Hypertension, twin pregnancy, and IUGR

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beth11
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Re : Hypertension, twin pregnancy, and IUGR

Postby beth11 » Thu Apr 16, 2009 12:07 am

Their sizes don't immediately seem alarming to this layperson :) It sounds like her dr. is just being proactive, which is awesome. The steroids will help with lung development, which is the most important thing.

auntieem
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Re : Hypertension, twin pregnancy, and IUGR

Postby auntieem » Wed Apr 15, 2009 11:59 pm

Hi Caryn, I don't think the size difference was thought to be caused by TTTS, although I don't know if she asked this specifically. I assume the Dr would have told her if he suspected it. I don't think she was given any explanation for the difference in size. I do know that the smaller twin is a girl and the larger a boy; I think boys tend to be a little bigger typically, but I don't know if that would account for the entire size gap.

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caryn
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Re : Hypertension, twin pregnancy, and IUGR

Postby caryn » Wed Apr 15, 2009 11:27 pm

Chronic hypertensives have about a 25% chance of developing PE, and there's also a higher risk for IVF and for twins, and IUGR is associated with PE. So I can't speak to what the MFM is thinking, but steroids are something you do in case you've got to deliver earlier than about 34 weeks, and there's no harm in having them onboard Just In Case.

Is the difference in their sizes twin-twin transfusion, or is it just that one has a more compromised placenta?

auntieem
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Re : Hypertension, twin pregnancy, and IUGR

Postby auntieem » Wed Apr 15, 2009 10:58 pm

Kim, thanks for your reply! That's very good to hear that your boy was about the same size when he was born (and that he's OK!!). I know it must have been a scary time.

auntieem
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Re : Hypertension, twin pregnancy, and IUGR

Postby auntieem » Wed Apr 15, 2009 10:54 pm

Thank you so much for the replies and for the information, Summer and Andrea! It's definitely not a fun time, but with the steroid shots and hopefully at least a few more weeks in utero, hopefully they'll keep growing some and make it without serious trouble. The concerning part is that their growth seems to have slowed dramatically (they've been monitoring by ultrasound for quite some time).

I really appreciate your info and advice. I'll let my friend know about this board, too!

jacobkaden
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Re : Hypertension, twin pregnancy, and IUGR

Postby jacobkaden » Wed Apr 15, 2009 10:53 pm

My boy was born at 26 weeks and was 1lb, 10oz and that was considered on target for his gestation, so those weights sound right. I wasn't diagnosed with IUGR, in fact they increased his chances of survival from 50% to 60% due to his size. Hope she's able to keep them in for many more weeks.

summerw77
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Re : Hypertension, twin pregnancy, and IUGR

Postby summerw77 » Wed Apr 15, 2009 09:24 am

Hopefully Caryn comes along soon or someone else with good info for you, I can tell you that my friend who delivered a 26 weeker, had a 1 lb 1 oz baby and that was severe IUGR.
THe good news I think is that the cord flow is good. I think it's wonderful they have the steriod shots on board, and with ehr being chronic and having twins, that is 2 risk factors for pre-e. Please print all of the signs and symptoms off of this website and give them to her. WIth pre=eclampsia it is hard to know how sick you are, and things can go downhill in a matter of hours. That is so nice of you to help out your friend! Keep checking back, I am sure that someone much more knowledgable than me, will be along soon with good info for you! You mignt want to send your friend to this site too, for support during the twins NICU stay.........

dohertyab
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Re : Hypertension, twin pregnancy, and IUGR

Postby dohertyab » Wed Apr 15, 2009 08:47 am

I can't say too much about IUGR or hypertension but if she's 26 weeks and one twin is 1 lb 13 that seems big to me. I can tell you that I delivered my twins at 29 weeks and they were 2lbs 2oz and 2lbs 4oz. No one ever said that was small. They also had steriod injections 5 days before they had to come out. I would suggest that since the twins are at a size and gestational age where every day they can stay in helps (someone said a rule of thumb was 1 day in equals 2 days less in the NICU) and that steriods are most effective at this stage that the doctors are just being cautious. Things can change quickly and if there is a discrepancy between the twins then it's best to be cautious. Some people can chug along for weeks like this and others can't. There is no way to predict if the twins are in trouble. I think that if all of them are being watched carefully, then the risks are greatly reduced. It's not a fun time but tell your friend to hang in there, my twins are now healthy 7 year olds and they really weren't too much bigger than hers are now.

auntieem
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Hypertension, twin pregnancy, and IUGR

Postby auntieem » Wed Apr 15, 2009 01:36 am

Hi, I'm not sure that this is the best forum for this question, but everyone seems very knowledgeable here, so I'm hoping that someone can help or at least point me to another possible source of information.

My friend is almost 26 weeks pregnant with fraternal twins via IVF. She has had chronic hypertension since before becoming pregnant, which has gotten progressively worse (although the doctor recently changed her BP meds). She does not have PE yet (they have done 24 hour urine twice now), although she is clearly at risk for developing this. Her ultrasound last week showed that the fetuses were a little small, so she was sent to a perinatologist and for a repeat ultrasound this week. As of yesterday, one fetus was in the 17th percentile and the other was in the 3rd. Their weights are approximately 1 lb 13 oz and 1 lb 5 oz, respectively. This is troubling, particularly for the smaller twin, but the heart rate, fetal movement, amniotic fluid volume, and blood flow through cord were all good. I know that chronic hypertension can be a causative factor for reduced fetal size (or Intrauterine Growth Restriction).

The perinatologist is recommending that she begin corticosteroid injections this week. I'm wondering whether he's thinking that their growth will slow down so much that they'll have to take them soon (next week?), or is he anticipating PE and a very premature delivery, or just being safe?

Does anyone have any experience with twin pregnancies and know how dire this situation is? I can't seem to find precise and consistent information regarding gestational age and size for twins. Twins are typically smaller than singletons, but is a 3rd and 17th percentile at week 25/26 extremely small and how much should we be worried? How much trouble are these fetuses in?

I would very much appreciate any advice or information. Thank you so much in advance.


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