Mono Twins

Hi all, am pretty new to TS but am loving it so far - it's a minefield of experience and I appreciate all that I've been learning so far.

I am just over 32 weeks with identical twin girls sharing a placenta in separate sacs (mono chorionic diamnotic).

I've been having fortnighly u/s at a the feotmaternal unit at a high risk clinic to measure growth and aminiotic fluid and apart from a couple of visits where the fluids didn't measure up, things are looking good so far, babies growing well, twin a head down, twin b floating between head down/breech/transverse.

At my antenatal clinic (separate from the FMU) yesterday, the OB told me to prepare to be induced between 36-37 weeks with sweep and stretch to induce labour which he says can take up to a week to progress to labour. If you have had this done, what was your experience?

And my question for anyone who has been through mono pregnancies, what do you know of the risks involved in letting the pregnancy progress further?

The studies I've read are mostly about 5 years old and I would really like to go as far as possible to full term 38 weeks, if I can.
I am aiming for vaginal delivery if twin A stays in position.

Thank you in advance!

 

Congrats on your pregnancy! I have ID girls but they were di/di so I didn't have the shared placenta issues common to ID twins.

As far as the stretch and sweep I had one with my girls at 38w1d and I am convinced it was what out me into labour naturally about 36 hours later so if your Dr is willing to start an induction with that I'd say it's the way to go. I was 3-4cm dilated already when he did it and almost fully effaced but I think the s&s was what got things moving. It was slightly uncomfortable for me but I have a very high pain tolerance (no pain meds for either of my deliveries) so if it keeps you from having to be induced in other ways it's worth it!

Also, A was head down for me but B flipped between breech and transverse and was transverse when I went into labour. A came out head first and then B flipped vertex as well. GL!

 

I had mono-di girls also. I had a s&s done (without being informed or with my consent) at 34w - it was really, really painful. I remember trying to crawl off the table away from the OB. I think part of that was that I simply wasn't prepared for it. By that point I'd had so many vag checks (which I'll be refusing for this pregnancy) that I figured I was an old hat. When that one felt so different, I knew something was up. My doc then went on to to say she was absolutely positive I was going to have the babies that weekend (my appointment was Friday afternoon). Well, I wonder why? Like the PP I was already dilated (2-3cm) & mostly effaced. My girls were born the next morning.

A s&s will usually push you over into labour if your body's already within a few days of going on its own anyway. The good thing about a s&s is that it is fairly low risk as interventions go (there's a tiny chance that your water could be broken by accident), but otherwise, if it works, it's great as it means you won't need additional induction/augmentation methods. It can also be repeated.

From what I understand, the risks of continuing a mono-di pregnancy past 36 - 37 weeks is an increased risk of still birth for one or both babies. I do not know what the relative or absolute risks are though (that would be a good question for your caregiver) as I never got that far. I was leaning towards refusing an induction though, as I knew I was not not comfortable with the risks of induction.

 

I second that the sweep was the most physically painful thing I ever experienced (and I delivered 4 children vaginally with no pain relief), but my body was nowhere near ready to deliver at that point. I had more than one with my first daughter because she refused to be born, and man was I happy she decided to pop out (non sweep indiuced when she gave up her stubborn position at 42 weeks), moreso because I knew I wouldn't need any more sweeps. I mean I was happy about the baby too...

But you know what, either with or without those babies will find a way to come out, so don't worry too much. Right now just enjoy being pregnant as much as you can. I worried like crazy about how I would deliver, and what if my babies were huge (my mother's all were) and then had 2 tiny preemies who almost fell out of me before making it to the OR.
M.

 

My boys were mono/di. I had a secheduled c-section at 37 weeks, my doctor would have let me go to 38 weeks, however baby B had stopped thriving. I know with a shared palcenta going past 37-38 weeks there is an incereased risk of still birth to one or both babies.

 

I can't believe a doctor would do that without your permission...that made my jaw drop!

 

Thank you so much for the replies!

I hadn't realised that the s&s would be painful - oh no, I'm such a wimp with pain...! :unsure: and from all accounts, is a better way to induce than the other methods which seem to carry a lot more risk.

I think I will go along with what the doc says, I really am not enjoying this pregnancy, I've had terrible PSD since 18 weeks and some days are just unbearable!

 

I'm now even more shocked that it was a WOMAN...in my head I saw some egotistical, arrogant male OB (sort of like the one I had for my pregnancy with my son ) never a woman...WOW!

 

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0020180

Please read this article...I delivered at 34 weeks..and I feel very strongly in my gut that had I gone to 36 or 37 weeks I would have lost one....Just my mommy gut.

 

I delieverd at 37 weeks but had my OB had her way, I would have gone to 38 weeks. I was very adament that they needed to come out. Baby B was showing a slow in growth from 32 weeks on and didnt grow my last 2 U/S. He was extremely ill at birth and I know that had I been made to go to 38 weeks, he never would have made it. THey should have been taken at 36 weeks when he showed signs of failure to thrive.

