Our Baby Has Arrived!

We are very excited to announce the birth of our daughter Audrey Peridot Leitao.

Please see her new website for pictures & updates:

http://audreyperidot.blogspot.com

Sandy & Michael

Less than 60 hours to go!!

I can't believe how soon we're going to meet our little girl!

I wanted to make sure to get some photos of me pregnant before it's all over. For those of you haven't seen me in awhile, this is me today at 31 weeks 1 day.

MARCH 11, 2009

We now know our baby's birthday!

Barring any emergency c-sections bumping us from our spot, we should be having our little girl around 8:00 a.m. EST on March 11.

She will be 31.5 weeks. On average, babies are able to go home when they reach 36 weeks gestational age, give or take 10 days. It seems likely though that unless she has any unexpected complications she will be home sooner that that because she has been forced to mature more quickly than an average baby.

Wish us luck!

Big News!

Our baby is getting ready to make an appearance!

On Thursday morning I was informed that my doctors had presented our case to the "Fetal Board" - a group of specialists that meets once a month to review complicated cases. Apparently the neonatologists were of the opinion that the baby is at risk of developing blood clotting issues as long as she stays connected to Bridget, and that it would be too late by the time we saw any change on the fetal monitor. The neonatologists didn't recommend going past 32 weeks, and really didn't see much of a difference between 31 and 32 weeks, so they were comfortable with her being delivered anytime!

This of course was a big shock to us! After reviewing all of the information we've decided to deliver her next week, we're still trying to choose which day will be her birthday, most likely Wednesday or Thursday. We have also decided that it will be safest for her to have a c-section - not what I was hoping for, but I'm okay with it.

We are also going to have a second round of steroids in the next couple of days to give the baby another boost to mature. I've been told lots of times that she behaves on the monitor like a much more mature baby, and that with the stress she's gone through as well as the steroids, she's likely to do quite well. The general consensus is that 32 weekers do really well overall. The baby won't have reached 32 weeks, but she'll be very close.

Unfortunately she will have to spend some time in the NICU, but we're hoping it will be a relatively short stay. My best guess is 3 weeks, but it could be less, and it could be more.

We're excited to meet her and find out what she looks like. We'll keep you posted!

Ceci n'est pas un Tuna Sandwich!

This is definitely not what I ordered!

Although some of you may believe that I have a secret love for american cheese and deli meat, you would be wrong. (Although it does have its place - in grilled cheese or on hamburgers, and nowhere else!)

Tonight's meal is definitely up there with the worst meals I've received since being at the hospital. I would say that the food has been one of the hardest things about living the hospital.

I ordered a tuna sandwich with cheddar cheese, and instead was sent HALF a turkey sandwich with two slices of american cheese on the side. Very bizarre. To make it worse, I ordered my dinner at 5:45, noticed the error at 6:45 (after the phones are turned off for ordering), and despite many phone calls from my nurse to various supervisors, never did receive my dinner. Thank goodness I have a small stockpile of food that I brought with me, so I ended up heating a can of soup at 8:45.

This meal ranks up there with the veggie burger that came with bacon on it. And the standard vegetarian meal of mashed potatoes, corn, and grean beans.

Just thought I would share a little of my hospital experience with you.

On a baby note, she is really active tonight, you can see her moving from the outside!

Big Baby!

We had another ultrasound today. They did a growth scan and a BPP, and decided to take a look at her brain to make sure everything is still looking good.

She is growing really well, and for the first time is above average for her gestational age :) Her estimated weight is 3 lbs 7 oz, which puts her in the 56th percentile. She is really curled up in there, she is still head down, with her little butt sticking into my right side and her feet up near my ribs on my left.

She also is practice breathing like a champion, moving well, and her fluid level looks like it is lightly up again - so she scored an 8/8 on her BPP. Her brain still looks normal, which is great.

We also are starting to - sort of, kind of - come up with a plan to bring this adventure to a conclusion. My doctor mentioned last week that he thought it would be reasonable to do an amniocentesis between 34 and 36 weeks to check for maturity, but that the group would have to discuss it. One of my other doctors this morning mentioned possibly around the 34 week mark. This is pretty exciting as I am already at 30 weeks! So maybe just 4 more weeks to go! Tomorrow I will have been here for 6 weeks, so if we have 4 or 5 more to go that seems manageable - although still a long time.

