IVF Pregnancy Information

1. sannino
   
   

   Has anyone had experience with this?

   I am currently just over 20 wks with fraternal twin boys. I had my level II u/s yesterday where they diagnosed me with a velamentous cord insertion on Baby A - and possible vasa previa. I have to go back for another detailed u/s in 2 weeks to determine if I do indeed have vasa previa. I was told that if this is the case I will have to stay in the hospital for the remainder of my pregnancy.

   What I did not ask is what happens with Baby B - who does not have VCI and whose placenta is fine? If there is an emergency and I need to deliver Baby A early via c-section - will I also need to deliver Baby B?

   Right now I feel like a ticking time bomb. I have put a call into my regular OB (saw high-risk doc yesterday who wasn't real forthcoming with information) - but he is at the hospital and I don't expect a call back till tomorrow.

   Thanks for any insight -
   G

3. nadiafilipfa
   
   

   sannino - I don't have any personal experience with vasa previa but I have had an attempt to deliver one twin while keep the other in.

   I was at 24 weeks and I was told by the docs that there was a 50% chance of it working.

   Possibly because I was in labour at the time I wasn't given the details as to what to expect, what to 'look out for' or what the worst case scenario was. I thought the worst case scenario would simply be that twin b would end up being delivered.

   In my case it was that when twin A was born the uterus shrunk and as a result twin b's placenta was partially torn from the uterus (placental abruption). Our second baby was born sleeping and in the end we lost both.

   To this day I'm not sure if that 50% chance was a "50% chance baby b would stay in" or "50% chance that baby b would survive".

   I'm not sure how far along you are but I would really encourage you to ask your doc as many questions as possible with this situation - the risks and the probability that one can be delivered and one stay in.

   Getting info on other's experience is great because it will help you with a list of questions but you'll only receive each individual's experience (one person at a time) while the docs should be aware of multiple situations and be able to provide you with a wide range of situations, risks and outcomes. But yes, its great to learn from others where you can - In the end all I can recommend is ask your docs questions, ask some more and then ask even more.

4. sannino
   
   

   nadiafilipfa-

   I\'m so sorry about the loss of your twins - that certainly does sound like the worst possible outcome. I can't begin to imagine what you have been through...

   Trust me, if I am indeed diagnosed with vasa previa I will be asking a million questions from both my regular OB and the peri. Yesterday I was just overwhelmed and was not thinking clearly. I've been doing some online research and while I have found some great information, I haven't found out a lot about outcomes for twin pregnancies.

   G

5. sannino
   
   

   Bump... anyone??

6. lykartem
   
   

   Me, me me. I can help. Posting this now and then will type up my longer reply in a minute.

7. lykartem
   
   

   I have 23 month old fraternal twin boys and one had vasa previa and both had velementous cord insertion (VCI).

   Since you have been diagnosed there is a 99.999% chance your boys will be fine. They will be have to be delivered via c-section around 35w and may spend a few days in the NICU but other than that they will be fine.

   Take a deep breath. I know this is scary stuff but it is all going to be okay. Undiagnosed there is nearly a 100% mortality rate but you have been diagnosed so it will all be okay.

   2 years ago almost exactly I was put on hospital bedrest at my request. There is a group called the International Vasa Previa Foundation that has a ton of info but not much on managing a twin VP pregnancy. There were ZERO medical journal articles on it either 2 years ago. With a singleton it is recommended that you go on hospital bedrest at 32w I think and earlier with twins. I went in at 30 or 31w and they were delivered at 35w1d. You want to keep them in as long as possible to prevent prematurity problems but you have to get them out before you go into labor or rupture. It's a delicate balance.

   I have a video clip on youtube if you want to see what a placenta looks like with VCI. You can't see VP after delivery because that is the umbilical cord crossing the cervix and once you deliver obviously you can't see that anymore. We knew baby A had VP and VCI but didn't know that baby B had VCI - that was a surprise but wouldn't have changed my management.

   I'm online here at IVFC all the time so please post if I can do anything at all to help you or answer any questions.

8. sannino
   
   

   Thank you Mustang64....

   It is scary stuff - that is for sure. I have scoured the internet and it does look like as long as you are diagnosed early things have a good chance of being okay. So far though - what I've read online suggests one should be put in the hospital for the entire 3rd trimester - which is not an exciting prospect, as I have a 3 year old DD at home. However, I'll do whatever it takes to have 2 healthy babies.