 

Thank you for the link - I agree with the authors that I would love to see additional studies done in this area.

 

I've read this report before, my only concern is that the report is 6 years old... another report done last year, (I will have to try to find the link), challenges this report.

But like you, I just have a gut feeling. What I may also do at my next appointment is ask what the lung maturity of the babes are as it seems this is the main high risk of induction...

 

I had mono-di boys in September 2009 at 38+5. My OB wanted to deliver at 37 weeks, but I pushed for a later delivery because my last baby, who was born at 39+3 was in the tiny percentage of "wimpy white males" who have not achieved lung maturity at that gestation. He spent five grueling weeks in the NICU and I did not want a repeat performance. My OB obliged me as long as I came in for visits twice a week (ultrasounds and scattered NSTs)for the last month - and stayed near the hospital (I live 100 miles from the hospital and stayed with my sister-in-law).

My final ultrasound - the Friday before my c-section, which was the following Tuesday - estimated the babies at 6 lbs. 10 oz. and 6 lbs. 12 oz. I never had any fluid issues. At birth, the babies were actually 5 lbs. 0 oz. and 6 lbs. 10 oz. - and the 5 lb. baby was an inch longer than his fat brother! The skinny baby did end up in the NICU for three nights, but not until the 4th day of life - he could not maintain his body temp. He quickly caught up in weight and they have been essentially the same size since about 6 months old - maybe earlier.

I've often wondered how much he would've weighed if I'd had my c-section at 37 weeks - I feel certain he was losing weight in there, based on his length and appearance - although I do not regret my decision to keep them cooking based on my prior NICU experience. I do think I would've had the babies at 37 weeks had they been girls (lower risk of lung issues for girls).

 

I had mono/di boys and delivered at 33 weeks 6 days. At 33 weeks and 3 days one of my boys started to have unexplained dips in his heart rate during a non-stress test. This baby was also my smaller baby. I was given the steroid shot for lung development, admitted to the hospital and told to prepare for an induction in 48 hours. I was willing to stay in the hospital and be monitored for weeks if necessary, hoping that the extra time would help the boys' development, but my doctors didn't see any benefit to doing that. They indicated that once the steroid shot had 48 hours to take effect, that the babies would be better off outside.

I don't think I had the "stretch and sweep" but they did insert a balloon into my cervix to help dilate it. They broke my water and administered pitocin and I delivered my boys vaginally. Although they were preemies they were both born healthy and have been thriving ever since. My OB examined my placenta right after delivery and my son's cord was becoming detached, which was the reason for the heartrate dips. Since I had no symptoms or pre-term labor, I'm certain that the early induction saved his life.

 

Thanks Amy and Shera - your posts were really informative....

I'm going to my next appointment armed with a lot more information which eases the confusion in my head for sure...

I keep hearing this, I've never heard of it before ^_^ - something to do with lungs maturity I'm presuming as per pp?

 

I found the link Click Here - basically says, the risk is about 1.3% and no different to a di-di pregnancy. But then again, every second report differs to the one previous as each study seems to be different, even the recent ones (2011) contradict each other.

At the end of the day it is a personal choice, but one I am still struggling with.... lol it will probably all be moot and the babies will come out by themselves before anyway.. we shall wait and see...!

 

Wimpy white male just refers to the fact that overall, white boy babies don't do as well as say African American girls when born early. When we have a 24 or 25 week delivery at work we always hope it is not a white boy because they, overall, don't do as well. Good luck to you!! I had Twin to Twin Transfusion and I was going to be induced at exactly 36 weeks. My water broke at 34 w 6 d so nature stepped in for us.

 

Thanks for that link as well! It is definitely a tough decision, with so much to weigh. One way I like to look at it though is to flip the stats around - so with a 1.3% chance of unexplained still birth that means you have a 98.7% chance of having perfectly healthy babies. And then you're also weighing that against the risks & benefits of induction for you & the babies, including that inductions lead to a higher rate of c-birth, it gets pretty overwhelming pretty fast. I found that what I tend to need to do is take in all the info (from my caregiver, my family & friends, stats & studies, etc) & then find a still & quiet place inside myself where I try & set aside fear to just sit & think/feel about it. Usually, over time (sometimes just a couple of minutes, sometimes weeks or months), I will reach a decision that feels right for me. I know that sounds a little hippy, dippy but I find it works well for me. :hug:

 

Not all hippy dippy Rachel, sound advice and one I am definitely going to take.. thank you for the hugs, it's nice to feel that I am not over thinking this (something I am wont to do at best of times !)

 

The only sweep I had was with my 3rd pregnancy. I ended up getting an urinary tract infection which then went to my kidneys. Two days later, my waters broke and the baby ended up getting group strep B. I personally will never get a sweep again, so ask your Dr. what the potential risks might be. It was absolutely painful and so was the infection while in labor. I hope though everything goes wonderfully for you.

 

Thank you for your post, Pam - did you stay in hospital after your sweep and until you went into labour?