I had like a super panic attack last night. I was so sure the chronic TTTS phase was over, and to find out about the possibility of acute TTTS made me go crazy, feeling out of control again. My husband was on his way home from work and I called him because I didn’t know where to vent my craziness (on hindsight, it was probably also a hormonal breakdown). He didn’t pick up but he messaged me on Facebook and I told him what I read and what I was worried about. As usual, he calmed me down for the millionth time this pregnancy.
But I am understanding better that prematurity might be imminent for my case. I had a complication-free pregnancy so far and that’s greats and all but there’s still a lot of risks involved for the identical twins. Anyone who carry twins who came from a single egg that split, ie. monochorionic diamniotic (MoDi) or monochorionic monoamniotic (MoMo) twins will have this risk. My twins are MoDi. They share a placenta and there’s a constant worry that the placenta decides to privilege blood flow to one twin and deprive another, that is why TTTS is called the “disease of the placenta”.
Acute TTTS sets in late in the pregnancy and can happen very fast. A doctor who has researched and treated thousands of TTTS cases recommended that MoDi and MoMo twins be delivered via C-section before the 36th week. I had read many bereavement forums of parents who had OBGYNS who were not well aware of TTTS and as a result, their MoDi or MoMo twins died very close to birth at 36, 37 and 38 weeks even through for the entire length of the pregnancy except towards the end they were perfectly healthy. Acute TTTS just happens that fast. Prof Biswas seems to know much about TTTS since he has been monitoring the identical twins for their sizes, amniotic fluids, blood flow, and bladders but we haven’t really talked about acute TTTS now that the chronic TTTS danger zone is over for me. Its something I intend to raise in the next detailed ultrasound scan coming up in 1.5 weeks.
In the meantime, I’ve been following the recommendations of the TTTS Foundation by getting a lot of horizontal rest (the best position for the placenta to work optimally) and downing disgusting protein shakes or milk with high protein content. I’ve cut down my carbs so that I will have more space to eat more proteins. But I feel better knowing now that I should deliver the babies earlier if necessary. It might mean a bit of a NICU stay, but its either that or risk acute TTTS. Though I’ve seen parents of triplets deliver at 34 weeks and they avoided NICU because their babies managed to achieve ideal birth weights. Again its down to a high-protein diet.