Thirty Little Toes

 

(Full report on today’s appointment coming soon…. but didn’t want to leave you in suspense. And yes, this is the proper order.)

Triple Decker

Gulp.

We ordered the stroller.

We decided on the Triple Decker stroller frame fitted for the Graco SnugRide 30 car seats. Here’s what it looks like, except I think those are the Evenflo car seats instead in the photo.

There aren’t very many options out there if you’re looking for a triplet stroller for infants, unfortunately, especially if you want one that works with car seats. Which seems to me to be the most convenient way to go. The Peg Perego looks quite nice. Luxurious, Italian – it’s the Maserati of strollers. But it comes with the Maserati price tag and, honestly, I’ve read quite a few stories from customers who had some grand mishap with it. So Triple Decker it is. We went ahead and placed the order because it takes about 4 weeks to be delivered and we would really like to have the stroller before we purchase the vehicle it has to fit into. Haven’t bought the car seats yet. They are kind of gender specific so we’re holding off for now, but now we do know which model we’re getting…

The stroller purchase is a milestone. It’s a commitment. It says: “I accept that my expected reality includes three infants.” Now, this may seem fairly obvious at this point. It may not seem like a major epiphany. But my cozy little house of denial has been steadily crumbling and there isn’t much of it left standing any more. This is good, right?

Side note: Ultrasound appointment tomorrow afternoon. Checking on the placentas again. Fingers are crossed that we’ll find out the sexes. Knowing that bit of info would really help to cement the reality of things.

17 Weeks

Necessarily there’s a change in background to my photos, since we are in the new house. And there aren’t any white doors to stand in front of, so just blank wall.

Anyway, measuring 42″ around and up to 14.5 lbs gained. My belly’s girth is now decisively greater than my derriere’s (though I’m not actually sure whether or how much that number may have expanded, too). I had a day of feeling suddenly and uncomfortably humongous yesterday. I’m sure it won’t be the last time. Also I made Hubs retake today’s photo several times, before realizing that I really need to keep my arms away from my back or else I just look bloaty and gross.

Sixteen was an interesting week. There were the BH contractions, which have subsided quite a bit since Friday actually. And another fascinating new thing that started Friday night that deserves its own post (intending to do that tomorrow.. but then, I intended to post it yesterday, and that clearly didn’t happen).

Placental Confusion

This afternoon I had the follow-up ultrasound to take a better look at the triplets’ placentas. It was done at the clinic where we had the NT scan, across the street from the hospital where the MFM’s office is and where I’ll ultimately deliver. The clinic is where they have the fancy equipment.

Early this morning, I had dropped Hubs off at the airport to fly to NC for a few days. We were both a bit upset that he’d miss the appointment – the first one he hasn’t been in attendance. What if he missed some critical information about the placentas? What if they could tell the sexes today, with the hi-def machine? Well, it turns out he didn’t miss much.

No sexes. The kids were being modest, and it’s still early anyway. A couple more long weeks, then, before we’ll know. The sonographer did offer a pure guess, two boys and a girl, but it wasn’t based on the images.

And the placentas? Well, C is definitely on its own, definitely in a separate sac and with an anterior placenta. With A and B, neither the sonographer or the doctor could say for sure. If you aren’t up on your “MoMo/MoDi/DiDi” terminology, here’s a quick fetal anatomy lesson.

Boring sciencey stuff warning! And please correct me if I’ve got any of this wrong!

The placenta is the organ that provides blood and nutrients to, removes waste from, and protects the fetus. It has two parts, the maternal part that is embedded into the uterine wall and connects to the umbilical cord (which is what’s usually being referred to when one speaks of the placenta), and the fetal part that forms the protective outer membrane around the fetus called the chorion. There is an inner membrane called the amnion that also surrounds the fetus. Depending on how many days after conception a fertilized egg splits, identical twins may share one or more of these structures. Late splitters will share all of these structures (diagram A). Most commonly, identical twins will share a chorion and placenta but each have their own amnion (diagram B). Early splitters will have separate chorions and amnions, and their blood supplies to the uterus may (diagram C) or may not (diagram D) fuse together. The thing is, fraternal twins can also have a fused placenta (it occurs in over 40% of dizygotic twins, apparently), or fully separate placentas, and fraternals essentially always have separate chorions and amnions. (Not clear enough? Here’s somegood reading material.)

So, what’s our situation? Well… Here are two views of what our triplets look like all together today.

I know it’s hard to make out the babies (which are labeled… uh, yeah) – but it’s not difficult at all to see the membranes in between. The membrane width between A and B is not distinguishable from that between B and C. The doctor said she really thinks they each have their own chorion. A and B’s placentas appear to be either really close together, or they are fused. In either scenario it is not actually possible to tell whether they are identical or fraternal; only about 30% of twins with fused placentas are identical. And the doctor says for now we can’t fully rule out that they are truly sharing a placenta, so for now we err on the side of caution and monitor them as if they are, tracking their relative sizes and rechecking things in a couple of weeks. They definitely at least have their own amnion, which is good, because when they share one there’s a significant risk of entanglement in one another’s umbilical cords. If their placentas are fused but not shared, the risk of Twin to Twin Transfusion is still theoretically possible, though it doesn’t seem to actually happen.

Ideally, we find out in a couple of weeks that A and B are not the same sex and therefore definitely not identical. Since we conceived on fertility medication, all fraternal is the most likely situation. But, we just aren’t sure.

Oh yes, almost forgot to mention, I had my blood pressure checked again today and it had gone from 164/80 on Monday to 134/76 today. So the medication is doing its thing. (And I felt much better today than yesterday.)

Whew, that was long-winded for a post in which nothing was actually determined. I shall reward your patience with more pictures!