   So far, the VCI is not a problem and the baby with the VCI is actually larger than the baby with the normal placenta and cord. Regardless, I will be monitored for IUGR fairly closely. I guess I won't know for sure about the vasa previa until my next ultrasound - which is not until 6/22. I'm confused as to why I need 2 ultrasounds two weeks apart to get a definitive diagnosis.... Peri said he did not want to jump to any conclusions and that I should not worry too much at this point - but of course, that is what I do best. This has been a very difficult pregnancy already.

   Again, thanks so much for your reply - I will keep you posted.

9. nicole.heller
   
   

   I too was suspected to have VP at 21w3d and needed to come back 2 weeks later for confirmation. Unfortunately, it was confirmed, but as Mustang said, fortunately it was diagnosed. My situation was even more high risk as I was carrying ID twins that shared the same placenta. I was admitted to the hospital at 24 weeks while my 3 and 5 year old sons were at home. I was there for 11 weeks and they proactively took them at 34w3days weighing in at 4 and 4 1/2 pounds each. They are happy, healthy 21 month old miracles today. Hang in there....it's a tough diagnosis to swallow, especially with kids already at home, but taking the precautions is so worth the prize in the end You will be fine if it indeed is VP.

10. sannino
    
    

    Thanks for sharing your story nicole.heller... Can I ask what you did in the hospital for 11 weeks? Did they monitor you daily? And what in the world do you do to pass the time....

    I go in next Monday for sonogram - hopefully will have more info then.

11. nicole.heller
    
    

    It was a very long haul for each one of us in the family.....a really hard time, but worth it in the end. They would monitor an hour in the morning and an hour in the evening. I had cable but it was summer so unfortunately, there were a lot of reruns on. I had internet connection, thank goodness!! I also loved having my boys come visit, lay in bed with me and have snacks. I did a lot of reading, watching DVD's and watched alot of minutes, hours, and days pass. It was truly the hardest thing I've ever been through, but you do what you got to do! Hope your news is brighter!

12. lykartem
    
    

    How was your appt?

13. sannino
    
    

    Appointment was confusing - but I suppose, good in that I am not in the hospital.

    Baby A most definitely has VCI - and there are veins that are not contained. However, at least right now - the veins are not covering the cervix - but are about 1.7 cm away from it.

    They have restricted me from all travel and strenuous activity and have told me to bring in extra care for my daughter and the housework. They will monitor me at least every 2 weeks with detailed ultrasounds and plan on delivering me by no later than 37 weeks via c-section.

    I'm still nervous however - I would suspect that those veins could still rupture if I went into early labor.... I'm not sure if things will change as I progress (only 23 wks right now) - but it does make me feel better that they are watching me so closely.

    Thanks for checking in on me.

14. lykartem
    
    

    Appointment was confusing - but I suppose, good in that I am not in the hospital. Yes, it is good that you are not there yet. Must mean your cervix is looking good and other things looking good, too.

    Baby A most definitely has VCI - and there are veins that are not contained. However, at least right now - the veins are not covering the cervix - but are about 1.7 cm away from it. If you look on a ruler 1.7cm isn't that big of a distance.

    They have restricted me from all travel and strenuous activity and have told me to bring in extra care for my daughter and the housework. They will monitor me at least every 2 weeks with detailed ultrasounds and plan on delivering me by no later than 37 weeks via c-section. All good things for you and the baby.
    
    I'm still nervous however - I would suspect that those veins could still rupture if I went into early labor.... I'm not sure if things will change as I progress (only 23 wks right now) - but it does make me feel better that they are watching me so closely. Yes, they can rupture during labor which is why they want to deliver you before you go into labor on your own. Do you have any risk factors for early labor or cervix issues?

    Thanks for checking in on me. Please continue to post your updates so I can see how you're doing.

15. sannino
    
    

    Yes, my cervix checked out fine - long and closed, and I have not had any problems with preterm labor or my cervix in the past.... I agree that 1.7 cm is a pretty small margin and a very short distance.

    I had such an easy pregnancy with my DD that I'm constantly shocked how hard this has been for me this time around - emotionally and physically. Phew!

    I go back for another sonogram in 2 wks time so I'll post again then with more info.

    Thanks Mustang!

16. lykartem
    
    

    Have you had another u/s?

17. sannino
    
    

    Wow Mustang - you are on the ball!

    I had a u/s yesterday and not much in the way of good news. Now they are telling me I have borderline placenta previa along with the cord issues. I don't have the exact measurement as to where the cord was yesterday - but Dr. remarked that it was still vulnerable and that he did not like what he was seeing on the u/s.

    So, I am not on bedrest - but am supposed to be off my feet as much as possible and I go back again in 2 weeks time for another ultrasound. I have a feeling they are going to either put me on bedrest of in the hospital at some point in the future.

