The two babies have the same placenta, and the elder sister "steals" the younger sister's nutrition

When I was about to write this article, I was very conflicted, worried that a few thousand words would not be enough to describe all the issues. My two children are now 9 months old. Looking back on the past year or so, it is more exciting than winning 5 million.

I hope the two kids can grow up together.

Named Junjun and Yunyun

In February 2019, I found that my period had not come, and the early pregnancy test showed double bars. When creating the pregnancy record, the ultrasound doctor looked at it for a long time and said, "You have twins? Oh, they are monochorionic and diamniotic."

Monochorionic diamniotic? I was completely confused. Before I could even feel happy, the doctor poured cold water on me. "Monochorionic diamniotic is prone to twin-twin transfusion syndrome (TTTS). Simply put, the placentas of your two babies may have vascular anastomosis. When fetus A donates blood to fetus B, fetus A will be anemic and underdeveloped, and fetus B will have too much blood. The difference in weight and amniotic fluid between the two babies will become larger and larger, and it is easy to lose both babies." The doctor asked me to come for an ultrasound every two weeks to observe the babies' conditions at all times.

From then on, I began my anxious pregnancy life. Because I wanted the two babies to grow up together, I nicknamed them "Junjun, Yunyun".

The situation was pretty good in the early and middle stages of pregnancy. The size of the babies was similar, and the amount of amniotic fluid was similar, but the ratio of the end-systolic peak to the end-diastolic peak of the umbilical artery (S/D value) of fetus A was a little high. The doctor told me that the higher the umbilical artery S/D value, the greater the resistance to the umbilical cord blood flow of the baby, and there may be problems such as hypoxia and ischemia.

Let me give you a sneak peek here: fetus A is the younger sister and fetus B is the older sister.

Ultrasound examination results | Image provided by the author

Uterine contractions occurred at 26 weeks of pregnancy.

We need to make the baby mature as soon as possible

I continued to suffer until 26+2 weeks of pregnancy. When I was taking a walk, I felt my stomach was as hard as a rock. I felt very uncomfortable and wanted to pee. I was really inexperienced in my first pregnancy and didn't know that this was a contraction. I went home and waited for a long time before going to the hospital.

When I arrived at the hospital, the doctor immediately put me on a fetal heart monitor. My uterine contractions were every 2 minutes, and I finished a bottle of magnesium sulfate in half an hour. My heart was beating very fast, and I finally knew what it meant to have a fluttering heart. I was sweating so much that my clothes were soaked, and then I was admitted to the hospital.

During the hospitalization, I underwent various tests and found that the two babies were about 2 weeks younger than the actual gestational age. The doctor added nutrient solution such as amino acids, injections to promote fetal lung maturity, and oxygen inhalation for 1 hour every day. The doctor explained that because I could give birth at any time, if the baby's lungs matured as soon as possible, the chance of survival would be greater.

Then, I received the first critical illness notice in my life. The doctor repeatedly told me that I had selective intrauterine growth restriction type Ⅰ (sIUGR type Ⅰ), and I should be mentally prepared because my gestational age was too young and the baby might not be healthy after birth.

But I am a very optimistic person. Due to work reasons, I wrote my thesis while in the hospital. I stayed in the hospital for two weeks in total, and had an ultrasound every three days. The umbilical artery S/D value of fetus A (sister) was still high and unstable, and her weight began to fall behind that of fetus B (sister).

After signing a "life and death statement" and being discharged from the hospital, I continued to go to the hospital every three days for B-ultrasound and fetal heart monitoring.

The younger sister's weight gradually widened the gap with her older sister

I and my babies were so happy that I made it to 30 weeks. During this period, I read a lot of literature about TTTS and sIUGR type I. I learned that the prognosis of sIUGR type I is still good, the survival rate of the child is high, and the chance of sIUGR type I developing into type II or type III is not high, about 20%. I breathed a sigh of relief (this breath of relief was really too early, and various excitement was waiting for me and my babies).

During a routine checkup at 30+1 weeks of pregnancy, my sister's umbilical artery S/D value suddenly increased to 14.29, and the blood flow resistance of the middle cerebral artery decreased, which means that the umbilical cord blood flow resistance is too high. My sister's body has reduced blood supply to the limbs to ensure brain development as much as possible.

I was immediately admitted to the hospital. This time, the doctor in charge told me very seriously that the high resistance of umbilical cord blood flow would affect the oxygen and blood supply to the baby's brain. It was uncertain whether the intelligence would be affected after birth, and I needed to consider whether to deliver the baby by caesarean section now.

I would be lying if I said I wasn't scared, but when I immediately checked my little sister's umbilical artery S/D value, it dropped to 8.33. Based on the literature I had read before and my baby's and my situation, I chose to continue observation, and then I received the second critical illness notice in my life. I wanted to keep my baby alive and let her grow a little bit more in my belly (my friends should still listen to the doctor's advice and not make decisions on their own).

