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October 14, 1998
23 weeks and 6 days
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Before I proceed with this days information, I must first say that all the news is not positive. So be warned if there are children who want to read this. Please read it first and judge accordingly.
Second, I want to say that this Internet Journal is Maureen's and my way of telling all of you what is happening. That does not mean you can't phone and talk to us, it is simply a way for us to get as much information to you, as clearly as possible. This Journal is also like a diary to us so that we don't forget what happened and how we were feeling.
I do not want this Journal to simply be a list of the dates and facts. I also want it to reflect our thoughts, our hopes, our fears and even our dreams. I know that the audience varies in age, and I want it to be direct without being blunt, and still try to cater to all audience members. On the other hand, I am not holding anything back, because this story is what we are living and dealing with each day, and I must tell you all so that you are as involved as we are.
I hope that I am reaching the right balance of factual information and day to day activity.
Thank you for your patience,
Back to Previous Page Finally the day we had been waiting a couple of weeks for. Today at 4pm was our appointment with Dr Kingdom, reputed to be one of the top 3 Placenta specialists in the world. 
I met Maureen at the hospital, and we arrived on the 12th floor (have I mentioned before that it is the Mt. Sinai, High Risk Pregnancy Unit, that is following and monitoring us?) and waited for our appointment. 
I think we were finally taken in around 4:45 by Dr Smith, the research assistant of Dr Kingdom. He began the ultrasound, asking confirming questions as he went, stopping and looking at the placenta, and the 2 babies for quite a long time. He was very open, and explained what he (and we) were seeing as he went. (You see, Maureen is lying down, and he is scanning the babies through her stomach, and we are watching on a monitor that is on an arm over the bed. We see everything he sees, though of course with an untrained eye) 

Here is essentially a summary of what he found, which Dr Kingdom confirmed at the end of the consultation: 

  1.   The graph of the blood flow from the right side of Maureen's uterus into the placenta, and from the left side of the uterus into the placenta shows a resistance. This indicates that the placenta is creating a bit of a blockage. The lulls between the compressions of Maureen's heart show some forward movement of the blood but resistance is shown. (i.e. when the heart beats, it pumps blood through the arteries, and in between beats, the blood should continue to flow in a positive direction) 
  2.   The Placenta as seen on the ultrasound is not homogeneous, it is heterogeneous, meaning that it is not the same texture throughout as would be expected in a healthy placenta. It is uncertain what the differences are, but they are probably the cause of the resistance that is shown in the blood flow. 
  3.   The placenta is across the top of the uterus so that is one reason why Maureen is not feeling a lot of kicking. Although both of them show activity on the ultrasound, with the placenta on the top between the babies and Maureen's stomach, it muffles anything she might feel. That helps explain why Maureen has only felt minimal kicking. (but she has felt some, and that has been reassuring). There are most likely 2 placentas but they have grown so close together that it is impossible to see where one ends and the other begins. They have not merged though, meaning that blood does not flow between the 2 placentas. 
  4.   "Abigail", baby "A", is doing better than "Boris", baby "B". The blood flow from "Abigail" to the placenta is very good. The graph of the flow shows some resistance, but it actually looks very good. 
  5.   The graph of the flow from "Boris" to the placenta shows a a different story. It shows a great deal of resistance, and in fact it shows the heart beating harder to force the blood toward the placenta, and in the lull between the beats, there is NO movement of the blood. So instead of positive flow, there is none. On its own, that is not terribly bad, but it does indicate that the situation may worsen. A "back flow" would not be good for the baby. 
  6.   Measurements were taken, and "Abigail" is showing a gestational size of approximately 22 weeks, and "Boris" approximately 20 1/2 weeks (we are at 24 weeks!). "Abigail" is approximately 490 grams, and "Boris" approximately 350 grams. The evidence from previous ultrasounds indicates that both of them ARE growing.
  7.   Though oxygen and nourishment is getting to both babies, "Boris" is showing some of the ill effects in the ratio of his head size to his body size. In a compensation effort to supply oxygen to the more vital areas of his body, his head is larger in proportion to his body that it should be. The head is getting the benefit of better blood flow than the rest of his body. It is just one more indicator that "Boris" is not doing as well 
It was a lot to take in. We didn't leave the Hospital until 6:30. Maureen underwent the ultrasound for at least 1 hour. 

To be direct, and not beat around the bush, the bottom line summary is like this: 

  • It is still too early to be able to make any sort of intervention for either baby even if it were decided that one or other baby needed assistance.
  • There is no possibility of bringing one baby out to be cared for by the neonatal unit, and having the other baby remain inside. That means any decision would come down to bringing out both babies, or leaving both in.
  • No one is giving up on baby "B" but he/she has a really hard uphill struggle. Baby "B" is not doing as well as baby "A" and we must face the possibility that baby "B" may not make it. He/she is small, and frail, and definitely showing the ill effects of the malfunctioning placenta. As mentioned above, any intervention say on behalf of baby "A" must take into account the frail nature of baby "B".
  • Since they are fraternal, and the placentas are separate, the death of one baby should not adversely affect the other. One can continue to grow even with the loss of the other. But we are still praying and hoping for the success of both of our babies. They have both come a long way. 
  • Since we are at 24 weeks, the babies are just barely viable outside the womb. Every additional day they are inside Maureen, gives them that much better chance at survival, if they continue to grow. We are hoping for the best.
We are really thinking as positively as we can. We have in the back of our minds "only 4 more weeks" which would take us to 28 weeks, and a good gestation for them to survive outside the womb. We pray that "Boris" can hold on until then.

Maureen is experiencing more and more activity by the twins, kicking and rolling and that is a good sign.

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