Pressured into being induced? Confused.

[TontoM]

Hi,

I’m pregnant with di/ di twins. At my 34 weeks scan today they said I have low amniotic fluid and my PI is 1.21 (above 95th centile) on twin 1. They then kind of pressured us into agreeing to be induced on Monday but both twins as 5 lb 6oz, much the same length and head measurements. Movement has been normal. Strong heartbeats. But Dr said that if I don’t go in I’m increasing risk during delivery for twin 1. Am I wrong in thinking we’re all well and growing so what’s the need to be induced? Can’t I just be monitored more regularly? Thanks.

With all due kindness, you're not a doctor. If the doctor says you need to be induced for the safety of your baby then why would you argue??

Nothing to do with being well right now...or having grown well up to now.

I've never been in your situation but personally I would take the medical advice seriously. They don't recommend induction for fun so there must be valid concerns.

I would ask for further advice, perhaps from the head of midwives? Ask about the risks and benefits of induction, as well as alternatives. You are always able to refuse interventions (including early induction), and often regular monitoring is a good compromise. I cant advise you as I dont know the risks of low fluid, and how accurately they can measure this. But if I was you, and wanted to avoid induction if possible, then I would certainly ask for more evidence and question whether this was the right step for me personally.

I would take the advice you've been given. If the doctors think they are better off out than in, then I would believe it, if they thought monitoring was an option that's what they would do.

Low fluid may result in a higher chance of preclampsia and infection - that’s why when you are over 34 weeks the solution is to induce. You could always refuse but as the fluid decreases the chances of a stillbirth increases.

They would not recommend induction unless they were getting concerned. They obviously aren't in immediate danger otherwise they would have induced/c-section today but they don't deliberately induce so early without cause. Listen to them

Hi fellow DCDA (di/Di) and also 34 weeks. I had a high PI reading at my 32 weeks scan but it was to the MCA not the Umbilicus. Do you know if yours is the umbilicus?
Mine was way off the top of the chart, so they got me back in for another Doppler scan a few days later and every thing was fine. They put it down to twin 1 being in an awkward position and had to try several times to get a decent reading.
If yours is the umbilical PI then it basically means baby won't be getting the right amount of oxygen/blood/nutrients from you. If you are concerned about not being induced yet, maybe ask of they can do another Doppler scan to check the PI to see any changes, and if no change then you should follow your doctor's advice for the health of your babies. They wouldn't induce this early unless absolutely necessary.

Can you call them back and ask this question? No one but your doctor can really say but what I do know from my own DDs premature birth is that they want to keep babies in you for as long as possible so if they’re recommending early induction there will be very strong good reasons for it.

@peamad I’m in again tomorrow for a second set of steroids so might ask them to go through everything in non medical talk so I can fully understand what is happening and what are the risks. Just was a bit of a shock and then lots of medical terms. Thank you 😊

@boodles101 thank you for sharing. They didn’t say what type of PI, and I have no chart or actual measurement. Just a few comments that twin 1 is Oligohydramnios, no cord free liquor pools and PI value is 1.21- but I’ve no indication of PI to what and what should it be? Like I said above, second set of steroids tomorrow so think I’ll ask for someone to talk to me and see if they’ll recheck maybe tomorrow or Monday.

user- thank you. I don’t actually have a dr, I’ve been seen by 12 different drs this pregnancy. So that’s also why I don’t feel 100% informed or like anyone is thinking of the full pregnancy and how we’ve progressed. Feel a bit like a statistic.

I would hazard a guess and say it's the Umbilicus PI but definitely ask more questions tomorrow and find out what measurements they arent happy with and what a 'normal' range is.
If you want I can check my last scan and provide my measurements. But I also have a decent amount of amniotic fluid around both babies, if they are saying you don't then find out what this can mean.

Think what I’m most confused about is, in a ‘normal pregnancy’ this wouldn’t be detected as you get scanned at 12 and 20 weeks then that’s it. She’s still active, kicking and following her pattern so if it was again ‘normal’ we’d have no signs so I’d be happily growing her over here waiting for labor.

I’ll ask a butt load of questions tomorrow.

Thanks for all responses.

I would go with what the doctor says ,there will be a reason just ask them to go into detail why they want to induce u. Your babies are a good size so having them a little early will be fine x

I totally understand what you are saying. They really scared me with an off the chart MCA reading and didnt explain what this meant. It was the first time they had even taken this measurement and as you say, in a single pregnancy they wouldn't even look at it any way. They can't get TTTS as they have their own placentas. But as I said it was all down to the way twin 1 was laying.

Just for reference if you want to know. My twin 1 PI last week was 1.06 and twin 2 was 1.14 and I was told they were normal. Definitely get more information so you can decide what to do.

Get more info OP, ask your questions. They are sometimes way too quick to try to guilt trip mums into inductions, you have the right to have all the info explained properly before you make that choice.

@boodles101 that’s interesting. I’m 1.21 not that far from your twin 2 🤔 definitely going in like the Spanish Inquisition tomorrow 😂 bet the midwives hate google and chat rooms for this very reason.

Just an update for anyone who finds themselves in a similar position.

2/8/19 high PI and low fluid on twin 1. Advised induction on 5/8/19. Couldn’t give me reason why other than risk of stillbirth, risk of restricted growth, risk on not producing urine- no evidence of this, no statistical risk either.

3/8/19 had steroids. Asked consultant to explain parameters for safe PI and fluid so I could make informed decision. Wouldn’t/ couldn’t. Used phrases similar to consultant day before. Better out than in, what are you waiting for, potential risks.

4/8/19 went in for reduced movements. I’d made myself so anxious I couldn’t feel either twin. Monitored at 10 am both fine heartbeat but they wanted to keep me in and induce me. Declined but agreed to come back at 1pm for second monitoring. 1pm both still fine, told me I’d have to stay until 8pm for third monitoring. I discharged myself.

5/8/19 I rang to cancel induction. Wasn’t convinced it was medically necessary. Saw another consultant who still couldn’t/ wouldn’t tell me acceptable PI range or fluid levels. After another emotive and vague chat agreed to give me another Doppler. Twin 1’s PI has gone back to good levels. Fluid was still low but I actually got a figure this time. 1.6cm. They tried to induce again. I declined as she was moving normally and PI had gone down.

8/8/19 consultant meeting with two consultants and a midwife. Readvised us of all risks- again with no evidence this had happened to twin 1. Agreed to Doppler 12/8/19 but against their advice. Still advising induction.

12/8/19 twin 1’s PI still back to normal and fluid up to 2.9 cm. twin 1 now perfectly ‘normal’.

At this meeting the midwife finally gave me some answers- answers I’d already found from extensive medical reading over the last ten days. PI is not a reliable reading, it can fluctuate due to position of baby. It should always be double checked. Unacceptable high PI is above 1.15 so we were barely above it (0.07). Fluid is not a reliable reading, maternal dehydration can cause it (you know after a mini heatwave in the UK 🤦‍♀️) and should always he double checked. Unacceptably low is below 2cm, we were 1.6 cm.

If I hadn’t been so stubborn and sure of my maternal instinct my babies would have had at least a week less in the womb (induction 5th August at 35 weeks) as it is we’re still healthy and in there today. 36 weeks and counting.

Ladies, it won’t be the same for everyone some people will definitely need it but I wonder how many people are pressured into unnecessary induction now. We trust the drs.