How long should mono/di twins REALLY cook?

My perinatologist said the twins should come out by 37 weeks at the latest, but I've read articles on PUBMED which said mono/di twins have a high risk of unexpected late fetal death before 36 weeks, and it was recommended that they be delivered at 32-35 weeks at the LATEST?

Did anyone else read these articles? How long should mono/di twins REALLY cook?

http://www.ncbi.nlm.nih.gov/pubmed/15971947
http://www.pubmedcentral.nih.gov/articlere...i?artid=1160585

LOL, it's funny I'm obsessing over this right now because I'm also obsessing and worrying over any possible chance of pre-term labor (I think I have 4 out of 6 predicting factors- cervical structural changes, twins, over 35, and high anxiety levels).


Anyway, if anyone has any information on this I would appreciate it. Thanks!

 

My docs (OB and peri) told me that they wanted me to go at least to 37 weeks ideally. My OB said he wouldn't really let me go past 38. I wound up delivering via planned C-section at 35w4d due to my creeping blood pressure. The boys were both a healthy 5lbs7oz and came home with us with no NICU time. I know there are other mommies here who've gone longer with mono/di twins and they've been perfectly healthy.

I had also taken 2 trips to L&D for PTL - once at 33 weeks and once 2 days before I delivered.

HTH!
Becky

 

I never read that for Mo/Di twins - My girls were MonoMono Twins (shared a sac and placenta) with that type of pregnancy fetal death is common after 32 weeks and they suggest delivery at 32 weeks - that was when my girls were delivered - with MoDi I though that they tried to go to 37/38 weeks - no doctor wants to deliver at 32 weeks unless they have too.

Good luck - try not to worry.

 

That study has a seriously small sample sizes, is retrospective, and has no control group. It may warrant further investigation, or perhaps closer monitoring during the 3rd trimester, but I wouldn't make any rash decisions based on it. On the other hand, the risks of preterm birth (even at 34-36 weeks) are well documented, and most advisory groups are now recommending strongly against elective preterm delivery. If your doctor chooses to take the twins early due to risks, of course that isn't really elective, but the risks from preterm birth are still the same.

When I asked my doc about this (my twins are monochorionic too), she said that it is better to go as long as possible - the risks from early delivery are higher (especially if taken by c-section) than the risks from carrying longer. She did say that she would be watching me like a hawk, though, which she has. If there is any sign at all of fetal distress, then at this point she'd take the twins immediately. I'd talk to your doctor to get his/her opinion, and see what extra monitoring and appointments he/she is going to do in the third trimester.

It's unfortunate there aren't a lot of studies on monochorionic twins, but when you think about it, the potential population pool for studies is really small, and there likely aren't many funding sources for the research. In the end, you've just got to find a doctor you trust and go with your instinct.

WBB
33w6d w/ mono/di boys
On hospital bedrest for 3 weeks, preceded by home bedrest for 2 weeks, for cervical shortening & funneling, dilation, and PTL

 

My Peri's believe this also and do not allow Mono-Di twins to go PAST 36 weeks. My friend who was also pregnant with identicals WHILE I was insisted on going past 36 and one of her boys didn't make it

I'm not saying that it happens often, but once is often enough for me and THAT hit WAY too close to home for me. I planned and had my boys at 35 and 2 days and my Peri said "That sounds like a PERFECT time to have these boys."

And they were just that. No problems at all I would not feel comfortable going past 36 weeks.

 

I had my mo/di twins at 38w4d by scheduled c-section because they were both breech. They also had struggled with TTTS since 16 weeks, so we were monitored frequently by u/s, and as long as everything stayed stable, my peri let me go. I had no signs of going into labor on my own.

Anyway, my peri would have done the section sooner, but she would have done an amnio to make sure their lungs were mature (assuming everything else was ok). She said that even for twins, the OB board (or whatever it is) recommends no c-sections before 39 weeks unless there is a medical reason! I was a little surprised by this, but whatever.

I had also read/heard about this, and my peri said that we should go as long as we can, as long as no other medical reason crops up.

In hindsight, I'm so glad we went as far as we did. My babies were very small for their gestational age, both less than 3rd percentile. The smaller baby had stopped growing in the last week, so she technically had IUGR, so it was definitely time for them to be delivered when we did.

As it was, my smaller one had to be in the NICU for a while on oxygen, and only had apgars of 3/8.

But, both were healthy and I'm glad we went as far as we did, but only with close monitoring. Both babies came home with me - you can't get better than that!

Jenny

 

i had my mono di twins at 32 weeks 1 day. I'm so glad that they delivered when they did. They didnt have any clue that ttts was occuring, until they pulled them out, they did it due to the fact that my A baby wasnt having alot of acels and decels and he failed his bio no movement in 30 minutes. Thank god for the 2 shots of steroids in before i delivered. And they had me in the hospital because i failled my ffn

my a baby came out 2lbs 8oz extremely anemic and my baby b came out 4.9 bright red.

They've both been in the nicu since the 2nd of july, and they're both doing beter. My drs kept pushing me to keep going, i'm glad i complained alot and kept my appts, and i failed that FFN i had a drs appt the day before they c-sectioned me and only had me go to the hospital because of the failed FFN they had no idea the babies were having issues even with the quick ultrasound.

 

I never specifically asked if my OB would take the babies early but she said that the American Academy of Obstetrics recommends performing induction prior to 38 weeks unless there is a medical necessity. I think she scheduled mine for 38 weeks to humor me as she doesn't think that I will go that far, but I also think that she approaches each case differently based on the circumstances. I know that a coworker of mine was induced with her twins (fraternal) at 37 weeks because she was so uncomfortable. My OB said that they need to be careful inducing prior to 38 weeks because of all the risks of premature birth. try not ot stress so much. I agree with the previous posts about the numbers in the study being very small etc.

