Di-Di fused placenta

Hi there,

I'm getting mixed info from my MD and my OB and the 2 u/s I have had so far.
I hope someone here can answer my questions....

U/S 1 showed a vivid "lambda sign" which the u/s tech said it meant they
were fraternal twins

U/S 2 showed (possibly due to an empty bladder & therefore an incomplete
scan) one placenta

OB is saying nothing was wrong with u/s #1 and that the preganancy is fine

MD is saying possible TTTS due to discrepancy in u/s #2 weight/ages (also a
possible typo in the report, as one is reportedly at 29wks and the other at
36wks...weights are estimated at 2lb 2oz which corresponds to about 26wks,
and other twin is est 2lb14oz which corresponds to about 29wks)

I've researched the internet regarding di-di fused placentas and can't find
any info on it, that i can understand. Is this a serious medical concern
(as serious as TTTS in idents) or is it rather common among di-di twins?

I'm waiting a call back from either my MD or OB. It's possible I'll be in
earlier than expected for yet another u/s to confirm or disprove the
current #2 report findings. (or perhaps they can contact the u/s tech and
have her confirm the report)

TIA........Carla
technically 27wks, due June 10/05

David Candler wrote:
Hi there,

I'm getting mixed info from my MD and my OB and the 2 u/s I have had so far.
I hope someone here can answer my questions....

U/S 1 showed a vivid "lambda sign" which the u/s tech said it meant they
were fraternal twins

No idea what that means.

U/S 2 showed (possibly due to an empty bladder & therefore an incomplete
scan) one placenta

That can be perfectly fine. My twins appeared to have one large placenta
(in fact, even the pathology report *after* the twins were born said it
was a shared placenta with one outer membrane), but in fact it was two
fused placentas. My daughters look *extremely* different, and moreover
have different blood types -- no doubt of their being fraternal! They
were born two days before their due date, nice big healthy babies.

OB is saying nothing was wrong with u/s #1 and that the preganancy is fine

MD is saying possible TTTS due to discrepancy in u/s #2 weight/ages (also a
possible typo in the report, as one is reportedly at 29wks and the other at
36wks...weights are estimated at 2lb 2oz which corresponds to about 26wks,
and other twin is est 2lb14oz which corresponds to about 29wks)

It's got to be a typo, considering you're 27 weeks. Two to three pounds
just can't be the 50th percentile for 36 weeks.

I've researched the internet regarding di-di fused placentas and can't find
any info on it, that i can understand. Is this a serious medical concern
(as serious as TTTS in idents) or is it rather common among di-di twins?

It is theoretically possible that twin transfusion syndrome could occur
with fraternal twins, but very unlikely. In most cases, the implanting
of placentas next to each other does *not* result in any conjoining of
vessels. It's more like two plants put close together in a hedge -- the
branches may intertwine to the point where you can't tell which is
which, yet each is definitely connected to one and only one of the plants.

I'm waiting a call back from either my MD or OB. It's possible I'll be in
earlier than expected for yet another u/s to confirm or disprove the
current #2 report findings. (or perhaps they can contact the u/s tech and
have her confirm the report)

TIA........Carla
technically 27wks, due June 10/05

It sounds highly likely to me that all is just fine, particularly since
it sounds as though the smaller of the two is only a bit below 50th
percentile for 27 weeks (or were you still at 26 weeks when you had
it?). I hope you get an official answer soon. The great thing is to see
appropriate growth from one u/s to the next. The measurements and
estimates may get more and more off, especially towards term (my babies'
weights were vastly *over*estimated near the end -- they were big
babies, but not the ten-pounders it looked as though they were going to
be!).

--Helen

Well, today I was referred to another OB in a larger center. I go in to see
him tomorrow (Wed) afternoon.

The MD and OB seem more concerned with their weights (rather than the
gestational age, which are obviously a typo on the report). A is 990gms
and B is 1300gms. From what I've read in my twin book and from what little
I can gather online, it didn't sound like a hug concern.

My twin book puts A at 26.5wks and B at just about 28.5wks. A 2wk
difference.....I was 27 wks at the time of the u/s.

Helen, you mentioned your twins had a fused placenta. I'm going to assume
there is nothing medically serious with that, they just happened to be in
the same location and grew together? Is that always the case? Can a fused
placenta ever be a serious issue?

The great thing is to see
appropriate growth from one u/s to the next. The measurements and
estimates may get more and more off, especially towards term (my babies'

If measurements & estimates get more & more "off" towards term, what's
stopping my MD or OB from getting over-concerned and intervening when it's
not truly necessary? I don't want the twins to be delivered early just
because the u/s says they should be.

