Bringing home one baby is a big life for any family, but for one Sioux Falls family, seeing double on the ultrasound made their latest pregnancy anything but normal. Little Natalia and her twin sister Amelia are a picture of perfection and they're fitting in nicely as the newest additions of the Soria family.
"Twins was not even on the radar, like not even something we had considered could happen, anything like that," said mom Nikki Soria.
Seeing these precious girls, you might think theirs was a smooth-sailing 9 months, but Nikki's pregnancy was anything but perfection.
High-Risk Pregnancy With Twins Sharing Placenta
"Right out of the gates, she was a high-risk pregnancy. Nikki's particular type of twins are called monochorionic diamniotic twins. So they have a single placenta that they share but are in separate sacs inside the uterus. And that type of twinning is very, very high risk," said Catherine Schiltz, DO, an Avera obstetrician and gynecologist
"So that means that you have ultrasounds approximately every two weeks, just to make sure that there's not unequal sharing of the placenta," said Shannon Backstrom, CNP, with Avera Maternal Fetal Medicine.
Starting at 14 weeks, Nikki and the twins had regular visits with the Avera Maternal Fetal Medicine team to ensure everything was progressing like it should.
"It is coordinated care at its best. So I was taking care of Nikki as her primary obstetrician, but relying very heavily on the consulting team of Maternal Fetal Medicine specialists," said Dr. Schiltz.
"We want healthy mom, healthy baby, healthy babies, whatever it may be. We all get kind of attached to these patients just because we see them so frequently. So we're just as much invested in their pregnancy as they (parents) are," said Backstrom.
Diagnosis of Placenta Previa Adds Complication
"That's how we manage all of our pregnancies, but in this particular situation, it was our key to success," said Dr. Schiltz.
The twins and their unique condition made Nikki's pregnancy more high risk, but at 16 weeks, life threw another curveball.
"That was our first hospitalization. We were there for four days when we found out we had placenta previa," said Soria. Placenta previa is a condition where the placenta implants lower in the uterus and very close to the cervix. This can lead to bleeding and other complications that can impact mom and the babies. The diagnosis of placenta previa was just the beginning.
"Nikki also had a history of three prior C-sections and her placenta appeared to be implanted over her prior scar site. And this is called placenta accreta. And that's where the placenta can attach firmly to the uterine wall and actually grow through the uterus and can be a life-threatening situation," said Backstrom.
"Significantly, significantly high risk with those two factors. So we had a lot to deal with in terms of Nikki's pregnancy," said Dr. Schiltz.
"It was panic and stress and sadness because we weren't sure at that point if we could continue the pregnancy, how far we could take the pregnancy, if it would be far enough or if they would be OK, what would happen to me, what would happen to them. And it became small goals like let's just get it here, then let's get here. And then as things progressed on, it's looking better. Things are progressing the way we want them to," said Soria.
Reaching 32 Weeks One Small Goal at a Time
"We tell patients day by day and we give them a week goal. And then once they hit that week, we say, OK, let's get you through another week and then another week," said Backstrom.
"It can get really daunting looking at the big picture and it's terrifying as a patient. It's even scary to take care of patients like this as a physician. So just trying to keep their chin up and make them feel hopeful about what's to come. And I think that the entire team did that for them," said Dr. Schiltz.
Week by week, Nikki and the girls continued to meet their goals until finally at 32 weeks and two days, it was time. By staying those critical extra days and weeks in the womb, the girls were stronger and the family had a shorter stay in the NICU with fewer complications. Now, half a year later, this family of seven is ready for their new normal.
"It’s chaotic, but it's a good chaos. You know, I was so worried about five before we knew anything crazy was even going on. Just how logistically, how do you manage five children? But you know, then when we got hospitalized and were told that we could potentially lose them, then you don't care about any of that. Like you'll figure it out. We're going to figure it out. Everything's going to be fine. Just let's them get here and let them be OK. And I'm so grateful that everything worked out the way that it did. That the stress of how we're going to do this kind of goes away," said Soria.
"We got two beautiful babies out of it, which is a miracle. And that's the beauty of what we get to do every day as obstetricians. It never gets old," said Dr. Schiltz.
"The twins, they're good. The siblings all actually get along. I mean, the older kids dote on the babies and love them. And I think they'll hopefully grow up and be close and a tight knit little herd of children!" laughed Soria.
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