We had our 16 week prenatal appointment (official prenatal appointment #3) today – Molly is 16 weeks, 3 days pregnant – still with twins!
This was our first appointment with the OB; up until now we’ve only seen the Certified Nurse Midwife (CNM). Because Molly has two things that make this a high(er)-risk pregnancy – twins and her bleeding disorder – we’ll be seeing the OB from now on. Besides going over all of her medical history, it was a pretty basic appointment. The OB briefly attempted to hear the heartbeats with the external Doppler, but when we told her the CNM had trouble finding both of them last time using the Doppler (which is true!), she decided to use the ultrasound machine to see them instead. We wanted to see them on the ultrasound so we were happy to convince her. The OB didn’t take any official measurements (crown-rump lengths or heart rates), but you could visually estimate they were normal for their gestational age. She didn’t seem particularly interested in taking the time to get us a really good photo, but we did get one slightly less-creepy looking one:
Due to their current positioning, it would be impossible to get a classic profile image of both of the twins at the same time, even if she had taken more time. We did get a photo of Baby A’s body, but it’s not a very good one (can mostly just see the spine) so I’m not going to post it. Even though ultrasounds are harmless, they still only perform them when indicated. So, it looks like we won’t be getting photo printouts very often any more, unless there is reason to look, which of course we don’t want to have. Our next appointment is in a few weeks, and it is with radiology – the whole point of the special radiology appointment is to take really good measurements and see how they are doing. We’re definitely looking forward to getting some good printout photos next time from radiology! Also, we’re definitely going to do a couple of the 3D or 4D elective ultrasounds, but those are recommended from 24 weeks on.
The next set of screening tests, the Second Trimester Screen (aka Triple Screen or Quad Screen), should be done between now and early January. These are blood tests that measure alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), estriol, and in the Quad Screen inhibin-A. The results are interpreted along with maternal age, ethnicity, weight, and gestational age of the babies to evaluate the risk for neural tube defects (such as spina bifida), Down Syndrome (Trisomy 21), Trisomy 18, or other chormosomal abnormalities. The testing of inhibin-A levels in the Quad screen results in a higher likelihood of identifying pregnancies at risk for Down Syndrome, and there is a lower false positive rate with the Quad screen. I’m not sure which one Molly’s healthcare provider uses, but I’m sure we’ll find out when the results come in.
One really good thing we learned at the appointment was that Molly doesn’t necessarily have to have a C-section. I was afraid that with the combination of her bleeding disorder and having twins, they would automatically say she should have a C-section so they can plan to give her DDAVP (a medication that temporarily helps improve her bleeding tendency) and deliver the babies. But I guess the risk of hemorrhage is actually more with a C-section – it is a surgery after all – so she has just as good of a shot at a vaginal delivery as any other twin pregnancy (so far). This is great news! The ultimate decision relies heavily on a lot of factors, including the position of the twins (which can change hourly until actual delivery) and what doctor is on call at the time of delivery. Some doctors aren’t comfortable with a breech extraction (vaginal delivery feet first of the second baby), which risks head entrapment. Specifically, if the first baby is delivered vaginally while the second is in breech position, all should go well if the first baby to be delivered is larger as it kind of paves the way for the second, smaller baby, even if the second one is delivered feet-first. But if the second baby is larger, there is a chance the second baby can get suck at the neck (“head entrapment”) where the cervix clamps down and prevents the head from coming out after the body has already been delivered. Luckily we have a lot of time to think about the pros and cons of the possibility of an emergency C-section if this were to happen versus a planned elective C-section.
We also learned that the fetuses are considered viable at 24 weeks. Up until 24 weeks, if any problems occur (bleeding, cramping, etc.), then you go to the doctor’s office. After 24 weeks, you go to the hospital to be evaluated for preterm labor (defined as cervical change, not just contractions). Although it seems like we’ve come so far (we’re less than four weeks away from being half way!), 24 weeks still sounds so far away. It just makes me realize exactly how far we have yet to go.
And that’s a good thing, because there is still a huge amount of prep work to be done. And I have a lot of Daddy-Book reading to do.