I'll be asking the OB tomorrow about these issues. He'll likely send me for
another u/s which will mean another trip to the city (2hr one way to the
bigger center.....and just 1hr one way to my regular MD or OB...ugh).
Somedays the boonies are a great place to live, but not when you need
medical appts!!

Carla
27wks, twin boys

David Candler wrote:
Well, today I was referred to another OB in a larger center. I go in to see
him tomorrow (Wed) afternoon.

The MD and OB seem more concerned with their weights (rather than the
gestational age, which are obviously a typo on the report). A is 990gms
and B is 1300gms. From what I've read in my twin book and from what little
I can gather online, it didn't sound like a hug concern.

My twin book puts A at 26.5wks and B at just about 28.5wks. A 2wk
difference.....I was 27 wks at the time of the u/s.

Helen, you mentioned your twins had a fused placenta. I'm going to assume
there is nothing medically serious with that, they just happened to be in
the same location and grew together? Is that always the case? Can a fused
placenta ever be a serious issue?

Even sharing a single placenta is not USUALLY a serious issue -- while
the twins may be slightly smaller overall than those with separate
placentas, the vast majority don't have TTTS. Fused placentas don't
usually share any vessels at all, and when they do, it's usually far
less than the effect of sharing the whole placenta. You can get issues
sometimes when one of the cords is not coming from an optimum place in
the placenta, but that's different. Actually one of my twins had a
membranous insertion, which I think can sometimes cause problems, but
there was no problem at all in her case. (To give you an idea, one twin
was 7 lbs 15.5 oz and the other was 8 lbs 11 oz! And no, I was NOT
diabetic, and they had normal sugars.)


The great thing is to see
appropriate growth from one u/s to the next. The measurements and
estimates may get more and more off, especially towards term (my babies'


If measurements & estimates get more & more "off" towards term, what's
stopping my MD or OB from getting over-concerned and intervening when it's
not truly necessary? I don't want the twins to be delivered early just
because the u/s says they should be.

My understanding is that there is not enough clarity about how to
estimate fetal weights based on the measurements late in pregnancy, but
that you *can* be pretty sure that things are okay if the measurements
keep going up. That's why a series of ultrasounds is a lot more valuable
than just one.

--Helen

"David Candler" wrote:
Hi there,

I'm getting mixed info from my MD and my OB and the 2 u/s I have had so
far.
I hope someone here can answer my questions....

U/S 1 showed a vivid "lambda sign" which the u/s tech said it meant they
were fraternal twins

U/S 2 showed (possibly due to an empty bladder & therefore an incomplete
scan) one placenta

OB is saying nothing was wrong with u/s #1 and that the preganancy is fine
snip

I can't offer much advice, but experience. My boys were di-di, and had a
fused placenta. When I asked my OB if that would be a problem, she said no,
it just meant only one placenta to deliver! I suppose it's possible for
TTS, but keep in mind that ultrasounds aren't really accurate at determining
weights. They can be a pound or two off. Good luck!!

--
-Lisa
Due September 2005
Mom to Aaron & Nicholas born 7/25/04
Mom to Mariam Averi, born sleeping 9/10/03
http://www.memoriesofmariam.com

Sheesh, who ever thought carrying twins could be so complicated.

MD called me this afternoon. I was right, it was a typo on the u/s report,
A is at 26wks and B is at 28wks. He agreed, not a big deal, and no real
cause for concern. Whew.

However, the big whig OB still wants to see me. MD is still saying 1
placenta and 1 sac. But I still want to question my first u/s in Jan, when
even the radiologist himself agreed it was frat twins.

It's quite possible the two placentas did, in fact, fuse together, so it's
looking like one now. I have to keep in mind, the Jan u/s was on a far
better machine (3D & color) than the most recent u/s (2D, which is used by
the entire hospital, not just OB patients).

Oh, and my OB had said too, that as long as the difference is
size/weight/measurements are always consistent from u/s to u/s, then
there's no real cause for concern. I just have to remember, that my MD is
an overly-cautious doctor with all aspects of medical care.

I'll let you know how tomorrow goes. Thanks for the support, I do
appreciate it!!

Carla

Helen wrote:

Even sharing a single placenta is not USUALLY a serious issue -- while
the twins may be slightly smaller overall than those with separate
placentas, the vast majority don't have TTTS. Fused placentas don't
usually share any vessels at all, and when they do, it's usually far
less than the effect of sharing the whole placenta. You can get issues
sometimes when one of the cords is not coming from an optimum place in
the placenta, but that's different. Actually one of my twins had a
membranous insertion, which I think can sometimes cause problems, but
there was no problem at all in her case. (To give you an idea, one twin
was 7 lbs 15.5 oz and the other was 8 lbs 11 oz! And no, I was NOT
diabetic, and they had normal sugars.)

