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Handling a High Risk Twin Pregnancy

*Original post released on 1/14/22

Being pregnant with twins can be high risk at times, but it usually doesn’t require a fetal maternal specialist’s involvement. In the case of our twin pregnancy, we are considered “high risk” for a few reasons in addition to simply having multiples. First, I’ll let you in on what those high risk criterion are. Then, we’ll move on to discuss what the associated risks are with our pregnancy and the methods we’re taking to counteract those risks.

Unfortunately, our twin pregnancy is “high risk” not only because there’s more than one baby in my uterus but also because of my past and current medical history. In a twin pregnancy, you can have any combination of one or two placentas and one or two amniotic sac. For placentas, the term for one placenta is monochorionic and the term for two is dichorionic. For amniotic sacs, the term for one is monoamniotic and the term for two sacs is diamniotic. The least risky combination for a twin pregnancy is dichorionic/diamniotic, meaning each baby has their own placenta and their own amniotic sac. Luckily for us, this is the case! One aspect working in our favor to make this high risk pregnancy less “high risk.”

As for my medical history, I have many factors at play in our pregnancy. In October of 2016, after suffering from debilitating migraines for more than a decade, I was finally diagnosed with a pineal brain tumor. I underwent imaging and lumbar punctures to gather insight into my health status at that time. The scans revealed the tumor is non-cancerous, however the lumbar puncture showed an increased intracranial pressure (25 mm Hg…with the high end of normal for an adult being 15 mm Hg). I underwent cerebrospinal fluid draining a few times and was placed on a medication regimen to reduce my ICP. Unfortunately, my body didn’t respond to high dose diuretics to try and lower my CSF production and ICP. At the time, I was also morbidly obese, weighing in at nearly 300 pounds. It was the recommendation of my neurologist and neurosurgeon that I undergo gastric bypass surgery to reduce my body weight rapidly which would hopefully also reduce my ICP and associated symptoms.

In just a matter of three months, I had gone from receiving a life altering diagnosis in October 2016 to having life changing weight loss surgery in December 2016. Luckily, the surgery fulfilled its role in dropping my weight and reducing the symptoms and migraines I had been experiencing for more than a decade. To this date, I’ve been able to keep off more than 115 pounds (with some of the original weight lost having been regained during this pregnancy). You may be wondering what the deal is with the tumor… Well, with its location and benign state, the neuro teams I’ve been seen under deem this as non-operable. An operation would be extremely high risk, so I’ve chosen to postpone that route of treatment for as long as possible and reserve it as a last resort.

One of the last remaining major factors for this high risk pregnancy happens to deal with my blood. Not only am I considered to be anemic, I also have a clotting disorder called Factor V Leiden. Many people are anemic and this can be improved with medicinal and nutritional interventions, which we’ll discuss later in this article. For those of you who aren’t familiar with Factor V Leiden disorder, it’s a clotting disorder that results from a mutation of one of the blood’s clotting factors. Because of this mutation, people afflicted with this disorder have hypercoagulable blood which predisposes them to blood clots of varying severity (Ex: deep vein thromboses, pulmonary embolisms, heart attacks, strokes, etc.). While I have yet to experience any of the aforementioned complications, my mother has experienced DVTs and PEs as a result of this hereditary condition.

Now that you know why our pregnancy is considered high risk, let’s talk about some of this complications that can occur during a high risk pregnancy. For instance, the risk of miscarriage or still birth is a little higher with multiple gestation pregnancies. Additional risks tend to set in during the second trimester and later in pregnancy; these include gestational diabetes, gestational hypertension, pre-eclampsia/eclampsia, and pre-term labor/delivery. These complications can affect the babies’ birth weight and possibly result in growth restriction. With pre-term labor and delivery, the risk lies with the babies being born before their lung function is sufficient enough (due to minimal or lack of surfactant production). Births that are too early can result in prolonged NICU stays while the babies strengthen their body systems and learn to feed for an increase in body weight.

Despite being a nurse and knowing the potential severity of these high risk pregnancy complications, I find some comfort in the approach our FMS team is taking to manage these risks. To manage the risk for common complications, we’ve implemented a weight lifting restriction to no more than 20 pounds and a long distance travel restriction after 24 weeks gestation. These guidelines can help us prevent pre-term labor and placenta-related complications. Plus, the travel restriction aids in ensuring that we are not stranded on a plane or in a remote location without access to medical care in the event of a complication. In addition to this, our OB and FMS team see us every 4 weeks or so throughout the first two trimesters and plan to increase the frequency of visits to every 1-2 weeks in the final trimester of the pregnancy. This allows for additional monitoring of myself and the babies to ensure our health, monitor for complications, and routinely evaluate for the potential need to deliver early.

In terms of my blood conditions, there are a couple of things we’re doing to lessen the risks to our girls during pregnancy. To address the anemia, I’m making sure to incorporate more iron rich meats and green leafy vegetables. I’ve also been taking iron supplements daily with a glass of orange juice (Vitamin C helps improve iron absorption!). Luckily, I’ve been able to improve my blood counts to only be considered “borderline anemic” at this point in time. In regard to the Factor V Leiden disorder, my FMS team has prescribed for me to self-administer daily low-dose Lovenox injections to help prevent blood clot formation. Once we near closer to birth, whether planned or spontaneous, there may be discussion of holding the Lovenox dose to prevent the reverse complications of hemorrhage during labor and delivery.

Regardless of what type of nurse you are, it’s always interesting to gain a little insight into a different aspect of the nursing field. I am an ICU nurse that deals exclusively with the adult population, so these risks and interventions are largely new to me in terms of pregnancy. I’m sharing my pregnancy journey with you to help you gain a little perspective too! This can also help you see just how complex a healthcare case can be, even if the patient appears “normal” and without blatant risk. I hope to be able to keep you all updated as the pregnancy progresses. I know it intrigues me, so I hope you learn something along the way with me.

Until next time, happy studying!

Andra Alyse

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