Mono/Di delivery - a few questions

I'm 34w2d with mono/di boys. My peri and midwifes & high risk OBs have never once mentioned the concerns with TTTS and a possible early delivery. They feel comfortable and confident with a 38week delivery- induction if they don't come spontaneously before that or there's the possibility of having to schedule a C-section b/c Baby A has been breach the last two weeks. Peri said that she wouldn't think about scheduling a c-section until 36w if baby A is still breach.

Anyways, I insisted on add'l ultrasound monitoring for fluid/doppler/bladder because of the TTTS risk and started doing weekly u/s I think around 28-29weeks. I have the growth U/S every three weeks. The boys have been doing great and up until last growth u/s which was at 33weeks they had only had up to 2oz size discrepancy. The 33w growth u/s they had an 8oz difference. The peri said it's still within normal sizes/weights and reminded me that the further along the more inaccuracy the weight estimates are.

I'm wondering what your drs (peris, OBs) have told you about TTTS, the risks of accute TTTS at the end of pregnancy, risk of TTTS at delivery and early delivery suggestions.

 

Well we *think* we are having mono/di twins, I've been told different things by different techs. I've only had my ultrasounds done every 4 weeks for growth and all that because they are still within the normal weight range of each other. I feel comfortable with it.

My dr is also comfortable with delivering the second baby breech if he has to and will reach up and get him I guess you could say. Different doctors feel differently about this. Mine doesn't like to rush into c-sections unless he has to and I'm glad about that. I also will be induced at 37 weeks by breaking my water which for me will get things going as I've had a lot of contractions and am on meds to stop them until 35weeks.

I hope that helped answer some of our questions. Every doctor has a different way of doing things. We don't have a peri anywhere near here and he is the only dr qualified to deal with twins in our area, but I'm very comfortable with him as my dr.

 

wrote a huge long response but it got eaten by the internet....

Unrelated- we are 34weeks 3 days (40 weeks December 1st) with mono/di boys as well! Small world, huh?

 

"My dr is also comfortable with delivering the second baby breech if he has to and will reach up and get him I guess you could say. Different doctors feel differently about this. Mine doesn't like to rush into c-sections unless he has to and I'm glad about that. "

Dido for me. My doc says the same thing. To add, He said it's best if baby a is bigger then baby b. He said as long as baby a is the biggest he really doesn't care what way baby b comes out. If baby a is smaller, then there is the matter of waiting for the cervix to open up more for baby b and that is sometimes where a complication can come up. But if needed, a c-section can always be done on just baby b. My doc pushes the v-birth, says it's the best way to go.

Sorry, my computer is quoting funny for some reason

 

I'm 26 weeks with mono/di girls and my peri and OB (and pedi) have agreed from day one that they will not let me go to 35 weeks. They feel that's when the risks of TTTS and another possible complication outweigh the risks of prematurity. They do take all precautions and have great results with 34/35 week deliveries. Also, they're more comofortable delivering girls early because, for whatever reason, they do better in the NICU.

ETA: I'll almost assuredly have a c/section as baby b is bigger than baby a and always has been. She's also never been head down.

 

I am also pregnant with mono/di twins and my peri and OB have alredy gone over the TTTS talk with me. I am only 15 weeks along, but they wanted me to be aware of what they would be monitering me for. I see my regular OB every 3-4 weeks right now and starting 11/17 I will be seeing my peri every 2 weeks. She will be doing the u/s for fluid and growth checks. Both would like to see me make it to 36/37 weeks if possible. The only way my OB will deliver naturally is if both babies are head down. Obviously we are too far away to know that now, but I think he is leaning towards a c-section. I am fine with that decision.

 

So what are the risks of TTTS at the end of pregancy and why do they suggest early delivery?

 

All my peri said was we constantly moniter you because TTTS can happen at anytime during your pregnancy. She said it is not one of those things we can pinpoint to an exact time frame. Since at the time I was only 12 weeks along, she didn't specifically say anything about the end of my pregnancy. All she really said about that was ideally she would like to see me make it to about 36/37 weeks if all is going well. As TwinsInFL said and from what reading I did, if they take them a little before the 40 weeks they actually have a better chance of surviving in the NICU. So basically there is more we can do for them out here than in there. Eventually we are just going to run out of room for them. Sorry I don't have more to add...but you are farther along than me and we haven't gotten into a lot of specifics regarding my delivery yet! Good luck!

 

The peri has been monitoring my fluid and growth levels closely as TTTS can come on at any time. However, the "average" onset time they quoted me when I was only 8 weeks along was 32 weeks. According to my medical team, that's when the risks go up. I have not read anything out there on the internet as I'm sure there's a lot of scary info that I just don't want to know! As I said earlier, my team has had great results with 34 week deliveries and feel that is the time when the risks of prematurity outweigh the risks of TTTS and a newly discovered phenomenon where one or both twins will suddenly pass after 35 weeks. Again, this is for mono/di twins only.

Just remember to ask a lot of questions and make yourself a part of your medical team so you're in the loop.

 

QUOTE(MamaZ @ Oct 24 2008, 10:01 AM) [snapback]1040203[/snapback]
So what are the risks of TTTS at the end of pregancy and why do they suggest early delivery?



I just asked my peri this on wednesday and she said that it can apprear at anytime during the pregnancy. She did say that it was a good sign that it hasn't made an apperence yet but that has no indication that it can't still happen..

 

My Peri doesn't let "us'' pass 36 weeks. I had mine via elective Csection at 35 and 2. My friend who was also pg w/ mono-di boys WITH ME went to 36 and 2 and lost one at 36 and 1!! There was no way i was going down that road. My Peri delivers ALL Mono-Di twins BEFORE 36 weeks. The benefits have been shown to greatly outweigh the risks.