During the hospitalization, my sister's umbilical artery S/D value remained high, and her weight gradually widened compared to her sister's. She was developing into TTTS, so the doctor began to discuss with me whether to do a fetoscopy (laser burns the placental vascular anastomosis to block blood flow). I heard from the doctor that if the condition continued to develop, he would recommend giving up my sister.

Fetus mirror丨fetusjapan

Fortunately, my sister did well and her umbilical artery S/D value dropped to 4-6. Her weight was also slowly increasing, so I was able to be discharged from the hospital.

In this way, we survived until 34+2 weeks of pregnancy. This time, the B-ultrasound examination found that the depth of my sister's amniotic fluid suddenly dropped from 5 cm to 2.9 cm. The doctor immediately asked me: "Is your water broken? Do you have stomach pain? How is the baby's fetal movement?" I said everything was normal. The doctor asked me to pay more attention. The sudden decrease in amniotic fluid is not a good sign.

In the next three days, I had to go to the bathroom frequently at night and my contractions became more frequent. But I was optimistic that I could last until 36 weeks with my baby because I was in good condition and even walked with a breeze.

There is a 20% chance of encountering

I went to the operating table immediately.

However, after the ultrasound at 34+5 weeks of pregnancy, the doctor did not give me the report. I was wondering, and the doctor called me in again, rechecked the ultrasound, and then gave me the report.

I looked at the report and it said that my sister's umbilical artery S/D value was infinite and the amniotic fluid was also decreasing. Without saying anything, I immediately rushed to the inpatient department. The doctor in the ward immediately held me down and said that it had changed from sIUGR type I to type III. I was really running wild in my heart. Why did I encounter this 20% chance?

The doctor requested an immediate cesarean section. I couldn't sign on my own, so my family had to sign. My husband had to hand in his cell phone at work, so I made countless calls before I finally found him. While signing, I tried to bargain weakly: "Does this have to be a cesarean section?" The doctor rolled his eyes at me and sternly said, it must be a cesarean section.

Just like that, I went on the operating table without any preparation or bringing anything.

During the spinal anesthesia, the anesthesiologist fumbled for a while and changed to another anesthesia method, and told me that this anesthesia method would allow the legs to move, so I had to stay calm and not move during the operation. I nodded repeatedly, thinking to myself, I wouldn't dare to move even if you asked me to.

Then the operation began. At first, the angle of the shadowless light above my head was probably wrong. I clearly saw the doctor cutting open my stomach, so I said to the doctor, "Can you adjust the position of the light? It's very uncomfortable to watch you cutting me."

Finally, after a sound of sucking water, the doctor came over with the baby and asked, "Check if it's a boy or a girl." I was so happy to see that it was a girl. Then the second baby came out. When the doctor saw it, he was amazed at how small it was (the little sister whose umbilical cord blood flow had always been poor).

At this point, my delivery came to an end. My elder sister scored 10 points (full score) and weighed 1830 grams. My younger sister scored 9 points and weighed 1380 grams. After 3 minutes, she scored 10 points. It was as if the two sisters had agreed that the weights could be different, but the numbers had to be the same!

There is another story about sister next, please continue watching!

Doctor's comments

Shi Junxia | Chief Obstetrician, Beijing Obstetrics and Gynecology Hospital

Twin pregnancies can be divided into monozygotic twins and dizygotic twins, of which monozygotic twins are rarer. Monozygotic twins are formed by the splitting of a single fertilized egg. Depending on the time of splitting, they can be divided into dichorionic diamniotic twins, monochorionic diamniotic twins or monochorionic monoamniotic twins.

It is very important to confirm the chorionicity of twins through ultrasound examination in early pregnancy. The protagonist of this article confirmed the diagnosis of "monochorionic diamniotic" through ultrasound examination in the early pregnancy, which provided direction for later monitoring and treatment.

While twin pregnancy brings the expectant parents the joy of winning the lottery, it also increases the risk of various conditions for the expectant mother and the fetus during pregnancy, such as premature birth, gestational hypertension, spontaneous abortion, postpartum hemorrhage, loss of one fetus, as well as the twin-twin transfusion syndrome (TTTS) and twin growth discordance mentioned in the article, and even the rarer cases of conjoined twins and twins with one fetus without heart malformation.

Therefore, according to the chorionicity of twin pregnancy, it is completely necessary to conduct ultrasound and subsequent fetal heart monitoring examinations in strict accordance with the requirements of the obstetrician.

When the two fetuses of monochorionic diamniotic have obvious abnormalities in the amount of amniotic fluid, that is, polyhydramnios (maximum amniotic fluid depth of the fetus> 8 cm) or oligohydramnios (