Preeclampsia and 34 Week Di/Di Twin Boys

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codymcg

New member
Hey there,

My wife is 34 weeks pregnant with Di/Di boys last Thursday we were sent to L&D triage to address high blood pressure (140s/90s). After labs we found that her urine marker for preeclampsia was just over the 0.30 reference range at 0.34. Today we went in for a growth scan and twin A measured in the 53rd percentile and was estimated to weigh 5.6lbs and baby B was in the 59th percentile and was estimated to weigh 5.9lbs. The doctor we met with said that my wife was showing preeclampsia without severe features now but that she expected severe features to show up soon. We will likely deliver in the next two weeks (36 or less weeks). Anyone else have a similar experience? Did you have NICU time? How can I best help my wife remain calm? Any general advice? Thanks!

-Sam
 
@codymcg Hi! I am in the exact same situation as your wife currently, but I’m about two weeks ahead of you, I’ll be 36 weeks tomorrow with di/di B/G twins. My blood pressure fluctuates, normally around 137/88, but with a few readings over 140/90. I had the same slightly elevated protein in my urine after a 24 hour test. Honestly, my doctors really do not seem too concerned, but moved up my delivery by a week to 37 weeks (I’m now scheduled for a c-section at exactly 37+1.) They said if my BP reaches 150/100, then we would have to deliver sooner. For now, they have me monitoring my BP twice a day at home, and increased my in-office visits to weekly. They said with twins elevated BP this late is very common, and again we aren’t quite in the danger zone at the 140/90 mark. I’m not having any other symptoms (headaches, sudden swelling, nausea, etc.) so be on the lookout for those, as that would be another story. 36 weeks is a great time to deliver twins, and yours are already great weights! I wouldn’t worry too much, just keep a close eye on things, have your wife try and relax and rest and hydrate at much as possible (I’m basically on self imposed bed rest at this point.) Good luck!!

ETA: My high BP readings started at my 34 week appointment, which is when I started monitoring at home. It’s been 2 weeks since and no major changes or worsening symptoms!
 
@codymcg I had a very similar experience during my pregnancy, and ended up being sent to L&D at 35+1 with high blood pressure (160s/~110). I delivered the boys that night (I opted for a c-section). The worst part of it was being put on magnesium (iirc, that’s to help prevent seizures, but somebody please correct me if I’m wrong). It made me really nauseous and unable to even keep small amounts of water down for a while. Both twins did end up in the NICU. Baby A was in for 10 days (he weighed just under 5# at birth; they only kept him to be sure he knew how to eat well before going home). Baby B was in for 30 days (he weighed ~5#; was kept due to being born with PPHN which was just random and unrelated to the preeclampsia). Overall, it really wasn’t that bad. A bit stressful in the moment, but everybody is now happy and healthy. My blood pressure remained a bit high afterward (~upper 130s/90s), but normalized after maybe six months or so.

It sounds like your wife’s doctors are already keeping a close eye on her, so that’s good! They should catch anything concerning relatively quickly. I wish you guys the best of luck and hope for a smooth and safe delivery!
 
@codymcg Similar experience, and twin b had Polyhydramnios. He was almost a lb bigger than twin a. Docs didn’t disclose that I was having symptoms, they had me go through to week 37. I had a really bad reaction after delivery, needed to stay a week extra. They had me on magnesium IV, blood pressure medications, and even padded my hospital bed. I swelled up so bad, my spouse was in tears. I couldn’t move and needed assistance with everything for the whole week. I wish the doctors had told me ahead of time I was showing signs of preeclampsia instead of waiting till it was so severe that I am still having blood pressure problems here and there. My twins are now 5mos. Before the twins pregnancy I was healthy, never had any issues health wise and hardly got sick. Now my immune system is different, everything is. The doctor tried to explain to me that it was the after effect of having two placentas and my body adjusting to losing those placentas. It was traumatic, I doubt the work of doctors less now. Btw, I had not only the family medicine doctor helping with delivery but also the maternal fetal medicine doctor helping (twin b was Breech) I also delivered vaginally for both.
 
