28 weeks – growth scan

This week we had our second growth scan. I get routine scans every 4 weeks now, so this is 4 weeks since the last one. I can tell they’re growing as I’m getting a lot bigger, but the hospital are mainly checking that they are growing at a similar rate and that one isn’t taking more nutrition from me than the other.

28 weeks

It was all good news. Both twins are still average size for their gestation, with an estimated weight of around 2lbs 12oz each (though this is really tricky to get very accurately from a scan, so has to be taken with a rather large pinch of salt, but it’s a rough figure at least). And the main thing is they are only 0.4% different in size, which is great. Both look healthy and are moving lots.

I was also pleased to see that they have both turned from being breech! Twin two is now head down, and twin one is lying across, or transverse as the doctors call it. Whilst transverse isn’t a good position for labour, and would mean a c-section, I’m encouraged that they have at least moved and hopefully twin one will carry on the turn and go (and stay!) head down soon.

The sonographer was lovely, and she made sure that I know that this configuration of twin pregnancy (DCDA – two sacs and two placentas) could still mean identical twins, though more likely non-identical. Tom worked out from twin stats that we found online that there’s about a 14% chance that they are identical. But lots of people, including health professionals that I’ve met in hospital, have automatically referred to them as non-identical because they are DCDA. If they are identical, it just means the splitting of the fertilised egg was really early, about 1-3 days after conception. Later splits result in just one placenta, and either two sacs or one (the latter being very rare, only 1% of identical twins).

This was before she scanned, so she had no idea if they were boys, girls or one of each. I looked away for quite a lot of the scan as I was worried I’d see something that would indicate it to me! I also told her it was OK to refer to each of them as “it”, because last time the sonographer referred to one of them as “he”, though in the context I think she was probably just defaulting to he because she didn’t like to say “it”, I’m not even sure she’d scanned down between the legs at that point.

After the scan I went to clinic as usual. We had the usual blood pressure conversation and actually my machine read higher than theirs (it’s usually slightly lower), so the registrar was happy that it can read high in hospital and that I’m monitoring well at home. It’s still on the lower side at home, which is good. She also checked with the consultant, and he was happy to not see me for another 4 weeks.

The only slightly weird thing this week is that my skin has started to feel a bit tingly/itchy. It’s really hard to describe. It’s not the pain of pins and needles, nor anything like that intense. It’s also not like I really need to scratch it. I will occasionally scratch, but not noticeably more than usual. I know that itching can be a sign of obstetric cholestasis, or the more recent term for it is intrahepatic cholestasis of pregnancy (ICP), which is a potentially serious liver condition of pregnancy, so I mentioned it.

According to the NHS website, ICP affects 1 in 140 pregnant women in the UK each year.┬áNormally, bile acids flow from your liver to your gut to help you digest food.┬áIn ICP, the bile acids don’t flow properly and build up in your body instead, which is what they think causes the itching at the skin. It’s more common in multiple pregnancies than in singleton pregnancies. There’s no cure for ICP, but it can be treated to some extent with a drug until birth, which is when it ultimately gets better as the body gets back to normal. There is an increased risk of preterm birth and stillbirth in severe cases, so careful monitoring of bile acid levels from blood tests and foetal movements would be necessary, and induction of labour or an emergency c-section if there is any concern.

The doctor agreed that it would be sensible to run some blood tests to check my liver function and bile acid level, even though it’s not severe (yet), and I have no other symptoms such as jaundice or vomiting (nausea still, but that’s normal for me). If those show anything abnormal then they will ring me next week and I would start on a drug to treat it, and this would then also involve more monitoring. So we will see what comes of that.

It’s also entirely possible that skin tingling and sensitivity is simply down to my increased blood volume (which is huge with third trimester twins!) and therefore blood flowing nearer the skin. Increased pregnancy hormones could also cause skin conditions that I wouldn’t normally get, though I don’t appear to have many other physical signs such as spots, other than a few on my legs, and some dryness on my hands and face, which I do get sometimes anyway. It’s also very normal for stretched skin on my bump to itch.

It feels so good to have got to the third trimester! We really are on the homeward straight now, as I keep telling myself when I’m feeling sick and tired.

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