Although 34 weeks sounds early, we still have a lot of unknown risks going on, and after that point, if the amnio shows that her lungs are mature, any risks due to prematurity are minor and not long-lasting. And if she keeps growing well she should be small, but not too tiny, probably in the 5 pound range.

Thanks for checking in!

Ultrasound Results

The ultrasound went well today!

We had another BPP and had a look at the amniotic fluid level.

The amniotic fluid is still low, but looking better. It was up to 7.1 from 5.6 last week, so that was a relief.

The baby did great with her practice breathing, she was doing it pretty much the whole time! She is also active and doing well on her heartrate monitoring.

Here's a picture of her face (in profile):

We've tried a few times to get 3D pictures of the babies' faces, but you need a certain amount of empty space for it too work and they have always been too close together, and with the low fluid it's even worse. So no 3D pics for us.

But, we did see something interesting on the ultrasound today:

It looks like our girl is going to have lots of hair! I didn't even know you could see that on an ultrasound :)

So everything is looking pretty good. I was having contractions last night, nothing major, but they were frequent and lasted for 5 or 6 hours, so I'm back on the meds to stop contractions. Other than that we're doing fine.

Not going anywhere anytime soon...

So my group of doctors met about my case earlier this week, and felt like with the relatively unknown risks of a monoamniotic pregnancy after losing one baby, in addition to the low amniotic fluid, that they are not comfortable with me going home for outpatient monitoring.

Apart from the fluid level, which they are concerned about but not sure why it's happening, the baby seems to be doing well. So they aren't too nervous, just watchful.

Our plan for now is to continue having an ultrasound with a Biophysical Profile (BPP) every Monday, a 20 minute heart monitoring session every morning, and 1 hour heart monitoring session every night. We'll also have a growth scan about every 3 weeks.

Here is a site that has a description of amniotic fluid and the biophysical profile in case anyone is interested:

http://www.gynob.com/biopamfl.htm

The fluid level at the last two ultrasounds has been around 5.6 or 5.7. Normal is between 8 and 18. She doesn't necessarily have room to make big movements anymore - especially because Bridget is still taking up some of the room, but she is still kicking and being active which is great.

I'll keep you all posted!

Status

Hi everyone.

Things are still going pretty well. The baby seems to be doing fine.

I had an ultrasound last week and her estimated weight was 2.33 pounds! So she is growing well. The only point of concern on the ultrasound is that the level of amniotic fluid is on the very low end of normal. It does not seem to be affecting her yet, so we are just observing.

I had another ultrasound this morning and the amniotic fluid looked about the same. Today was the first time we saw her making practice breathing movements, so that was exciting and a sign that she is continuing to mature and develop properly.

This weekend my doctors changed my monitoring to one NST (non-stress test) a day. Which basically means that the baby is only being monitored for 20-30 minutes a day. I also have the option to put the monitor on at any time if I am concerned about anything.

I have asked them to consider letting me go home and be monitored as an outpatient if they think it would be safe. I don't want to sacrifice any necessary care, but if there is a way I can be monitored by going to the hospital at home once a day and coming up to Louisville once or twice a week, that would be much much better for me. Apparently my group of doctors are meeting in the morning, and this will be up for discussion.

I'll keep you updated, thanks for checking in!

MRI Results

We finally received the results this morning, and they look good!

We are very relieved & thankful. The report said that there were no obvious abnormalities and no signs of blood flow changes. Not exactly the most glowing terms, but very reassuring.

According to my doctor this week our main concern at this point is the continued potential for blood flow problems to the baby. For now my monitoring will continue as before, three times a day for two hours.

We will have an ultrasound one day this week and they will check the baby's growth, as well as look for signs of maturity such as practice breathing motions. If they get everything they need I might even ask them to try to look in 3D for a minute and see if we can get a good picture.

We are at 27.5 weeks now, so the baby's chances are quite good if she has to be delivered - but hopefully we can keep her in there for a while still.

Thank you everyone for your continued support, thoughts & prayers.

No news yet

I had the MRI on Friday. It was an interesting experience, but not especially stressful or anything. The most frustrating part was the delay in getting it. They mentioned at the last minute that they wanted me to take a valium to keep the baby still for the MRI, so that took awhile.

We hoped to get the results Friday afternoon, but apparently the MRI was sent to the wrong radiologist. Fetal MRIs are still a relatively new thing, and they don't do very many of them here. There is only one radiologist who can actually read them, and he won't be back until Monday. We expect to get the results tomorrow morning.

