Monochorionic Diamniotic twins monitoring?

Hi Everyone,

I have a question for those of you who have or had MoDi twins. I am 13 weeks pregnant, with MoDi twins. So far, I have been monitored via ultrasound rather frequently (every 1-2 weeks since 7 wks) due to a large subchorionic hemmorhage. The subchorionic hemmorhage is getting smaller and my babies are growing at a normal and equal rate so far. My last ultrasound was at 12 weeks, and my next will not be until either 16 or 18 weeks. I am just wondering how often everyone else was monitored via ultrasound for their MoDi twins? I know that TTTS can occur about 15-20% of the time, so I am just curious if I should be monitored more frequently. I see an MFM, but not a peri.

Thanks for any input!

 

I was suspected ttts at 13 weeks so had weekly monitoring (confirmed ttts at 15 weeks) the whole time. Actually some weeks a few times a week but that is because they were watching the progress. If I didn't have ttts I think if I understand right it should be pushed for weekly after 16 weeks in case something comes up. I could be wrong though maybe that too is just if they suspect something.

 

I'm wondering the same thing. I am 14 weeks with mono/di twins and when I found out I had twins at 10 weeks they had my next u/s scheduled at 14 weeks. I had no idea what ttts was at that point so i didn't question it. I have been researching it and I have heard other people saying u/s should be at least ever two weeks with mono/di. So, I am going to push for that at my u/s today.

 

I had an U/S every 2-3 weeks throughout the pregnancy, and then started having NST's around 30 weeks.

 

My dd was monitored every other Friday all the way throughout her pregnancy by her MFM doc. She also saw her ob on the opposite weeks. The MFM did the u/s each visit (ttts check) and the ob only did a couple throughout. She delivered at 36w 1d via scheduled c/s..

 

i had a u/s by my dr every four weeks and by my peri every four weeks, so it ended up that i had one every two weeks until about 26 weeks, then i had three a month. i was stuck in the hospital at 30 weeks, so i dont know when the NSTs would have started or how frequent the u/s would have been

 

I had mo/di twins. I had u/s at 8w, 12w (NT scan), 16w (to look for membrane, they hadn't found it yet). At 16 weeks they saw size discordance, so I saw a peri/MFM at 18w. We did have TTTS, and so then we got u/s weekly to monitor that. I think until about 16-18 weeks, there's not much they can do for the TTTS (surgery-wise), although from 16-18 weeks until 26 weeks is critical for TTTS, because they can do the surgery in that window. After that, if TTTS is diagnosed, if other treatments (bedrest, amnios) don't work, then they deliver. I would want u/s weekly or every other week to watch for signs of TTTS during that time, although with no other signs of it, every other week might have been ok. Since we found it, I insisted on weekly.

 

Thank you all for sharing your experiences. I am not trying to add any more stress to this pregnancy, but I would rather be safe than sorry. I think at my next appt (14 weeks) I will really push for more frequent ultrasounds. Going from 12 weeks to possibly 18 weeks makes me nervous. Again, thanks for all of your input!

 

sounds like you are being monitored well. MFM is pretty much the same as a peri - I had mono-di girls and i had monthly u/s until about 30 wks then weekly.

 

QUOTE(denali_ice @ Apr 23 2008, 10:11 AM) [snapback]735149[/snapback]
I had an U/S every 2-3 weeks throughout the pregnancy, and then started having NST's around 30 weeks.



Me too, I went to the peri every 2 weeks and had an U/S and my Dr every month.

 

I had my first US when I was 13 weeks (when we discovered it was twins)... and I believe I had US every 4 weeks afterwards, maybe down to every 2 weeks when I got to 30 weeks... My twins did have TTTS, but not serious enough to be concerned, their size difference was 1.5 lbs, and they were born at 35 weeks, 5 days... No NICU, no trouble breathing... I did have a TON of amniotic fluid though, once my water broke, it never stopped until they were born... Try not to be too worried...

 

My boys were also mono/di and we had an u/s at 6 weeks which is when we found out there were twins, another at 7 weeks to search for membrane (at peri's), and then weekly alternating between my ob's and the peri's until 12 weeks when we had the nuchal scan and then nothing until 16 weeks and then bi weekly at the peri's right up until the end. I have a photo album full of u/s pics. Congratulations on your twins...

 

OH MY GOSH.. YES! You need to be seeing a Peri. I started w/ mine at 13 weeks and had a weekly u/s until 28 weeks where I was having 2 per week! You are HIGH RISK w/ mo di twins and need to be seeing a specialist no matter what!! A LOT can happen when pregnant w/ identicals--- you need to stay one step ahead cuz it can happen VERY fast.. You should absolutley under NO circumstances be going that long w/o an u/s!!

 

I had never heard of TTTS when our OB told us at 9 weeks we were expecting mono/di twins. As a matter of fact, he said, "I don't treat twin pregnancies any different than singletons. . . unless something comes up, and that's rare."

So we didn't get another u/s until 19 weeks when a 21% size discordance was noted. Two weeks later, we were diagnosed with TTTS. We did not get the laser surgery as our case has not been serious enough for that, but I am borderline for an amnio reduction. And our babies still have a size discordance, and the Recipient does show a little stress on his heart from having to deal with so much extra nutrition, blood and fluid. But we're hanging in there. We started going to the MFM for u/s 1X week at 21 weeks when diagnosed, to the fetal cardiologist once every two to four weeks, and to the OB once every two weeks. Now that we are so borderline and need good surveillance, we go to the MFM 2X week.