    Only bright spot is both twins were measuring fine and both were over 1.5lbs. Also my cervix is still long and closed (4.5cm).

    I\'ll update again in another 2 weeks.

18. lykartem
    
    

    Thanks for the update. Still worried about you and the baby and if you don't mind I'd like to keep following your progress. I belong to the Int'l Vasa Previa group and another person joined today who just lost their baby to VP. Another one had a very dicey delivery with a VCI that was moments away from rupturing.

19. elizabeth
    
    

    Hi sannino, I also had VP. I had a bi-lobed placenta and the veins connecting the two parts of my placenta were across my cervix. My son is 14 months old now.

    I was in the hospital for 7 weeks and delivered my son via c-section at 35 weeks. He was 7.5 pounds and healthy. He was very, very tired. I was unable to breast feed him because he had such a hard time staying awake, but other than that he was/is perfect.

    Have you joined the VP yahoo group yet? lykartem and all the other women in that group are so helpful!!! I couldn't have gotten through it without that group.

    I am not positive, but I don't think 1.7cm is far enough away from the cerix. I think the veins have to be at least 10cm away to allow for dilation.

    Will you be going into the hospital? It sounds like a long time (and it is),, but I hardly remember it now. Now it seems like such a small blip on the radar.

    let me know if I can help you in anyway.
    Catherine

20. sannino
    
    

    Thanks for the notes. I'm worried too - but since it is still early, I don't think there is too much else I can do other than take it easy. I will most definitely be having an early c-section - the question is how early, and if I will be put in the hospital prior. I'll check out the yahoo group - and I so appreciate your support.

    Mustang - I hate hearing such scary stories - but better to know what worst possible outcome is I suppose.

    I have an appt next Friday with my OB and then a u/s the following Monday. Will pick OB's brain again and get his opinions. Peris who do my u/s not so forthcoming with info - and I seem to get a different Dr. from the practice every time I go.

    G

21. lykartem
    
    

    The yahoo group has a file of letters for patients to give to their doctors who need an education on what to do and how to handle VCI/VP pg. There is a board of doctors for this group so it's not a group of moms telling drs what to do.

    Here is the link:
    vasaprevia.org

    In the middle of the page on the right it says Email Group - that's the yahoo group I was referring to. I also now see a forum that I didn't know existed. Maybe it is new and not there 2yrs ago when I had my babies.

22. lykartem
    
    

    Best of luck with your appt on Monday. How did Friday's appt go?

23. sannino
    
    

    Just back from sonogram.

    Things seem to be about the same - though both my regular and OB and peri seemed somewhat positive. The veins are still about 1.3 cm away from my cervix - and cervix itself is still long and closed. Both babies are measuring fine, have plenty of amniotic fluid and blood flow is normal. Although I am still scheduled for a c-section - right now it is booked for week 37. I will continue with u/s every 2 weeks and also see my OB every 2 weeks.

    I guess my only concern is that the veins still seem very close to the cervix to me - and what are the chances of them moving? Dr. told me that if they move it should only be further away... they don't seem overly concerned. I'm still not on bedrest, just supposed to stay off my feet as much as possible.

    Any thoughts?

    FYI - did join the yahoo group as well.

24. lykartem
    
    

    So glad you joined the group. Please read every single document the admin tells you about. These people are all experts in this area. IMO, 37 weeks is a week or 2 too late. I would go more with 35 or 36 as twins tend to come early and you want to avoid that whole dilating cervix and dropping down into position thing not to mention water breaking at home.

    I would love to see you on hospital bedrest at 32w with delivery around 35-36w. I can hear you now telling your dr that some woman on the internet said that!!!! What your drs can do is read all of the documentation from the advisory board of doctors from the IVPF.

25. sannino
    
    

    I hear you.

    For some reason however, doctors aren't calling what I have vasa previa as nothing is directly over my cervix... Not sure if I should be more concerned than I am at the moment....

26. lykartem
    
    

    I would post your story on the IVPF yahoo group and let them give you their opinions. They know a lot more than I do on this. Your dr cannot say for sure that it will move away from the cervix. It could very well move toward it. It has already moved from 1.7 to 1.3cm. Once you start dilating all bets are off on what will move and where.

    VCI is nothing to sneeze at. Did you look at my youtube video? As the babies get bigger and things get really tight in there those unsupported vessels are stressed. Once you start to dilate and baby A makes his way down his head can put pressure on those vessels cutting off blood flow. Lots of women walk around dilated 4cm for several weeks before they deliver. Your c-section has to come before any dilating starts.

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