by: Dr. Pinky Imperial [1]
My family and I came back in May 2010, and we had barely settled down when I began to have hyperacidity, nausea and eventually vomiting, which in my experience signified only one thing – that I was pregnant again! After 3 sons, my husband and I were not really planning on adding to the family, but the 2 pregnancy tests that I took proved my suspicions to be all too true. I knew that I was already a high-risk patient since I was now an elderly multigravid. Not wanting to leave anything to chance, I immediately consulted a perinatologist in the hospital nearest our home. In the week following our return, the ultrasound done showed that I was pregnant with twins! And thus began the steady uphill climb that would characterize the course of my pregnancy.
I usually had excessive vomiting bouts during the first trimester of all my pregnancies, but this time around, the very high hCG levels in a twin pregnancy amplified my vomiting even more. When I reached my fifth month and the vomiting had just started to abate, I had my second ultrasound which showed that we were expecting girls. My husband and I were ecstatic at the thought of having girls this time around, but the joy dimmed considerably when my doctor told me that there was a “double bubble” sign in the first twin, accompanied by polyhydramnios, which were both signs that she had some form of gastrointestinal obstruction. I knew that her condition could only be remedied by surgery, and I started to become fearful of the possible outcome when the twins were delivered. Another few weeks went by and my blood pressure, which hovered in the higher limits of normal, became persistently elevated and I had to be maintained on anti-hypertensive medications. By the sixth month, I had already developed edema in my legs, which was quite early compared to my previous pregnancies. Laboratory tests done also showed mild hypothyroidism. Subsequent ultrasound tests showed persistence of the double bubble sign, progression of the polyhydramnios and beginning discordance in the weights of the twins. My perinatologist maintained a calm demeanor but by this time she was asking me to return more frequently for check-ups and by my 32nd week she already advised me to have a course of betamethasone injected in the event that a combination of all the existing conditions would trigger premature labor. It slowly began to sink in that the babies would, in all probability, be born early, so I informed my doctor that I had planned for EINC to be done when I gave birth. It was still the pre-EINC period in the hospital and she acknowledged my request but replied that it would really depend on the twins’ condition upon delivery.
A few days after I had my betamethasone injections, I came in for check-up and while my non-stress test showed that at 33 weeks age of gestation the babies were fine, I had to be confined for blood pressure control. Soon I was being treated for pre-eclampsia, and after 3 more days my OB made the decision to do emergency cesarean section due to non-reassuring fetal heart rate patterns. Having previously delivered all my sons by NSD, I was terrified at the thought of undergoing surgery this time around, and I was crying as they wheeled me into the operating room. My anesthesiologist gently reminded me that crying would hinder my breathing and advised me to calm down. I composed myself and asked her not to sedate me because I wanted to be awake when the girls were delivered and placed on skin-to-skin contact with me. When my OB came in, I again asked her if we could do properly timed cord clamping and she assured me that she would discuss this with the neonatologists attending the delivery. She started the procedure, and a little while later the first twin came out, and after drying and cord clamping, she was placed on my chest. I knew she was the one with the problem but was relieved to see that she looked stable and was comfortable. Then soon enough the second twin came out and she joined her sister on my chest. After a short while my OB gently asked me if the twins could be taken to the NICU already and I nodded, knowing that they had to be worked up and referred ASAP. They were 35 weeks by pediatric aging, and weighed 1.49 kg and 1.62 kg. Neither of them had any breathing difficulty.
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| Mika and Ella together again |
After spending some time in the Recovery Room, I was finally wheeled back into my room. It was a good thing that the NICU nurse started to bring Ella, the second twin, to my room to breastfeed, and I would do this every 3 hours or when the baby would demand to be fed. After the first 24 hours, they could no longer bring her to the room as a matter of hospital policy, and I had to go to the NICU for the breastfeeding. So despite still having an IV line and a urinary catheter I continued to go to the NICU regularly for feeding. It was the following evening that the pediatric surgeon finally made rounds on Mika, the first twin. The x-ray done showed massive pneumoperitoneum, certainly one of the worst ones I have ever seen in all my years of practice. I instantly knew the risks my baby faced, and I burst into tears as the surgeon explained to my husband and my siblings that immediate surgery was indicated. We requested for a priest to come and the baby was baptized prior to the contemplated procedure. Mika was stable and did not look distressed, which was totally incompatible with the ominous x-ray picture. She was prepared for surgery, and our family and dear friends started storming the heavens for a miracle.
