ICSI Twin Pregnancy at 7.5 Weeks: Questions & Concerns

Question
Hi Dr Ramirez,

I am writing to you from Riyadh, Saudi Arabia.
I am 7.5 weeks into an ICSI twin pregnancy. I am still under the care of my IVF clinic for another month. I was seen at 7 weeks for "threatened abortion", transvaginal u/s showed 2 fetal poles w/ fetal heart movements, yolk sacs etc, but also showed an implantation bleed. CRLs were good 6+6 and 6+4.
My questions are:
do I need a high-risk ob/gyn?
would I represent to hospital if new spotting occurred? (has been dark blood on/off for 4 days, no other symptoms),
should I wait to restart my low-dose aspirin (was told to stop for 4 days, but have not restarted yet)
is it safe to fly long-distance in 3rd trimester (i.e. flying from Saudi to New Zealand?)  

Thanks!
Rebecca

Answer
Hello Rebecca from Saudi Arabia,

Yes, you need a high risk Ob/Gyn doctor because you are an IVF pregnancy and have twins.  You don't need to panic or go to the hospital unless the bleeding is heavy like a period or you have severe pain/cramping.  You should take the low dose aspirin again.  No, flying in the third trimester is usually not allowed, especially with twins.  If you need to go to New Zealand, it should be done in the early second trimester i.e. before 20 weeks gestational age.  In general, if there are going to be problems with twins, it will occur after 20 weeks.

Good Luck,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf, and follow me on Facebook at http://bit.ly/9Iw9oV