It was basically an ultrasound where they monitored blood flow and heart dopplers. I didn't understand most of what I soucl see them measuring. Unlike when you go in to your usual doctor, they didn't explain as they went. The process took almost an hour, so I completely understand not explaining...that would have taken an eternity.
The gist of the echo told us that Baby A's heart was enlarged-it took up almost half of the space in his chest cavity (WAY too big). And his little heart was working overtime. What we eventually came to understand is while Baby B was shrink wrapped and not getting all of his nutrients, TTTS was almost harder on baby A. The strain on his hear was worrisome, and if the surgery was successful, his heart would have to be monitored for several weeks afterward.
On to our meeting with Dr. Crumbleholme. We met in a conference room with several doctors and our case manager. The doctors introduced themselves and got the meeting started.
On a scale of 1-5, with 5 being the worst (which is death of one or both boys), our twins were at a 3. In Cincinnati, they also break level 3 into three parts of progression from A-C, with C being most severe. So in their terms, we were at 3-C. Obviously not good. With as quickly as it had progressed, if we did nothing, it would likely result in the loss of one or both boys.
Dr. C. had a fabulous bedside manner. He talked to me and not at me, gave me a folder full of studies and research (Yay! My geeky science brain was so excited), answered all of our questions, and even managed to make us smile and joke. He truly understood the level of strain I was under, and did everything in his power to make me feel as comfortable as possible.
We were candidates for surgery and the surgery would be the next day around noon (they had another surgery in the morning). The surgery was fetalscopic and a laser ablation (laser severing the blood vessels they shared). The doctors would go into the uterus with a camera and map out the placents to find the blood vessels shared by the boys-there could be anywhere from 2 up to hundreds. After they mapped it once, they would map it again to make sure they found eeverything. Next would come the laser and sever the connected vessels. This would allow each boy to have his own nutrients. Additionally, the Dr. wanted to do an amnio reduction on Baby A (remove some of the excess amniotic fluid) and a microseptostomy (tiny hole in the barrier membrane between amniotic sacs-would allow for fludi to evenly flow to both boys). We had the option to deny anything we weren't sure about-and could even make a final decision as of the next morning.
One other issue-Baby B had a marginal cord insertion. His umbilical cord was attached at the tail end of the placenta, and it meant that even under ideal circumstances, he would not get as many nutrients as his brother. The surgery would give them more information as to what percentage of nutrients he was getting.
I initially opted for all 3 things, though I was incredibly wary of the microspetostomy. The main risk of that was the potential for the rupture of the membrane which would put the boys into one sac.
The surgery had risks of its own. One or both boys might not accept the change, the amniotic sacs could rupture, etc. I couldn't do nothing...I had to take the risk.