Baby A, on the bottom, was sitting on its head during the whole ultrasound. (Spine on the right of the image, leg at the top.) The sonographer was cracking up about it.

Baby B, in the middle, was again hanging out with its hands by its face.

Baby C, on top of the other two, looks like it’s in a little bubble. It also has a hand to its face, and still has more room to stretch out than the other two.

MFM Appointment No. 1

We went up to Providence this morning for the first appointment with the maternal fetal medicine specialist, aka MFM, aka high-risk OB: Dr. D. We liked her a lot. We will be seeing Dr. D for most of our regular appointments from now on.

First of all, I know you’re all holding your collective breath. No, we didn’t find out the sexes today. I did get a quick ultrasound, but it was a low resolution mobile machine and was only a couple of minutes of checking to make sure all heartbeats were accounted for.

The appointment was long and there was a lot of information, both given and received. A lot of it was repeat of things covered between Dr. G, the various books, and the internet. Dr. D  talked to us about different complications, especially preeclampsia (more on that in a minute). She talked about realistic timelines and kind of echoed the milestones I posted recently. She is not concerned about me working for now, so that’s good.

We met with several staff members other than Dr. D, including a social worker, a nutritionist, and Nurse N who’s the one we call in case of problems. Everyone was really really nice, though the social worker was, uh, a little spacey. The nutritionist knew exactly which book I’d read as soon as I started to open my mouth, and said not to make myself sick or over-stress myself worrying about Dr. Luke’s weight gain schedule and calorie counts. The nutritionist gave me a sheet of daily serving suggestions that doesn’t include any calorie estimates or goals as far as grams of protein. She will be keeping track of my weight gain, and said that 45 to 50 lbs total is usually plenty and instead of 36 by 24 weeks, 20 by 20 is what she tends to look for.

There were a couple of major important things that did come out of this morning. One, my blood pressure was the highest it’s been, ever. So now I have a prescription for Labetalol. This makes me unhappy.

Second, for the first time the possibility that two of the fetuses are sharing a placenta was raised. Apparently during the NT scan, the sonographer wasn’t able to tell for sure, but she didn’t mention it – just wrote it in the notes for Dr. D to bring up with us. If they share a placenta, that means they are identical (#3, which I believe is Baby A, is clearly fraternal). Identical means a riskier pregnancy, particularly with the chance of Twin to Twin Transfusion Syndrome. So if they do share a placenta, then the way in which we’re all monitored changes somewhat. This Wednesday afternoon, I go back to the clinic (adjacent to the Providence hospital) where we had the NT scan and they will try to get it figured out for sure.

The next MFM appointment will be April 12. I mentioned that I’d get back to the preeclampsia thing? Well, I’m at greater risk for that because of the blood pressure issue, and protein in the urine is one indicator of preeclampsia. So they want to get a baseline for the amount of protein in my urine somewhat early on. This is not done with a single ordinary pee-in-a-cup-at-the-doctors-office scenario, either. I will be collecting all of my urine on April 11. ALL of it. In a three liter jug.

You’re thinking, “That isn’t going to fit in the toilet!” No, indeed not. That’s why I have to place this “hat” into the toilet, pee in that, and then transfer it to the jug.

I find the prospect pretty hilarious, honestly. There are a couple of things that add to the awesomeness, other than the doctor calling the second item a “hat.” One, is that April 11 is a Monday. They didn’t have any appointments available that Monday, which would have allowed me to collect my three liters of urine discreetly on a Sunday. Instead, I have to take my pee-hat and pee-jug to work. Two, is that it’s someone’s job to inspect my three liters of urine, and that person has one of those no-nonsense Massachusetts accents. Three, is that this is the bag in which they gave me these devices:

“Especially Yours,” indeed. Thanks, Mr. Egret.

 

15 Weeks

Measuring 41″ around, and I’ve gained about 9 pounds now. I find the complete lack of correlation between weight and inches to be pretty interesting. How is it that, pound-wise, this week I gained half again what I had gained this whole time up to last Sunday, but only put on half an inch out of 5 total inches increased?

A 3 lb increase is encouraging though. If I’m going to meet Dr. Luke’s suggestion of 36 lbs by 24 weeks, then the math works out to 3 lbs every week from now until then. Crazy, right? I have been extremely lucky to not have battled with morning sickness, but frequently I feel a bit ill just because I’ve overstuffed myself. The hefty grocery bills have been telling the tale. Of course, my changing profile really gives it away now, too. I mean, I look down and see The Belly every day and I know it’s getting bigger, but it wasn’t really until taking this picture that I realized how much The Belly now sticks out past my boobs. The Belly is firm to the touch, too. It’s bizarre. Pregnancy is weird.

14 Weeks Pregnant With Triplets: Second Trimester!

Measuring 40.5″ around and up approximately 6 lbs. Still have some regular clothes that fit, such as the ones in this photo, but more and more I’m wearing the maternity clothes.

Fourteen weeks is a milestone, as it marks the beginning of the second trimester! A normal pregnant women apparently looks forward to trimester two for a reprieve from the challenges of trimester one – more energy, less nausea, etc. My first trimester was astonishingly easy, and besides, I expect that all bets are off for any relief in a triplet pregnancy. I mean, before the end of this trimester I am supposed to be as big as a regular full term mama. I’m already seeing occasional evidence of tougher times ahead. In the last couple of weeks, I’ve started to have some stiffness in my lower back and hip joints, especially when first getting up in the morning or if I’ve been sitting for a while. I know, of course, that I’ve just barely scratched the surface as far as discomfort goes. And while I’m complaining, I can’t seem to get much relief from my super-dry sinuses, or my itchy skin. Also, I keep waiting for the ravenous appetite to kick in.