How we stand as of Friday, January 12th

It occurred to Melissa that we should indicate where we stand as of now in light of all of the info we've provided in general below. Here's the scoop:

- Our twins are roughly the same size right now. Spencer (the donor) is something like ten grams lighter than Micah (the recipient)--not a big difference. This is good.
- Both twins measure within a week of appropriate developmental size and weight given their age: 21 weeks +/_ a week. This is very good.
- Both twins have fluid in their bladders. This is great, especially for Spencer. As the donor, he's likely to suffer from dehydration at some point, but he isn't now.

Taken together, all of this means that we're currently sitting as a Stage I case of TTS. Here are some quick definitions of the five stages of TTS (again borrowed from the good folks at the Cincinnati Fetal Care Center):

Stage I: polyhydraminos in the recipient, severe oligohydraminos in donor but urine visible within the bladder in the donor
Stage II: polyhydraminos in the recipient, a stuck donor, urine not visible within the donor's bladder
Stage III: polyhydraminos and oligohydraminos as well as critically abnormal Dopplers (at least one of absent or reverse end diastolic flow in the umbilical artery, reverse flow in the ductus venosus or pulsatile umbilical venous flow) with or without urine visualized within the donor's bladder
Stage IV: presence of ascites or frank hydrops (fluid collection in two or more cavities) in either donor or recipient
Stage V: demise of either fetus.

Here's another go at the five stages, in English this time:

Stage I: More amniotic fluid around the recipient than the donor. Urine in the donor's bladder.
Stage II: More amniotic fluid around the recipient than the donor. The donor is stuck against the chorionic wall because the recipient's amniotic sac is so large. No urine in the donor's bladder.
Stage III: Amniotic fluid imbalance is severe. Doppler imaging of the fetus' umbelical cords indicates that blood-flow isn't normal for one or the other or both. Maybe urine in the donor's bladder, maybe not.
Stage IV: Fluid has collected somewhere it shouldn't in one or both twins. Usually, this means fluid around the heart of the recipient or fluid on the brain of either or both twins.
Stage V: One twin or the other has passed away.

We've been stable at Stage I since Tuesday of last week--the "best case scenario" given that the twins have the condition at all. Doctors have stressed to us that twins don't usually "progress" through the stages serially; that is, they don't usually move from 1 to 2 to 3 and so forth. They can jump around at seeming random and "skip" stages in the midst. Changes between stages can happen overnight, but typically take 72 hours or so.