My Ultrasound Story

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After mentioning this experience on a mailing list earlier today (2/11/96), I decided to put it up on a web page. First, because I think it makes for an interesting enough story, and second, because it documents a phenomenon that most people have never heard of but which is actually quite common. Read on and you'll see what I'm talking about.

My ultrasound story as I had wrtten it up on 4/5/94

You had probably heard that I had a miscarriage on 3/23, when I would have been about 14 1/2 weeks pregnant. It was like the miscarriage I had had seven years earlier, in terms of that there was nothing more recognizable than hunks of tissue, and in the amount of tissue and bleeding. It was unlike the miscarriage I had had seven years earlier, in that there was no cramping nor gush of amniotic fluid. There can be a lot of variation in these things depending on why the miscarriage occurs.

I did not have any of the warning signs of infection resulting from an incomplete miscarriage, but went to the local women's health center on 3/28 for a checkup. They thought everything looked fine (and complimented me a lot on my medical knowledge) but were concerned that my blood HCG levels were still at the full-blown pregnancy stage. All my subjective pregnancy symptoms (heartburn, fatigue, gagging, breast tenderness) were also continuing in full bloom.

So I went back in for another checkup on 3/31. My HCG levels were still high, but the nurse-practitioner said that my uterus felt "on the large size of normal rather than pregnant." They thought that the next step should be to get an ultrasound, so I made an appointment to get one on 4/4, yesterday. I had come up with various scenarios for what was up, such as:

What I thought was most likely was that I was just taking a long time to get back to normal.
I could have had fraternal twins and lost one, but if my uterus was at a pretty normal size then that would seem to be ruled out.
I could have had a "missed abortion" (embryo/fetus dies but doesn't get expelled for some time; you may start ovulating again in the meantime) and then had a second pregnancy start, which was still there despite the first one finally being expelled, but that didn't seem that likely either.
Enough of an incomplete miscarriage to be somehow still registering to my body as a pregnancy, etc. etc.

So I went over to the hospital for the ultrasound. I had a bad attitude about this because when I had called earlier to talk to someone at about the procedure, she had had the attitude most guaranteed to piss me off, which was "Oh yes, we read/interpret the scan right after it's done, but we certainly wouldn't talk to you about it, we call your physician and then your physician talks to you, and also we charge you a reading fee for that, on top of the $$$ for the scan." I assumed it would be a big waste of time and money, dished up with a lot of patronizing treatment.

Instead, the technician was very nice and talked to me about whatever I wanted, once I finally got her talking. (I thanked her for that when I was leaving, and she said something like, "yeah, we aren't really supposed to say much.") I was lying down and watching two large screens, though at enough of an angle that it was hard to resolve the images as much more than "looks like fast-motion cloud photography." I could tell you a very long story about everything that went on at the ultrasound, but maybe I should just get to the point here:

Me: "Is that round shape an artifact of the shape of the transducer?"

Her: "No, that's the baby's head."

Me: (much surprised, because I had not been able to get her to say anything about what she was seeing before that) "You probably can't tell whether or not it's alive, or dead as part of an incomplete miscarriage."

Her: "Oh no, it's alive, I can see its heart beating, good strong heartbeat."

Me: (thinking again of the supposedly non-pregnant-sized uterus and the possibility of a second pregnancy having developed) "Can you tell how old it is?"

Her: (after doing something with the machine) "About 17 weeks. This baby is moving around so much that I'm having a hard time getting a good picture."

Later she brought in a doctor, who complimented me on the write-up I had done up about my situation ("we probably could have diagnosed you from that"), and said, "You may have had another sac that you lost." I repeated what I had been saying to some people about the possibility of having had fraternal twins but having lost one of them, and he said "exactly!"

That would certainly be fine with me if that were the case, that I could blame all the spotting I had throughout the pregnancy on a second twin that never really developed, and that now everything is fine. I haven't had any spotting for several days now (since the miscarriage stuff trickled off) whereas beforehand I was having it most every day. But who knows?

What happened afterwards, plus some background information

Well, of course the main thing is that my wonderful Arthur was born at home on 9/20/94 after a short and easy labor. Hurray! :-)

But the other thing I want to talk about here is the matter of the apparent miscarriage of an undeveloped twin. After I had had the ultrasound, and told people about what had happened, most of them were quite amazed and/or alarmed -- they had never heard of anything like it. The midwife at the women's health center even said that she thought that because of this I should be considered a high-risk pregnancy and go sign up with a doctor. But I didn't agree with that assessment, and luckily the midwives I'd been planning to use in the first place weren't as put off by it either, so again, I was able to have a good home birth and a very healthy and happy baby.