@codymcg Mono/di. Admitted to the hospital for pre-e without severe features at 33w5d. Doctor said it usually progresses to severe within 2wks; but for some people it's a lot faster.

They prepared to deliver within 48hrs and gave me two steroid shots, but my BP stabilized. I was monitored for another 10d during which my BP remained elevated but not severe range.

Due to stabilization and my proximity to the hospital (5m drive) they discharged me at 35w1d and I got to hang out at home until my induction at 36w.

I labored for 2d during which my BP spiked into severe range and I was put on magnesium (ugh). Ultimately magnesium caused my labor to stall and I had a C-section.

Baby A had a few hours of NICU fine, baby B had none; both came home with us after and have been happy/healthy since, coming up on 1yr old.

How to help:
* Ask your doc about their plan for steroids and make sure you've discussed it and know what you want to do based on how your partners BP is trending
* Work with the doc to make sure you've completed any outstanding pre delivery testing/prep (strep b, TDAP shot, etc)
* Discuss the odds of being on magnesium during delivery and what that REALLY means from an experience perspective (it sucks) and if/how it'd change your delivery plans (for example if I had known then what I know now, I would have requested a C-section around the time I went on mag vs waiting another half day, getting more exhausted and making no progress.)
* Reduce stress in your partners life as much as possible - for me this meant going on leave from work early. Honestly, I regret not going on leave earlier.
* Be vigilant and encourage your partner to trust their body; when my BP spiked to hospitalization levels I felt just sort of... Weird. Trusting that feeling, taking my BP and being persistent with the doctors helped make sure I got the care I needed.
* Remind yourselves if you are hospitalized it is the absolute best place you can be for you and your babies - my nurses reminded me if things got really gnarly they could easily have me on the OR and the babies delivered in under 30m
* Do what you can to make the hospital comfortable; my husband brought my pillow and blankets from home. AND made and brought me home cooked meals which made a huge difference
* If you don't have a portable speaker, get one and take it to the hospital. The nurses loved the music vibes in our room and I really think it helped everyone enjoy their time a bit more.

Best of luck to the four of you in the next few weeks, and may your BP remain in the non-severe level
 
@codymcg Yes. Have a bag packed. Delivery will be any day now. Do not get discouraged by repeated visits with them monitoring and then sending you home only to come back 2 days later for the same thing. My wife delivered under very similar circumstances around the same time via emergency c section for the same reasons. At one point the doc will just come in and say it’s time and in an hour or 2 you’ll have 2 babies. Ours just turned 2!

Edit: as far as advice goes. Make sure your work knows you could be gone at any minute and that you could be out 2-6 weeks. We stayed in the NICU for 2 weeks. Our baby’s were perfect, but a little smaller than yours and needed some time to feed and grow. As dad, I stayed on the couch the whole time split between NICU and my wife’s room. Make sure the nurses give your wife plenty of baby time, demand it, if they are in separate rooms for the first few days. Remember to eat. You won’t sleep for the next 5 months but that’s ok because you don’t need it. You will adapt. She needs the sleep. Until delivery just try and keep her calm, there’s some iPhone apps with headphones that can help with that like SleepStream 2. Make sure to take advantage of any services the hospital offers, like meals, rooms, showers.
 
@codymcg This was pretty much my exact situation with my di/di boys! They are now 3 years old and very healthy.

At 34 weeks exactly, my blood pressure was fine in the morning but spiked to around 155/95 that night. Called my OB and they said to head to the hospital. I was admitted, but similarly there was little protein in my urine so I was just on bed rest. I was given two steroid shots.

Although they had hoped I would make it to 36 weeks, it was clear after a few days that I was going to get worse. C-section was scheduled for 35 weeks exactly. I was told that anything before 35.0 was automatic NICU admission, so we toured the NICU where they already had incubators ready for our boys.

We fully expected NICU given the timing, but miraculously, they were both breathing completely fine at birth and no other issues, so we’re able to come directly back to recovery with me. No NICU, and I credit the steroid shots. I believe we are in the minority with that outcome, but it’s certainly possible.

