Today I am 22w1d (13 days until viability) and my weekly appointment was... not great.
I am gaining weight well, my uterus measures at 32 weeks (!) and my blood pressure is nice and low. They did my glucose screening and CBC to check for anemia, and I will get results tomorrow.
The scan of the babies showed them healthy and active, but with some fluid issues. Baby A has plenty of fluid, but Baby B and Baby C are both low. While this is most likely caused by the fact that I have been taking Advil for contractions (hence the reason you should not take it without the doctor's approval) we are still a bit worried about TTTS. We don't ever want to see a difference in A's and B's fluid. Dr. P was confident that once I have been off of the Advil for a few days, their fluid should increase, but we will be watching closely to ensure no other signs of TTTS emerge.
I asked her what we'd do if they developed it this early and she said I'd have Selective Photocoagulation surgery (or Laser Ablation) to treat the condition. This is an amazing procedure only offered at a few hospitals around the country (one of the reasons I chose the practice we are in) but they literally shoot a laser through the abdomen and uterus into the placenta. SCARY, but very effective. If they develop it later, after 28 weeks, they would do serial amniocentesis to draw of excess fluid from the recipient twin. More info on TTTS here. Dr. P seems very confident that the discrepancy in fluid is due to the Advil, not TTTS, but we'll be paying more attention to their fluid.
As if that was not already enough to cause me to enter high-anxiety mode, my cervix shortened. Just a little, but STILL. It was about 3.5 last week and this week it was down to 3.1, 2.7 with pressure. Again, not an incompetent cervix but it is reacting to increased contractions. I have noticed and reported many more contractions this week, so my Niphedipine was doubled in an attempt to stop their effect on my cervix.
Also, my bed rest is now much stricter. Not yet "strict" which means bed pan and being horizontal all day, but much more limited. I am only allowed to stand up to use the bathroom, shower and get meals, but should remain reclined the rest of the day. No more outings, puttering around the house or walking much to the car. My activity has slowly increased lately, without me meaning to, and I need to stay down all day now. Hey, at least I got to scoot around Target a couple times.
I asked her:
1. When will we do an fFN (a test on the cervical mucus to determine if labor is imminent in the next two weeks)?
Starting at 24 weeks. If we ever get a positive test, then I will be admitted to the hospital for the rest of the pregnancy and given steroid shots.
2. Will we get to 28 weeks?
Yes! Prepare that you may be in the hospital and will certainly be resting much more.
3. Why else would you put me in the hospital?
If your cervix shortens again, if you have four contractions in an hour consistently or if the twins develop TTTS.
The good news is the Nifedipine has worked for me in the past, and we assume the higher dose will help. Also, the twins have NO OTHER signs of TTTS and we hope the fluid thing will normalize next week... yes, I have to wait a whole week! These are the positive things to which I am clinging.
Feeling pretty anxious on the couch over here, and wishing there was a way to know for certain that all will be well. I cannot imagine losing these boys now, and hope with my whole heart that the rest and medications will help my body hold on for another 10 weeks or so. Thanks for reading this extremely long post, and for all of your support. Hopefully next week will bring us news of normalized fluid levels and a longer cervix.