The doctor this morning said that the baby's heart tracings look great, and she even appears to be a little bit ahead of what they expect for her gestational age. He said that since she looks so good, he expects the MRI to look good. That made me feel very hopeful since this doctor is not exactly the bubbly and optimistic type - I don't think he would want to give us false hope.

Anyway, hopefully we will have some good news tomorrow! I'm also looking forward to discussing what our long term plan is since they have not wanted to discuss that at all until we get the results of the MRI.

Update

Things seem to be going pretty well for me and our surviving baby.

I have been gradually reduced in the amount of monitoring I'm receiving as the baby is doing really well, and the doctors believe that the risk of entanglement is becoming much less of a concern. Her heart rate has been looking really good, with no real areas of concern.

Right now I'm being monitored three times a day for two hours. On Friday I've been scheduled for an MRI to look at the baby and see if she suffered any damage when we lost Bridget. Once that is done they are planning on moving me upstairs (where I started, I'm on my 3rd room now) for intermittent monitoring. They seem to be waiting for the MRI to make any further decisions.

So at this point I'm just trying to stay calm and healthy, and hoping that the MRI will show that our surviving baby is perfectly healthy.

Thank you again to everyone for your support, thoughts and prayers.

Very sad news

We've tried to contact everyone, and I'm sorry if you are finding out this news here.

Unfortunately it looks like the difficulty with monitoring both babies last week was due to the fact that sometime after my ultrasound on January 21st, one our of girls passed away. We have chosen to name her Bridget Evangeline Leitao.

It's been pretty rough but we're hanging in there. I started having contractions shortly after learning we had lost Bridget and have been put on medication to stop those. I am now on 24 hour monitoring and our surviving twin has been doing well.

I was given a round of steroid shots over the last 24 hours, which will help boost the baby's lung maturity and lower some other risks of prematurity in case she has to be delivered in the next two weeks. We're hoping I can stick it out for as long as possible. The problem with the 24 hour monitoring is that I am basically on bed rest in order to keep the baby on the monitor. I'm allowed up for showers and bathrrom breaks, and have started taking a couple of 5 minute walks around the maternity ward every day. It's hard on me, especially since we are still reeling emotionally from our loss, but I'm staying focused on the health of our surviving baby.

Our main concerns at this point are premature labor, cord entanglement -the original issue we were worried about and the most likely reason we lost Bridget- and possible brain injury as a result of the babies' shared vascular systems. We're planning on having an MRI in a couple of weeks that we hope will show that our surviving baby was able to escape any serious brain injury.

Thank you everyone for your thoughts and prayers.

Monitoring these girls isn't easy!

We've had a few bumps in the road getting our monitoring started.

Our current goal is to try to get a 5 minute "strip" of the girls' activity three times a day. So far I've had two sessions and each one has lasted about an hour. Each time they can only get one baby to stay on the monitors. It's a little disconcerting, but they spend the hour chasing the second baby around, so we're pretty sure they are both okay. They are going to bring up the ultrasound machine this afternooon to try to help them find both babies.

Some nurses are fine with this, others are more negative. I keep hearing how hard it is to monitor babies this young and that it's "never" done, and is "useless." That get's a little frustrating, but I know why I'm here, and the good nurses make up for the not so nice ones. I realize it's going to be hard, but we have a very rare, very high-risk type of twins, so they need special treatment and I'm not going to feel bad about it.

Sleeping here is somewhat difficult, but not awful. I know a lot of women who are admitted long term take something to help them sleep but I would rather not do that unless I have to. The food is also okay, and at least I get to order from a menu each meal so I'm not stuck with standard meals - unfortunately the selection isn't fabulous and they don't always get my order right, but this is a hospital after all.

I got out for a walk outside yesterday afternoon. That was really nice. I felt like a real person & even had a decaf latte and muffin at a cafe. I'm also making an effort to get dressed properly every day and not just stay in my pajamas :)

Here are a few photos from the ultrasound yesterday - I had another of those "ohmygoodness there are babies inside me" moments when I was looking at them. I can't wait to see what they look like!

Baby B was ready to be photographed.




Baby A was hiding, but you can see her face a little on the right (next to her sister's head).

I've moved in!