Anyway, as Arthur was coming up on a year old I was reading a long article on twins ("Double Mystery", by Lawrence Wright, in the August 7 1995 issue of The New Yorker), and one of the things it talked about was how surprisingly common this really is. I've typed in the relevant excerpt here:

---------- begin excerpt from The New Yorker ----------

With the increasing use of ultrasound to detect early pregnancies, we now know that twinning is a far more common occurrence than anyone had previously imagined. Although only about one out of eighty or ninety live births produces twins, at least one-eighth of all natural pregnancies begin as twins. Many of us singletons, in other words, began life as something more -- as part of a pair.

Doctors equipped with color-Doppler and vaginal ultrasounds and high-speed scanners have been able to observe multiple pregnancies as early as five weeks after conception. "People are picking up twin pregnancies the size of garden peas," says Professor Charles E. Boklage, a developmental biologist at the East Carolina University School of Medicine and a well-known maverick in the world of twin biology. "They're seeing a lot more twins than they ever knew were there." Many doctors have undergone the unnerving experience of spotting twin embryos one month, only to find a singleton the next time they looked. What was happening? At the Third International Congress on Twin Studies, held in Jerusalem in 1980, this question was raised, and one of the participants cried out, "Vanishing twins!" -- thus giving a name to a phenomenon that has caused as much confusion as excitement.

Boklage studied reports of three hundred and twenty-five twin pregnancies and found that sixty-one ended as twins, a hundred and twenty-five as singletons, and the remainder -- a hundred and eighty-six -- as a complete loss: a reminder of how risky twin pregnancies are. Often the only external sign of a vanishing twin is vaginal bleeding. "The so-called phenomenon of the 'vanishing-twin syndrome' is neither phenomenal or a syndrome," Boklage contends. "It is much too common to be considered phenomenal, and it occurs for too many reasons to be considered any kind of syndrome." He says that most pregnancies, whether multiple or single, fail anyway, so it is not as surprising as it seems that twins often disappear. "Somewhere in the vicinity of ten to fifteen percent of us -- and that's a minimum estimate -- are walking around thinking we're singletons when in fact we're only the big half," Boklage says. He estimates that for every set of twins born live there are at least six singletons who are survivors of twin conceptions.

---------- end excerpt from The New Yorker ----------

Why I can't believe that so many women have so many ultrasounds just as a matter of course

Ugh, having that ultrasound was one of the most painful experiences of my life! Not because they used a cattle prod, mind you, but because of having to drink all that water and then not being allowed to go to the bathroom!. And then on top of feeling like I was going to go the way of Tycho Brahe, and having had that rude treatment on the phone beforehand, it cost me something like 400 bucks! I kept thinking "I can't believe some women do this every month!!!" In short, aaarrrggghhh!!!

For more information, here are some "vanishing twin" and ultrasound-related links

Wikipedia's Vanishing Twin page.
eMedicine's Vanishing Twin Syndrome page.
Doing a search for "vanishing twin" on PubMed will bring up almost 50 scholarly articles on the topic.
http://www.vanishingtwin.com/ has many technical articles.
In ParentsPlace's "Ask the Midwife" column's article Concern About Fetus After Loss of Twin, CNM Peg Plumbo informs and reassures a woman going through a similar experience.
Cathy's story "I was told it is common."
Sue's "vanishing twins" story
For one hell of an education (from the mainstream-medical point of view), try Joseph Woo's super-slick (animation! audio! etc.!) and incredibly-comprehensive Obstetric Ultrasound page.
And there's always the (gag) misc.kids Ultrasound FAQ.
For Facebook users, there's a Facebook group for the surviving twins of Vanishing Twin Syndrome.
There's a lot of controversy surrounding the safety of ultrasound and the way it has so quickly become routine and even mandated for normal pregnancies, and I would like to include a link to a page about this as well, but so far I haven't been able to find one that isn't stuck in the middle of some fundie screed ... oh well, maybe later ...
Also, when I was searching for more "vanishing twin" pages to link to, I discovered that some of the "UFO abduction" types have taken the word "vanishing" so literally as to have written up long and hilarious tracts describing how these twins are abducted and raised by aliens. If you're easily amused by such things you might want to check out Caryl Dennis and Robyn Quail's VANISHING TWIN PHENOMENON, for starters.

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