The placenta is being used by TWO babies and starts to fail earlier (not always) so my Peri adds this into the mix as well.

I would NEVER advise anyone to go past 36 weeks.. EVER.

They are fine at that pt anyway Mine were six lbs each at 35 weeks, mature lungs etc.. They will do an amnio before just to ck maturity.

 

I would agree with the not past 36 weeks but Kaiser in general, and the doctor I have now doesn't work that way- the earliest they would deliver them is 37 weeks, except now I'm in the hospital with pre-eclampsia they will test their lung maturity at 35 weeks and I am SO hoping they will be in the 20% that are mature. If not they will test their maturity at 36 weeks, if not mature they won't deliver until 37 weeks.... that is of course if pre-e doesn't become severe

My last perinatologist gave me a little more control (said 37 , and when I showed him article by Mary D' Alton he said she was really smart and respected her, but thought her viewpoint on delivery might have changed due to recent findings in even late preterm infants- he said I could email her and let him know what she said but then I had to switch peris)
this one doesn't.... reluctantly agreed to 37 if lungs mature, his standard is 38 weeks) but since I'm here they will try testing the lung functions, etc. I have no say at all over this ain the hospital. At least from what I've heard from nurses what the perinatologist here is being more lenient than he normally would be in testing lung function, etc. probably because they are mono/di twins, which he normally wouldn't do for pre-eclampsia- they said normally patients are just monitored until they become severe or are at term.

At least they are put on monitors 3x a day (non stress tests, w/out ultrasound) so hopefully if there are any issues it will be caught...

 

My Peri doesn't let "us'' pass 36 weeks. I had mine via elective Csection at 35 and 2. My friend who was also pg w/ mono-di boys WITH ME went to 36 and 2 and lost one at 36 and 1!! There was no way i was going down that road. My Peri delivers ALL Mono-Di twins BEFORE 36 weeks. The benefits have been shown to greatly outweigh the risks.

The placenta is being used by TWO babies and starts to fail earlier (not always) so my Peri adds this into the mix as well.

I would NEVER advise anyone to go past 36 weeks.. EVER.

They are fine at that pt anyway Mine were six lbs each at 35 weeks, mature lungs etc.. They will do an amnio before just to ck maturity. quote]
My Peri doesn't let "us'' pass 36 weeks. I had mine via elective Csection at 35 and 2. My friend who was also pg w/ mono-di boys WITH ME went to 36 and 2 and lost one at 36 and 1!! There was no way i was going down that road. My Peri delivers ALL Mono-Di twins BEFORE 36 weeks. The benefits have been shown to greatly outweigh the risks.



I'm in Twin Cities- delivering at HCMC. Who is your Peri? I'm concerned that I should be arming myself with more research to give my medical team & Peri so they can explain their medical opinions to me verses the research. I've been told during my prenatals that at HCMC they don't place protocal into place unless it's research proven....so I'm sure I'd need to have some solid research to present before I have the discussion with them.

 

Im expecting Mono/di girls, My Peri expects me to go naturally around my 36week mark (due to effacing, dilation, running out of room ect). But if the girls dont come on there own, she will induce at the 37 week mark. She has told me countless times, they she is certin they will be coming sooner then later, and for any reason medically if they *NEED* to come sooner, she would take them. So far our girls have meassured with in 1oz of each other. They are consistantly 1oz diffrerent. If suddenly that changes she advised me, so would our action plan.

 

The topic of TTTS was never brought up and when I asked the high risk OB she said it would not be a concern unless the were close to a pound apart or any other signs of problems my boys were consistently different in sizes. Sometimes 8 oz sometimes 2oz it changed every appt. when they were born they were the exact same weight!

 

QUOTE(MamaZ @ Oct 24 2008, 01:30 PM) [snapback]1040530[/snapback]
My Peri doesn't let "us'' pass 36 weeks. I had mine via elective Csection at 35 and 2. My friend who was also pg w/ mono-di boys WITH ME went to 36 and 2 and lost one at 36 and 1!! There was no way i was going down that road. My Peri delivers ALL Mono-Di twins BEFORE 36 weeks. The benefits have been shown to greatly outweigh the risks.

The placenta is being used by TWO babies and starts to fail earlier (not always) so my Peri adds this into the mix as well.

I would NEVER advise anyone to go past 36 weeks.. EVER.

They are fine at that pt anyway Mine were six lbs each at 35 weeks, mature lungs etc.. They will do an amnio before just to ck maturity. quote]
My Peri doesn't let "us'' pass 36 weeks. I had mine via elective Csection at 35 and 2. My friend who was also pg w/ mono-di boys WITH ME went to 36 and 2 and lost one at 36 and 1!! There was no way i was going down that road. My Peri delivers ALL Mono-Di twins BEFORE 36 weeks. The benefits have been shown to greatly outweigh the risks.
I'm in Twin Cities- delivering at HCMC. Who is your Peri? I'm concerned that I should be arming myself with more research to give my medical team & Peri so they can explain their medical opinions to me verses the research. I've been told during my prenatals that at HCMC they don't place protocal into place unless it's research proven....so I'm sure I'd need to have some solid research to present before I have the discussion with them.



Hey!! Congrats. I was at MN Perinatal. LOVE THEM!! Dr. Diana Danilenko was my Peri!!

Good luck!! It's really up to YOU! I think people dont' realize that but you can decide as long as lungs are mature and by 35 and 3 they def should be!!