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Growth Disparity between DCDA Twins and Positive Outcome Stories (long)

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Rememberallball Sun 30-Jun-19 18:32:37

Hi there, first time on multiple birth section. Apologies as this will be long.

I’m currently 26+3 with much longed for IVF DCDA twins. Donor egg conception using icsi. DH sperm used. He is 50 I am 47.

Since 20 weeks I’ve been having scans every 2 weeks - was booked for 4 weekly growth scans plus ANC as per RCOG guidelines for DCDA twins but has happened like this......

20 weeks anomaly scan - unable to visualise all structure of hearts/vital arteries for both twins due to positioning so booked for repeat scan at 22 weeks. Also it was noted that, while twin 1 was growing appropriately and following approx 50th centile, twin 2 had abdominal circumference <5th centile and femur length on 6th centile. Twin discrepancy rate of 20.1% so referred to fetal medicine consultant.

21+5 - repeat anomaly scan - twin 1 fine on remaining structures to be identified. Growth not measured. Twin 2 head circumference now on 8th centile (had been on 70th at previous scan); abdominal circumference remained <5th centile and femur length on 8th centile. All remaining structures identified and normal.

22 weeks (so 2 days after repeat anomaly scan) I saw fetal medicine specialist ho did full measurements again. Twin 1 measurements good, plotted approximately on 50th centile, weight around 452g. Doppler studies and liquor volume measured within normal ranges.
Twin 2 head circumference on 21st centile; abdominal circumference on 11th centile and femur length on 7th centile. Plottedapproximated 15th centile so better, and weight around 386g. Doppler studies and liquor volumes measured within normal ranges.

Consultant opinion was twin likely healthy (though unable to rule out chromosomal abnormality without amniocentesis but, at that time, not advised) but probably naturally smaller. Plan to refer back to regular twin clinic and continue 4 weekly growth scans.

24 weeks growth scan - twin 1 growth good though measuring on 32nd centile for weight at 663g. Doppler studies fine as was liquor volume. Twin 2 head circumference now down on 12th centile; abdominal circumference 41st centile but femur length down on 7th centile. Weight 569g and plotting on 9th centile. Doppler studies and liquor volumes measurements ok. Fetal discrepancy rate measured as being 14%. Referred back to fetal medicine team/small for gestational clinic and told will be scanned every 3 weeks after initial appointment in 2 weeks.

Which brings us to most recent scan/appointment.

25+6 growth scan by fetal medicine consultant. Twin 1 growing well with approximately 260g weight gain in 2 weeks and measuring just above 50th centile for weight. Doppler studies and liquor volumes remain good. Twin 2 now measuring head circumference approx 30th centile; femur length approx 7th centile and abdominal circumference now under 5th centile as is weight with a gain of just 83g. Liquor volume and Doppler studies both normal. Both twins seem to be coping with things as they are at present so no need to rush into intervention.

Consultant brilliant and had long discussion with us. Risk of very preterm labour as a result of carrying out double amniocentesis outweighs benefit of having results at this point so not advised for now. She believes possible placental insufficiency is the cause of continued poor growth of twin 2 (most likely related to my age!) and her plan is to now do scans every 2 weeks and keep me on a very low threshold for increasing scan frequency.

I am also doing blood glucose monitoring for a week to rule out GD (because of previous weight loss surgery I can’t do standard OGTT so have to test capillary blood 4 times daily). This is in case GD is affecting placenta function. They will also have a very low threshold for starting treatment if results indicate GD - though, so far I’m doing ok on that front.

I’m not even sure why I’m posting other than to offload and ask for positive stories from other mums who have had similar issues during pregnancy and now have healthy twins.

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