I now live at the University of Louisville hospital, and hopefully will be here for 10 weeks or so. The babies need to monitored closely, even though I and they are healthy and doing well so far.

Luckily I am able to work from the hospital, so that will keep me busy!

Yesterday was my first day and it went relatively smoothly. I didn't actually check in until late in the afternoon so that made it go faster.

I had a consultation with a nurse practitioner from the NICU last night. She gave me a couple of books to read and shared with me some general information about premature babies, and specifically what our babies chances & hurdles would be if they were born this week. She said a good rule of thumb is to expect to go home 2 weeks before your actual expected due date - which is May 9th. Hopefully I can keep them growing for as long as possible.

Everything looks fine with the girls today. I had my second growth ultrasound and they also looked at the cords. The babies estimated weights are 1.25 and 1.5 pounds, which puts them in the 21st and 46th percentiles. The doctor said that's great, they are both in the normal range. We also looked at the cords and didn't see any serious entanglement issues although they are tangled - you can tell where their cords start, but you can't tell whose is whose in between.

I haven't had my first monitoring session yet, so I will update everyone on how that goes. Our current plan, since it's still early in the pregnancy and very hard to monitor the babies, is to have 2 short monitoring sessions each day, really only looking for major problems at this point. I'll have increased monitoring after next week & they will start doing BPP's (Biophysical Profiles) which is an ultrasound exam where they are really looking at the health of the baby. I got this info from WebMD:

A biophysical profile (BPP) test is done to:
Learn about and keep track of your baby's health. Special ultrasound methods are used to keep track of movement, increases in heart rate with movement (nonstress test), muscle tone, breathing rate, and the amount of amniotic fluid surrounding your baby. If these five areas are within a normal range, your baby is considered to be in good health.

And for those of you who are interested, here are a few photos of my hospital room.

Our Plan

I am being admitted to the hospital for monitoring on January 20th. I will be a few days past 24 weeks, which is considered viability - the babies are considered to be developed enough that they have a good chance of surviving outside the womb if they have to come out. We're hoping they stay in there for a long time though!

To start I will be monitored at least 3 times a day for about an hour each time. This will likely be increased as we progress or if the babies have any trouble.

The hardest part about the whole thing is that I will be away from Michael and our friends, but hopefully it will be worth it.

Here is the link to visitor info for anyone who wants to come see me :)

http://www.uoflhealthcare.org/Default.aspx?tabid=426

More than you ever wanted to know about Monoamniotic twins

Monoamniotic twins are a rare type of identical twins that occurs in approximately 1% of identical twin pregnancies or somewhere between 1 in 35,000 and 1 in 60,000 pregnancies. It occurs when the "split" happens about 9 days after fertilization. Most identical twins split much earlier than this. If our twins had waited any longer to divide they might have been conjoined!

If the split occurs early, each baby will have its own placenta and own amniotic sac. A few days later and the placenta will have formed, but each baby will have its own amniotic sac. Around 9 days later like our girls - and they will be share both a placenta and amniotic sac. Basically they are already having to share a bedroom!

A monoamniotic twin pregnancy is quite high risk because their umbilical cords become entangled and can eventually get compressed. Most monoamniotic pregnancies do not go beyond 34 weeks (40 weeks being full term).

This twin thing isn't going to be simple!

When our doctor confirmed that we were having twins she said that she thought they might be monomaniotic. I had done some reading and although the possible diagnosis was scary, I was aware of how rare it was and how frequently it was misdiagnosed - especially early on. So I didn't really get too stressed. I was referred to a specialist in Maternal Fetal Medicine at the University of Louisville for a higher level ultrasound and consultation.

During my first trip to Louisville the ultrasound tech and doctor were unable to find a separate amniotic sac for each baby. It was decided that I would make the 1.5 hour trip every two weeks from that point on (I was about 12 weeks pregnant at that time).

At every visit since then I have had an ultrasound. They have never been able to find a separation in the amniotic sac. While we continued to hope for misdiagnosis for several months, we are now certain that we have a very rare type of identical twins know as monoamniotic twins (or MoMo's).

Twin Surprise

We learned we were having twins on September 30th, 2008 when we were about 8 weeks pregnant. The doctor thought she had possibly seen twins a couple of days earlier, so we were eased into it a little bit, but it was still a shock. In fact, I still can't believe it!

I still have a waist here!

The lumps!

Do we look a little stunned?