Closure

I had sent my MFM doctor a message, thanking him for the wonderful medical care he provided, and his quick decision making when it was time to take my girls out. I also asked for a copy of the placenta pathology report.  Mono-di twin placentas are always sent to pathology for examination.

I was disappointed that during their birth, I had forgotten to ask to see the placenta. Once the babies were out, they were my only concern, and I completely forgot that I had wanted to see it. I just thought it would be interesting to see the one huge placenta with the dividing membrane that separated my twins and the two umbilical cords attached.

The pathology report is extremely eye opening. It shows that without a doubt, my twins are 100% identical (although I seriously question it sometimes because they look so different!). It was a monochorionic, diamniotic twin placenta. It states “the dividing membrane consists of a double layer of amnion without intervening chorion.” If there was a chorion in between, then my twins would be di-di and possibly non-identical. So there is no doubt.

Other items of interest:

Baby A’s cord was 10 cm long and Baby B’s was 16 cm. I had heard the doctor say “short cord!” as Magnolia was being pulled out, so this verifies that.

The placental shares for the two babies were not exactly equal. How they determine this is by running two different colors of dye through the blood vessels on each side of the placenta to determine where the division lies, and also see if any blood vessels are crossed (indicating TTTS or TAPS). The report stated that placenta B (Baby B’s share) was larger than placenta A (Baby A’s share).

It also says “many small vascular anastomoses are identified.” What this means is that there were crossed blood vessels carrying blood from one baby to the other. Here’s some more info on this:

“Monochorionic twin pregnancies are at increased risk of adverse outcome because of the vascular anastomoses that connect the 2 fetal circulation systems. The shared circulation is responsible for some unique complications in monochorionic twins, such as the twin-to-twin transfusion syndrome, the twin anemia polycythemia sequence, the twin reversed arterial perfusion sequence, and monoamniotic twinning. Another consequence of the shared circulation is that the well-being of one twin critically depends on that of the other.”

I have suspected that my babies could have been in the beginning stages of TAPS, which is twin anemia polycythemia sequence, where one baby gets more red blood cells than the other. With TAPS, one baby will be born very pale and anemic, often requiring blood transfusions, and the other will be born bright red with too many red blood cells. I was told that both my babies’ blood counts were within the normal range, but looking back on the photos from their birth, Baby A was noticeably pale and Baby B was darker/redder. They still have different skin tones, with Baby B being darker, which could be attributed to this. I’m wondering if their RBC counts were on the high and low ends of “normal” and perhaps it was the beginning stage of TAPS.

There was a pathologic diagnosis of “plasma cell deciduitis” which is inflammation of the maternal side of the placenta. The most common cause of this is from fetal antigens. Remember the E antibody issue that I was being monitored for? Well, most likely, based on this report, the babies DID have the E antigens and it was affecting the health of their placenta. Plasma cell deciduitis leads to preterm labor/premature birth. I am pretty sure I was already in labor when I showed up at the hospital for my scheduled c-section at 34+3, so perhaps this is why.

The last thing of note is “chronic villitis” which is a “pattern of placental injury occurring in term placentas.” Villitis is “an important cause of intrauterine growth restriction and recurrent reproductive loss.” My babies had intrauterine growth restriction!

All of this information is extremely enlightening. I have been really struggling with feelings of guilt and inadequacy over the fact that I had failed to grow my babies well enough, and that they needed to be born early. Their NICU stay was extremely difficult for me emotionally, and I am still trying to process it and move on. I have failed to exclusively breastfeed them, in part due to issues related to prematurity. There have been times I wondered if my medical team had made the right decision in taking them at 34 weeks.

I know now that the right choice had been made. There were several things going wrong with their placenta simultaneously. It was time. I’ll forever be grateful that my babies made it into my arms safely. Perhaps I can lay some of my worries to rest now.  Closure is a good thing.

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