A Journey Through Heartbreak: Navigating the Loss of My Di-Di Twins Due to Fetal Growth Restriction
Hello, I’m 35 years old and three weeks have passed since I experienced a stillbirth late in my second trimester during my second pregnancy. I am currently waiting for a maternal-fetal medicine (MFM) consultation to go over everything concerning my condition and to plan for future pregnancies. However, I am concerned that the specialists may not delve deeply enough into the details of my pathology report. Therefore, I am reaching out to see if anyone could help decipher it alongside the story of my pregnancy. I'm desperate to find out why both of my twins did not survive, and to understand what transpired during this challenging time. Here’s a brief overview of my pregnancy journey: * **Medical Background**: I have a history of mild asthma, subclinical hypothyroidism (managed with medication), sleep apnea, and obesity (BMI of 31). Additionally, I am considered an advanced maternal age (AMA). Throughout my pregnancy, I did not experience hypertension, nor did I consume tobacco, drugs, or alcohol. My previous pregnancy, three years ago, progressed without complications, resulting in an induced vaginal delivery of a healthy baby weighing 7 lbs 8 oz at 41 weeks and 3 days gestation. * **Prenatal Care**: I was diligent about taking prenatal vitamins while attempting to conceive and throughout my pregnancy. I also began taking an 81 mg baby aspirin at week 12 to help prevent preeclampsia. ### Timeline of Events and Complications: * **9 Weeks**: Confirmed pregnancy with di-di twins. * **10 Weeks**: Non-invasive prenatal testing (NIPT) revealed I was having a boy and a girl, both with a low risk for trisomies 13, 18, and 21. * **13 Weeks**: During a scan, it was discovered that Twin 2 had passed away around week 12, with no abnormalities detected. Twin 1 exhibited a marginal cord insertion. * **16 Weeks**: Alpha-fetoprotein (AFP) screening returned significantly high results (~8 MoM). A subsequent growth scan indicated Twin 1 was in the 6th percentile, yet this did not seem alarming at the time. * **19 Weeks**: Anatomy scan showed that Twin 1 had fallen below the 3rd percentile at an estimated fetal weight of 192g, indicating severe early-onset growth restriction due to suspected placental insufficiency linked to the elevated AFP levels. * **21 to 24 Weeks**: Follow-up ultrasounds reflected minimal growth and worsening Doppler results. * **25 Weeks, 4 Days**: Twin 1 was stillborn, weighing 302g. Genetic testing, including whole exome sequencing, returned no differences in genetics between the twins. I profoundly loved Twin 1 and Twin 2; I named him Arthur. ### Concerning Pathology Report: **Final Diagnosis**: * Twin placenta, delivery following intrauterine fetal demise at 25 weeks and 4 days gestation: - A significantly underdeveloped single disc twin placenta weighing 88 grams (far below the expected 341 grams, less than the 3rd percentile). - Membranes showing a dichorionic diamniotic configuration. **Placenta 1**: - The umbilical cord measured 20.5 cm, included three vessels, with a marginal insertion. - Fetal membranes appeared normal. - Chorionic plate also showed no abnormalities. - Notable was the accelerated maturation of the chorionic villi for gestational age, coupled with microscopic parenchymal infarcts. - The basal plate displayed signs of lymphoplasmacytic deciduitis. **Placenta 2**: - Evidence of changes consistent with prior fetal demise: - The umbilical cord displayed significant necrosis. - Increased pigment-laden macrophages and vessel involution were evident in the chorionic plate. - Chorionic villi revealed sporadic involutional changes. - The umbilical cord here was considerably shorter at 5 cm, presenting with three vessels and was hyper-coiled. - Slight edema in the fetal membranes was noted. - The basal plate included a substantial retroplacental hematoma. **Diagnosis Commentary**: The placenta’s diminutive size was alarming, indicating it would rank below the 3rd percentile even if it had been a singleton. The report highlighted maternal vascular malperfusion, likely connected to intrauterine growth restriction and potential hypertensive disorders or hypercoagulable states during the pregnancy. This condition raises concerns about recurrence in any subsequent pregnancies. **Gross Description**: * The placenta from Twin 1 was marginally larger compared to Twin 2 (60:40 ratio). Twin 1’s umbilical cord was 20.5 x 1.6 cm, inserted marginally four cm away from the dividing membranes, presenting standard three vessels, but exhibiting diffuse dusky discoloration. Twin 1's membranes were consistently thickened. * The placenta from Twin 2 was notably smaller, exhibiting signs of significant complications, including a large retroplacental hematoma altering much of its basal plate. * Overall, the pathological assessments revealed no additional lesions of concern. This painful experience has left me with a desperate need for understanding, and I wish to navigate this loss with clearer insights into what transpired during my pregnancy.
Answers (1)
8/30/2025, 4:51:45 AM
OpenHealth AI
I'm deeply sorry for your loss and want you to know that your feelings of confusion and determination to understand what happened are completely valid. The experience of losing twins is incredibly challenging, and seeking clarity about your situation is a healthy step forward. Let’s break down what you’ve shared and outline the critical points and next steps you can take in preparation for your upcoming consultation.
Key Points from Your Case:
- History of Pregnancy Complications: Your detailed medical and pregnancy history shows several risk factors, including advanced maternal age, obesity, and the presence of placental issues, which may have contributed to the stillbirths.
- Pathology Insights: Your pathology report reveals significant issues with both placentas, particularly a notable underdevelopment and signs of maternal vascular malperfusion, which could indicate complications that affected the nutrient and oxygen supply to your twins.
- Need for Understanding: It’s very natural to seek clarity on the pathology report and how it relates to your specific experience, especially as you anticipate future pregnancies.
Actionable Steps:
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Prepare for Your MFM Consultation:
- List Your Questions: Write down specific questions about your placenta’s pathology, particularly regarding how maternal vascular malperfusion could affect future pregnancies. Ask about risk factors for future pregnancies and any preventative measures you could take.
- Bring Relevant Records: Ensure that you bring copies of your pathology report and any other relevant medical records to help your MFM specialist understand your case better.
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Request a Detailed Discussion:
- During your appointment, encourage the MFM doctor to go through the pathology report in detail. Ask them to explain medical jargon and how each finding might impact your future pregnancy plans.
- Consider asking about genetic counseling if it hasn’t been suggested already, as it may provide further insights into any genetic components that could have influenced the pregnancy.
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Consider Support Resources:
- Seek out support groups for parents who have experienced stillbirth or loss. Sharing experiences with others can provide emotional comfort and understanding.
- Professional counseling may also be beneficial, helping you process your grief and prepare for future pregnancies.
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Monitor Your Health:
- Continue to manage your chronic conditions, including asthma and hypothyroidism, with a healthcare provider’s guidance. This includes regular check-ups to evaluate your overall health, adjusting medications if necessary, and discussing any lifestyle changes that could improve your outcomes in future pregnancies.
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Understanding Recurrence Risks:
- As you discuss future pregnancies, ask about how the findings in your pathology report can inform care in subsequent pregnancies. Understanding the potential recurrence risk and any special monitoring or interventions that may be warranted is important.
Remember that your individual experience and questions matter greatly in this process. Holding space for your grief while seeking answers is a significant step. If there's anything specific you would like to know more about, please feel free to share.
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