My understanding is that there is not enough clarity about how to
estimate fetal weights based on the measurements late in pregnancy, but
that you *can* be pretty sure that things are okay if the measurements
keep going up. That's why a series of ultrasounds is a lot more valuable
than just one.

--Helen

At birth Kathleen was 6.11 and Christopher was 8.6 and both were healthy, he
was a heafy 21 inches and Kathleen a peanut by comparison 19.5. The irony
was that almost their whole life up to now they have consistently stayed the
same height difference. Now that Kathleen is in her puberty surge she's a
whopping 5'1" and Chris 4'11 1/4". Good luck

Shirley
Chris and Kathleen 1/95

"Crystal Dreamer" wrote in message
...

"David Candler" wrote:
Hi there,

I'm getting mixed info from my MD and my OB and the 2 u/s I have had so
far.
I hope someone here can answer my questions....

U/S 1 showed a vivid "lambda sign" which the u/s tech said it meant they
were fraternal twins

U/S 2 showed (possibly due to an empty bladder & therefore an incomplete
scan) one placenta

OB is saying nothing was wrong with u/s #1 and that the preganancy is
fine
snip

I can't offer much advice, but experience. My boys were di-di, and had a
fused placenta. When I asked my OB if that would be a problem, she said
no,
it just meant only one placenta to deliver! I suppose it's possible for
TTS, but keep in mind that ultrasounds aren't really accurate at
determining
weights. They can be a pound or two off. Good luck!!

--
-Lisa
Due September 2005
Mom to Aaron & Nicholas born 7/25/04
Mom to Mariam Averi, born sleeping 9/10/03
http://www.memoriesofmariam.com

Well, had my 3rd u/s yesterday. All is fine. Both boys are definitely
di-di frat twins. Doc said that's the best prognosis for twins, no real
complications to expect. Still possibility of pre-term labor, growth
discordance, and mall-presentation. A is still bum-down and hopefully
he'll find the road-map soon and get head-down.

I need many more u/s to track their growth & positioning. One at 30wks,
every 2wks till 36wks, then weekely till delivery. Thankfully I can have
these done at my local hospital (1hr drive). Doc says no reason I can't
deliver at my local hospital too, as long as they don't arrive till 36-37
wks, or later. Anything earlier, he'll do it in the larger center (with a
NICU). Our goal is to hit 36-37 wks, and then not much worry when they
come after that.

So, all is well, like I knew it was. Just had to find a doc that agreed
with me.

Thanks for the support, I'm glad to have found this list.

Carla

Carla-- I've been following your thread and am so glad to hear that things look
better than you originally thought for your boys. Just keep 'em in there as
long as you can!! I saw an ad today that there is a special on the Discovery
Health Channel on Tuesday night about TTTS, if you're interested. I know its
no longer a concern for you, but I thought it looked interesting. And, BTW, it
looked like the family they focus on has a good outcome-- I wouldn't advise a
pregnant woman to watch something that didn't!! Best wishes and keep posting!!

-Cindy (mom to Ashlyn and Allyson 6/99--33wk. frat. girls and Jenna 6/03)

In article , says...

Well, had my 3rd u/s yesterday. All is fine. Both boys are definitely
di-di frat twins. Doc said that's the best prognosis for twins, no real
complications to expect. Still possibility of pre-term labor, growth
discordance, and mall-presentation. A is still bum-down and hopefully
he'll find the road-map soon and get head-down.

I need many more u/s to track their growth & positioning. One at 30wks,
every 2wks till 36wks, then weekely till delivery. Thankfully I can have
these done at my local hospital (1hr drive). Doc says no reason I can't
deliver at my local hospital too, as long as they don't arrive till 36-37
wks, or later. Anything earlier, he'll do it in the larger center (with a
NICU). Our goal is to hit 36-37 wks, and then not much worry when they
come after that.

So, all is well, like I knew it was. Just had to find a doc that agreed
with me.

Thanks for the support, I'm glad to have found this list.

Carla

David Candler wrote:
Well, had my 3rd u/s yesterday. All is fine. Both boys are
definitely
di-di frat twins.

I am glad all is well! I have been thinking of you. I am curious
though, the fact that they are Di-Di, is that the only reason they are
concluding that they are fraternal? Because I was under the impression
that they could still be identical... just curious.

Kimberly