Well, the appointment took 3.5 hours, but things are moving forward. The ultrasound showed that things have gotten worse for the babies. 10 days ago, the fluid pocket for the baby with too much fluid was 11cm--now it is 18cm. The doppler flow is now abnormal--which means that the staging of severity has progressed from stage I to stage III. This places Jessica in a risk category where laser ablation gives the babies a better chance of surviving than amnioreduction. He said, with what he sees now, the mortality for the babies would be ~100% without any intervention. We discussed at length his experience with the procedure, where he trained, etc. He has a partner in practice who will be there for the procedure as well.
Of concern, Jessica's cervical length has decreased to a worrisome degree. The risk of this is basically premature delivery and represents a separate but related issue. There are interventions that can be done to treat it, but Dr. Watson suggested we just watch it for now. There is some hope (how much I am not sure) that it may reverse once the pressure of too much amniotic fluid is removed.
Specifics about the procedure:
He will call us tomorrow morning to tell us a time, but it will be sometime tomorrow afternoon. Jessica will not be able to eat anything after 6:00 a.m. He said the procedure takes about 40 minutes or so once the scope is in. After giving Jessica some local anesthetic and IV pain medicine/sedation, they will make a small incision in the left lower quadrant of her abdominal wall. The scope will be passed through the abdominal wall and uterus and angled to get a very close look at the vessels. They will "map" the connections between the two babies, then use the laser to ablate the vessels in a specific sequence. When they are done, the scope is removed and the wound closed with a steri strip or a stitch.
When the procedure is done, Jessica will be transferred to the antepartum unit (ie, high-risk OB unit) for an overnight stay. Thursday morning/afternoon, they will recheck the ultrasound. Depending on how things go, we will head home Thursday or Friday.
He reemphasized that in the immediate period following the procedure, there is a higher risk with laser ablation than with amniocentesis. Specifically, there is a higher risk of Jessica's water breaking. If that happens at this point, it is likely we would lose both babies. However, taking this risk is better than doing nothing or only the amnioreduction.
While we are nervous going into this, we feel that this is the right thing to do to give both babies a good chance of not only survival, but also lowering their risk of problems once they are born. Our prayer is that no matter the outcome, we still made the best decision for our babies.
Thank you for continuing to keep us in your prayers. We are so comforted knowing so many people are praying for our little girls.