They were both a little over 5 pounds at birth. Bilirubin numbers were borderline for one twin, but he improved enough that they both came home with me when I was discharged 3 days after they were born. My total hospital stay was 10 days. From there it was as normal as having twin newborns could possibly be.

Wishing your wife a safe delivery!! The best thing you both can do to stay calm is to trust the doctors. If she is already in hospital she is in the best place she could possibly be. If she is at home for now, do not hesitate to call her doctor with ANY questions or concerns, no matter how small they seem or how often. Go to ER if needed. You are in the home stretch now. Babies could realistically come any day if her condition suddenly gets worse, but delivery between 34-36 weeks is pretty common for twins. Every day they get stronger.
 
@codymcg My preeclampsia did not show up until the last month at week 36 and my c section was then moved to week 37. The doctors told me they were willing to wait a week and potentially have me get really sick because it was worth it to keep the babies as long as possible.

And they were right, that last week put so much strain on my heart. Right after c section my blood pressure could not be controlled. I had a CT scan for possible blood clot but the only thing they found was my heart was slightly enlarged.

PLEASE have your wife monitor her blood pressure after discharging from the hospital! I went to the ER three times in the two weeks after giving birth because my bp was very high, it went up to 180/100. In the end they have me three bp meds to control it as needed and after 2-3 weeks that issue went away.

My Di/Di girls were 6.5/6.2 lbs and they did not require NICU at week 37
 
@codymcg My wife was hospitalized at 32w for the same thing with di/di boys and the plan was to schedule a c-section at 34w. She ended up having an emergency c-section at 32w4d and delivered 2 healthy boys 7mo ago. They were 4lb1oz and 3lb6oz amd needed 3 weeks in the NICU to grow and gain weight.
 
@codymcg I delivered at 34+5 (not for pre-e). My twins were estimated smaller than your wife's at 34w and came out smaller than estimated. They were in the NICU for 8 days. First had low blood sugar which resolved, then basically needed to learn to eat and stop losing weight. Their bilirubin was watched like all newborns but it ultimately went down on its own without needing light therapy. They went home on supplemental oxygen. I only got one steroid shot 18 hours before they were born so if I'd had both maybe their O2 saturation would have been better, but we also live at high altitude so I guess it's more common here.

After 34 weeks babies are considered late preterm and with a high risk pregnancy they basically deliver you at the slightest problem after that because the babies have the same long term outcomes as a term baby. It will be rough for awhile (I say as I'm entering week 9 of the newborn phase with no end in sight) but statistically speaking everyone will be fine.
 
@codymcg Since she's at 34 weeks and without severe features, they will try to keep the babies in until 37 weeks.

Expect the babies to be born on the day she develops severe features or 37+0, whichever comes first. Severe features include something innocuous-seeming as a headache, so go-time is basically any day now. Have the car seats installed in the car and a hospital bag ready to go today.

I was clearly working on pre-e from 33w on but mine was progressing slowly (sometimes it can be very fast!) so I didn't meet the diagnostic criteria until 36+5, and had the c section scheduled for 37+0.

Know that pre-e can continue and even worsen after delivery so while most people start recovering soon after delivery, keep monitoring blood pressure and be alert for severe features like headaches for ~2 weeks after delivery.
 
@codymcg My wife had it at 32 weeks with our trips. Doctor wanted us to get 35 weeks for C-section. Well went to the ER the night she had it and the next morning our trips were born. Nicu time was 3 weeks for them.
 
@codymcg This is almost exactly what happened in my pregnancy. Pre-e diagnosed at 34 weeks, put on bedrest (at home) at 35 weeks, delivered via c-section at 36+4. I was monitoring my blood pressure at home and when I woke up the day they were born it was 190s/115 and rising. The
babies were healthy but a little small and didn’t need any NICU time. They latched well and I was able to breastfeed for a year. Absolutely no trouble bonding or anything like that, despite a stressful birth. It’s scary, but as long as she is being monitored everything will be ok! Good luck.
 