 

QUOTE(ivfbound078 @ Jul 11 2008, 03:26 PM) [snapback]872025[/snapback]
My Peri's believe this also and do not allow Mono-Di twins to go PAST 36 weeks. My friend who was also pregnant with identicals WHILE I was insisted on going past 36 and one of her boys didn't make it

I'm not saying that it happens often, but once is often enough for me and THAT hit WAY too close to home for me. I planned and had my boys at 35 and 2 days and my Peri said "That sounds like a PERFECT time to have these boys."

And they were just that. No problems at all I would not feel comfortable going past 36 weeks.



Hey, do you mind me asking, do you know if your peri has any literature he/she relies on that I could pass on to mine?

I'm a little nervous about 37 weeks, and would like to make sure my Peri has all information available.

 

I think they need to be closely monitored after 32 weeks regardless of when they are delivered. Just my opinion based on my experience and what I read.

My OB was going to deliver mine the day before 37 weeks (if I hadn't gone into labor at 34w1d). He felt that was the longest they should go with TTTS and all that bedrest I did (those 13 weeks).

 

Originally I was told they wouldn't let me go past 38 weeks. The next week I was diagnosed with ttts. They wanted them out no later than 36 weeks-earlier if we took a turn for the worst.

 

I am really scared now. After I read your post I once again began to wonder about these things as well and I posted asking if anyone knew Dr. DeLia's recommendations. I only received 2 replies though so I e-mailed Mary, the founder of the TTTS foundation. She promptly e-mailed me back saying that she thought it to be scary that my OB was going to let me go to 38 weeks. She said there are studies that recommend no later than 36 weeks and the TTTS foundation recommends no later than 34 weeks (if there are no previous signs of TTTS). If there have been any signs of the syndrome they recommend 32 weeks. I am going to bring it up with my OB but I don't think she will go for it. I am torn because I am an inpatient infant/toddler nurse and I know all of the problems that can come with prematurity. Mary suggested being admitted at 34 weeks and monitored until delivery at 36 weeks if I were to go that long. I don't know that my OB could justify an admission if there were no complication either though. If you find anything else please let me know. Thanks.

 

Wow. I'm truly shocked by that recommendation. Even the study of monochorionic twins with the small sample size showed a death rate of 4.6% - half of those at 34 weeks or earlier. At 34 weeks gestation, there is general death rate of 3%, along with a 14% chance of Respiratory Distress, 4% chance of Sepsis, and 3% chance of necrotizing endocronitis (http://www.emedicine.com/MED/topic3245.htm). In addition, babies born in late preterm have higher death rates throughout infancy (http://www.medscape.com/viewarticle/566012). I'd be really interested to hear on what other data they are recommending that babies with no signs of TTTS or distress should be delivered at or before 34 weeks, given the risks from prematurity. Maybe they have access to additional studies?

 

QUOTE(WildBlueBerry @ Jul 12 2008, 11:59 AM) [snapback]873109[/snapback]
Wow. I'm truly shocked by that recommendation. Even the study of monochorionic twins with the small sample size showed a death rate of 4.6% - half of those at 34 weeks or earlier. At 34 weeks gestation, there is general death rate of 3%, along with a 14% chance of Respiratory Distress, 4% chance of Sepsis, and 3% chance of necrotizing endocronitis (http://www.emedicine.com/MED/topic3245.htm). In addition, babies born in late preterm have higher death rates throughout infancy (http://www.medscape.com/viewarticle/566012). I'd be really interested to hear on what other data they are recommending that babies with no signs of TTTS or distress should be delivered at or before 34 weeks, given the risks from prematurity. Maybe they have access to additional studies?



I was really surprised too. Like I said my Ob is more concerned with the outcomes of prematurity at and before 34 weeks than fetal demise. I had asked for any information/studies that I can pass onto my OB but she did not send any. The only study that she mentioned was one that she said found that monochorionic pregnancies were found to have a higher incidence of demise of one or both of the babies after 36 weeks. She said that it was the recommendation of the TTTS foundation to deliver no later than 34 weeks, but did not mention any studies etc. I don't know what info to go by. I will approach my OB but what do I do if she does not agree? Seek another opinion? I personally would not feel comfortable delivering by choice and without reason before 36 weeks.

 

I agree with the recommendation of NO LONGER than 36 weeks and my Peri's did too!! I had mine at 35 and 2 and I refused to go any longer and would have put up a fight and even changed docs if they would've denied me my wish.

I know I already posted in this thread but after reading what Dr. DeLia (THE identical twin God), I am even more sure that mono-di twins shouldn't go past 36 mark.. I was even too afraid to go tHAT far after seeing what my friend went through 2 days after 36 weeks.

I'm pretty sure your Peri will do what you ask. I had no problems and they wanted to deliver me then anyway. I cannot see why anyone would have an issue with this at all. If they do, refer them to Dr. DeLia.

Good luck

 

QUOTE(ivfbound078 @ Jul 12 2008, 03:14 PM) [snapback]873308[/snapback]
I agree with the recommendation of NO LONGER than 36 weeks and my Peri's did too!! I had mine at 35 and 2 and I refused to go any longer and would have put up a fight and even changed docs if they would've denied me my wish.

I know I already posted in this thread but after reading what Dr. DeLia (THE identical twin God), I am even more sure that mono-di twins shouldn't go past 36 mark.. I was even too afraid to go tHAT far after seeing what my friend went through 2 days after 36 weeks.

I'm pretty sure your Peri will do what you ask. I had no problems and they wanted to deliver me then anyway. I cannot see why anyone would have an issue with this at all. If they do, refer them to Dr. DeLia.

Good luck



Thanks, I tried to send you back a PM, and I don't think it went through. Thanks for everything!