Best time to deliver mono-di twins

Hi everyone,

I'm 32w4d with mono-di twins. I see two different peris within their practice. One says no later than 36 weeks and the other has a "wait and see" approach.

My twins are doing great. At my 31w4d growth scan last week, one was measuring 32w4d and 4lb3oz, the other was measuring 32w0d and 4lb1oz.

I have heard the placenta can break down at some point, but not really sure when. I know it may be a moot point because I may go into labor on my own. But I just don't really think it's too likely. I obviously have a cervix of steel because it was measuring 5.6cm when it was last checked at 30 weeks. Plus, I had to be induced at 40w4d with my daughter. And even then my cervix never opened past 4cm and I had to have a c-section. I guess my cervix is stubborn, which is a good thing right now.

Any thoughts on the best time to schedule my c-section?

 

My ob wanted to deliever me at 38 weeks with my mono/di boys. I was delivered at 37 weeks 1 day though, as baby B was no longer thriving.

 

I am carrying DI/DI twins, is there a timeline for this type also? I try to stay off the internet for info but haven't found much on DI/DI's. My cervix is also one of steel measuring at 5.29 last visit so my Peri released me to my OB for majority care.

 

My doctor had shceduled my mono-di twins for 36 weeks, he didn't want to go beyond that point because of they looked great at my last ultrasound and since we were planning a c/s he didn't want me to go into labour and have to do it under rushed conditions, but my water broke at 35 weeks and that's exactly what happened.

 

I have di/di twins and my OB doesn't want me to go past 37 weeks b/c he said the placenta starts to break down. He just told me that it was "better safe than sorry" and that 37 wks IS considered full term for twins. (I'm in Canada so not sure if its different)
So if it's up to you, I would go on how YOU feel and what your hearts telling you.......

 

I'm having di-di as well and my peri said 37 weeks would be the max. For me I'm also very short so there is a space issue to consider, whether they will have room to continue growing and thriving much past that.

 

My OB and peri had the wait and see approach... I was being monitored so closely that I felt comfortable with that approach.. I ended up going into labor on my own at 35w4d so it was a moot point for me.. Good luck!

 

I'm gonna talk to my OB next week when I see her. I know she won't deliver me if I go before 35 weeks due to the facility there so I would be taking a helicopter ride to the next level hospital. It's just hard trying to get things in order with the unknown. It also seems like noone wants to let me try for a vaginal delivery, why do they push the c-section so much?

thanks!

 

My OB wanted to do a vaginal but my baby A was breech and my baby B was transverse.

 

If everything had been normal my ob said 38 weeks

 

my girls were mono-di & my OB said not past 36 weeks. i disagreed with her and would have fought an induction or c-birth at that gestation, but it became a moot point because i went into labor spontaneously at 34w1d.

aquickworld - whether your OB pushes for a c-birth or not depends on a lot of factors, including their own personal beliefs/philosophies on labor & birth, your health, the babies health, etc. with multiple pregnancies there's a longer list of potential complications and so some doctors feel that with a c-birth more variables are under their "control". on the other hand, there are also many OBs who push for & prefer vag births. that's why it's so important to find a caregiver you trust, who's philosophy & approach mesh with yours.

 

Mine said 38 weeks was the earliest with di/di twins- the culture for di/di's among docs are changing, I think. Some docs won't schedule a c/s for anything before 39 or 40 weeks anymore, b/c of lung maturity and growth. Of course, if there is a growth problem or you go into labor past 34 weeks they don't stop it, which is why mine were born at 37w5d.

Knowing what I know now, I think it's important for them to get as much as they can on the inside, :tomato: but also have monitoring so that you know if a placenta is failing. It's a delicate balance.

 

My mono/di twins started TTTS late in my pregnancy so I had my c-section at 34 weeks. Other than that .. I might have been able to go a bit further .. but was really uncomfortable. My guys were HUGE (for 34 weekers) 5.5 and 7.3 !

 

for mono di most docs recommend between 34-36 weeks. This is based on some studies. that intra uterine demise for no known reason can occur if these pregnancies go past that.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1160585/

 

Thanks for your replies everyone.

TandC: that study you linked to was extremely helpful. I think I am going to insist on no later than 36 weeks. But honestly after reading that study I'd rather go earlier. Tough decision!

 

That article was extremly interesting. I have always believed that my boys should have been delievered at 35-36 weeks. At my 36 week u/s my baby B had shown no growth at all. When they were born at 37 weeks, my baby A was red, baby B was very pale, Anemic, extremely jaundiced and septic. I believe had they been delivered earlier, William who was my baby B, would not have been so sick

 

I have mono/di too and I'm also 32 wks and 4 days today and my OB said no later than 37 weeks because of possible placenta deterioration. She is very happy that both my babies are head down as she really would like me to have them vaginally and so am I! At first I was not comfortable with the deadline but it may become a moot point for me as I'm having quite a bit of contractions already... I'm going to ask for a check up on Monday just to make sure everything is still close...

I'm also being monitored every week now which I feel good about, an ultrasound and NST. Also she won't stop labor after 34 wks.

I'm praying that I will reach at least 36 wks though, the longer the better I think as my babies are quite small...

Good luck to you!

 

Thank you for this very helpful article! I guess I won't feel too bad if they come sooner than 37 wks now That makes me feel good as I have a strange feeling that I won't make it to that point.

 

I totally agree with all of the above. I think the culture and science on di-di twins is changing. It used to be docs wanted twins born no later than 38 weeks, which may be right in some specific circumstances - high blood pressure, IUGR, etc. But in an otherwise healthy di-di pregnancy, it's important for the babies to get all the time to grow they need. Term is term; twins don't really develop faster than singletons.

Here's a good study on the subject:

http://www.uptodate.com/home/content/topic.do?topicKey=labordel/5122

Mono-di twins are a special case though. There is research suggesting a higher rate of unexplained stillbirths after a certain gestation. It's not the placenta breaking down; they just don't know what the cause is. The chance of this happening is low, but it appears to be a real increased risk, and is worth discussing with your doctor and making an informed decision about.

Good luck with your little ones, and best wishes for a smooth and happy birth!

 

Well, my c-section is scheduled for 36w1d on Nov. 29th. My OB and peri both agreed on the timing, so I feel comfortable with that.

Thanks for all of your very helpful responses. I appreciate the advice!

 

Hope your last few weeks of pregnancy are as comfortable and easy as possible!

Cheers!

:youcandoit:

 

My MFM scheduled my c-section for 35w 1d with my mono-di boys. She said she was comfortable with that gestation in a mono-di pregnancy as long as the lung maturity amnio came back positive for maturity. It did and they were delivered 5 hours later.

 

They do not really consider mono/di to be uuber special here...other than a couple extra u/s we were not given any more care than a normal di/di preg.
That being said, the do not schedule any section prior to 37wks and mine was at 38w2d. I had no problems at all - the babes were healthy and weighed in at 6lb5oz and 6lb9oz.

 

Good luck with your delivery!! How exciting!! Only two more weeks before you see and hold your little ones!!! I guess, I have one more week than you to get ready as I just learned today that my induction day would be Dec. 6th, 37wks exactly for me, if nothing happens before...

Can't wait to read you birth announcement

Mag

 

Thanks again for your replies! I'm counting down the days now - only 15 left! Good luck on your induction, Mag!!