedure “irritates” the uterus).

They offered me fentanyl and I did take it this time, but honestly didn’t feel it had any effect. I still felt the same level of pain and did not get sleepy like they said I would. So I dunno if I just had too much adrenaline going at that point to feel it or what? But anyway, I felt kinda bad for saying yes to such powerful drugs at only 25 weeks pregnant… but damn, that pain was intense.

Let’s just say don’t judge another mama’s choices until you’ve walked in her shoes. 😉

One fun part of this reduction was how many people were in the room. My surgeon teaches a lot (this is a teaching hospital) so she had a resident in there who was witnessing the procedure for the first time, and she explained everything to them as she was doing it.

Then there was another surgeon holding the needle in, an ultrasound tech, like 2-3 nurses, another student observer and of course, my husband. The mood was really light and there was a lot of chatter going on which I think helped distract me from the pain too and made me feel at ease (as opposed to the very quiet room last time).

My husband even handed them the new drainage bottles from a nearby cart. Someone joked they should hire him.

But yeah. 4.2 LITRES of amniotic fluid. Do you want to see what that looks like? Probably not, but here is what it looks like:

TTTS Pregnancy Update Week 25 - Amnioreduction

This is amniotic fluid. Sorry if I ruined white wine for you forever.

 

I literally felt my belly shrink on the table as they were doing the procedure. It was sooooo weird.

I feel much better afterwards, and most importantly, we got Baby B’s DVP down from 19cm to 8cm!! That means there is less pressure around him for now and should give his heart and organs a break.

Again, amnioreduction does not treat the underlying problem (TTTS), so the fluid will come back. It’s just a question of how quickly. I’m hoping for at least 3 weeks this time! Undergoing 2 amnioreductions in 2 weeks was not great.

Aftercare for My 2nd Amnioreduction

Recovery was a little rougher for this one, which is understandable considering they took twice as much fluid! I continued to have regular pre-labour contractions for 3-4 hours after the procedure and stayed in the monitoring room hooked up to fetal monitors for that time.

There was some concern this could turn into full-blown labour, so they watched me very closely. The nurse was not allowed to leave the room!

It was also quite painful, not like full on labour but like really, really, really bad period cramps every 5-8 minutes.

Oh! But, as I was recovering, these massage school students came around asking if people wanted free massages. REALLY. Can you believe my luck? I was like YAAASSS.

TTTS Pregnancy Update Week 25 - Amnioreduction

OK maybe the fentanyl did have an effect, or maybe it was just this Snapchat filter.

 

Eventually, my uterus settled down a bit but I still experienced regular contractions all through the next day. I stayed overnight at the hospital and didn’t sleep well. I woke up at my usual 6am puke time and vomited (thanks, heartburn), which felt extra sucky with my sore and tender belly!

I went home later that day and continued to have regular Braxton Hicks (no pain) contractions for all of Friday and Saturday. As of Sunday, they have calmed down a lot though am still getting some irregular ones here and there.

I am really hoping to make it to at least 28 weeks before delivering these twins!! Of course, would be great to get to the 30s…

I’m very thankful for our care team at BC Women’s Hospital. They are truly amazing and are the reason these twins are still doing so well! Just going day by day and hoping that continues.

Also their breakfast menu is really quite good!

TTTS Pregnancy Update Week 25 - Amnioreduction

I bet they get the most random orders from pregnant women.

 

As for me, I’m taking it easy for another few days and avoiding anything strenuous (although I am doing laundry and house stuff and getting the nursery ready… just no lifting or anything difficult!). My husband has been amazing and cooked most of our meals the last few days, brings me things, is taking care of walking the dog, and lots of household chores I give him.

I have a followup appointment on Tuesday to check the twins, when I’ll be exactly 26 weeks, so I’m hoping fluid stays low. 🤞🏼

Have any of you had repeat amnioreductions? I’d love to hear your experience… especially if you’ve done 3 or 4 of them as it’s looking like that’s in my future!

  • Reply
    C Eastman
    April 22, 2018 at 8:08 am

    I had two laser ablation surgeries with amnioreductions a week apart when I was expecting my triplets and was diagnosed with stage 3 and (the next week) stage 4 TTTS. The week after that, my recipient got a fetal blood transfusion, and the week after that I went into spontaneous labor at 27 weeks. All 3 babies are healthy with no long term medical issues and are currently crazy off the wall 2 year olds! This surgery was a miracle, and so glad things went well for you!

    • Reply
      Michelle
      April 22, 2018 at 10:00 am

      Wow, 2 lasers! That sounds like a crazy journey and so scary, but I’m glad your triplets are all okay now. Yeah I am a little worried as I couldn’t get the laser but so far things are going okay. The treatments developed over the past 10-15 years are truly lifesaving for this condition and I am so glad they exist! 🙂

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