@123vicky Yes, my oldest was born at 27 weeks, same day as my diagnosis of severe preeclampsia and hellp syndrome. My BP had been steadily creeping up since about 20 weeks but was never emergent until that day when it was 225/110. With my twins I was again diagnosed with preeclampsia at 27 weeks but made it to 30+6 before I developed hellp syndrome again.
 
@codymcg I had GD and preeclampsia. I never had high blood pressure but had the markers in the urine. The pre-eclampsia was diagnosed between 32 and 34 weeks. It was last year so I don't remember exactly the timing. I was sent to get 2 NSTs weekly along with an ultrasound. About two week before I delivered at 36+5, i started getting bi-weekly blood taken. At some point the blood results indicated higher liver levels and that's when they called for an earlier delivery.

Both boys were born over 6lbs. The doctor was primar oily concerned about their sugar levels. Luckily they were fine and we didn't have a NICU.

My recommendation for your wife is to trust the NSTs. Not only did they monitor the babies but also my blood pressure and other indicators which I can't remember. If anything is just a little concerning, they won't let her leave the hospital. Also, to regularly monitor movements on her own. I had one day where I couldn't feel baby b movements so went to urgent care for an NST. This definitely appeased my fears.

Also, get yourselves a blood pressure monitor so that she can measure it at home regularly.
 
@codymcg I was hospitalized at 33 weeks with 140s/90s and delivered at 34+0. They should want to track her liver lab work and may want to do a 24 hour urine collection as well.

With preeclampsia, it’s not “will the wheels fall off the wagon?” It is “When will the wheels fall off the wagon?” Preeclampsia doesn’t show up and then resolve and the pregnancy continues. It’s a progression toward a dire situation and at 34 weeks, you’re at the point where the doctors will feel comfortable deciding that babies are safer in the NICU and mom is safer not pregnant than continuing onward with the pregnancy.

I would work with your wife on embracing a delivery plan that may not have been her dream delivery (the docs are likely to recommend scheduled c section) and preparing for NICU time (the typical estimate is that babies go home from the NICU around their due date).

As far as remaining calm, this is a situation where you need to trust the doctors. They’re in charge of balancing mom’s health, babies’ health, and gestation length. If they say it’s go time, it’s go time. Embrace that it’s out of your control.
 
@codymcg I was diagnosed at 34+0 with preeclampsia w/ severe features. My indicators were high blood pressure when I went in for my NST and the fact I had gained like 25lbs of fluid in two weeks. I didn't have any other markers (no protein in urine, no floaters etc) The week prior I was admitted and diagnosed with hypertension following an NST that came about suddenly (was normal and low through out the pregnancy until 33 weeks) Those pesky NST are great at catching things I will say.

The large research hospital I delivered at is proactive when it comes to multiples and preeclampsia- so there was no wait and see. I was scheduled to deliver that night immediately and its a good thing we did. My scheduled C. turned into an emergency crash C to get my baby girl out due to bradycardia/fetal distress from what we assume now was a failing placenta. (she had a velamentous cord insert) It got really dicey with her heartbeat and I was rushed into surgery and they were out in under 6 minutes. My kiddos were 4 lbs and a few oz. Sounds like your two boys are at a really nice weight and hopefully may not need and NICU time. We only got one shot for their lungs, because this hospital has done studies on late preemies (so 33 weeks+) and the steroid shot if it helps or doesn't. My twins spent 20? or 21? days in the NICU as strictly growers and feeders. They coincidentally were released from the NICU on the day I had ORIGINALLY scheduled for their evac date at 37 weeks.

It took me however about 5 months to completely recover from the high blood pressure (get off the meds etc) post delivery I spent 9 days in the hospital, with a few days actually being in the CICU (cardiac ICU) because it took a few attempts at a drug regiment to bring my BP down. I didn't have any issues with the magnesium drip other than it made me really hot and they gave me a ton of ice packs to combat that. So I ended up having a longer tail that's not nesc common. Just be also prepared for the effects of the hypertension on your wife.

*edited to add- there is studies and research that the placenta (insertion etc.) is what plays a role in preeclampsia.
 
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