Now that I know more about mono/di pregnancies, I would have wanted to be seen and have an u/s every two weeks starting at week 15 or 16. If a problem revealed itself, I'd request to be seen more often.

 

I can't believe I have already forgot these things but I am pretty sure that up until 28 weeks I had u/s once a month with ob visits every 2-3 weeks and then at the end my u/s were every 2 weeks and my ob appts. were every week. My boys were always within 4oz of eachother and I had a pretty uneventful pregnancy (besides being enormous!) I also had weekly NST's for the last month and a half.

 

I'm currently 22 weeks pregnant with mono/di girls. I'm seeing my OB every 3 weeks as well as an MFM every 3 weeks. I had a nuchal scan at 12 weeks and then did not have another u/s until 17 weeks. Thankfully, no problems between that time. I wasn't even aware that TTTS could be diagnosed before 20 weeks so I wasn't concerned. I was told that I'll continue with the every 3 week appointments to check my cervical length (I have a preventative cerclage) and for growth until 28ish weeks or if a problem presents itself. At my 20 week u/s, both girls were measuring 13 oz., fluid, kidneys, heart, etc. looked great so I guess we're doing ok. I would speak with your OB and voice your concerns if you want closer monitoring.

 

I am currently writing a research paper on TTTS and it's management.

Here we recommend US every 2 weeks from week 16 to week 26 (that is when 80% of TTTS start), then if no signs of TTTS are seen at 26 weeks, they should come back at 30 weeks (unless they feel a sudden increase of volume) and just again at 34 weeks and 38 (this is purely for US).
They go to their regular OB/GYN every 2 weeks throughout the pregnancy (I think, but it depends on the Dr).

Hope that helped, Millie

 

If you are know you are having mono/di twins then you need to be having weekly ultrasounds from 16 weeks on. This is what the tttsfoundation.org website recommends. If you contact the website they will fed-ex a packet out to you about TTTS. That way if you find you have it later you have already been able to read up on it and make some decisions regarding the care of your babies. I strongly suggest following the weekly ultrasound schedule. With mono/di twins there is always a risk of this syndrome even if the percentages are low and if you are getting u/s weekly you'll probably catch it more quickly.

In our case we didn't know any better. At my 17 week scan both babies were measuring almost completely equal. I went back to my OB for my 20 week ultrasound and in only that 3 week time period our babies had a severe, level III case of TTTS. I had laser surgery for them the very next day. Had we been seen weekly we probably would have noticed changes earlier and may have not reached such a severe stage.

I'm not trying to scare you but just trying to say that if you are proactive and insist on weekly u/s for this reason you may be able to catch and treat any problems alot sooner.

 

I would see a Peri too. I was watched every 2 weeks in the begginig and then once 20 weeks hit I was monitored every
week due to a mild case of TTTS and cervix issues. My friend that had a bad situation with her cervix did not see a peri
and wish she did so she would of been more closely monitored. Take this seriously. Enjoy your pregnancy of coarse,
but your are at high risk. You want them to catch any problems early enough in case you need to go on bed rest or
fix any other issues. I was on bed rest in the hospital at 23 1/2 weeks due to a drastic shorten and funnel in my cervix.
I was in the hospital for 8 weeks. It was hard, but I'm glad I was closely watched.

Take care and good- luck!!

Tina

 

I am kind of on the other end.. I am expecting mo/di twins and I have only just now been referred to a Peri because of a slight size difference at 24 weeks. I see a MW and an OB. I have had u/s's every 4 weeks up until now.. we are doing them every 2-3 weeks now. Its possible I will be seeing the Peri more often but for now its just a consult.. to make sure baby B is doing ok and to rule out TTTS if possible.

I do see that many of the mo/di twins are monitored much closer.. but for me I was comfortable with the amount of monitoring I was getting.

 

I had an u/s at 11 weeks (found out we were expecting mo/di twins) and then not another one until 18 weeks. I was a wreck the whole time, but my OB said there was no need to do another. At my 18 week u/s and appt. my DH and I requested a transfer to a MFM. We had another u/s at 21 weeks and from that point on we had an u/s every 10-14 days up until 29 weeks and then at 29 weeks I started getting weekly u/s and 2xweek NSTs.

My MFM also did a lung maturity amnio and chose to deliver my boys via c-section at 35w 1d. There were minor fluid and size discrepancies throughout the pregnancy, but nothing major. TTTS was a concern for me for the entire pregnancy - and towards the end my MFM felt that it would be best to get them delivered once their lungs were mature.

 

I wish I had some advice to give you.... but I am really glad you asked this question

 

I just wanted to thank everyone for their replies. I had my appointment with my doctor and it didn't go as well as I had hoped. I said that I would feel more comfortable with more frequent monitoring. He actually made a face and said that their practice has a policy to see twin moms every 4-6 weeks during the second trimester, so I could be seen every 4 if that would make me feel better. I didn't mention in my original post that I also take a heart medication that has been shown to cause IUGR, so I would think that would be even more of a reason for more closer monitoring.

Needless to say, today I will be searching for a new doctor. The bottom line is I just don't feel comfortable with this practice. I really appreciate everyone's honest replies. I hate to be that "troublesome patient", which is how this practice is making me feel, but reading your stories has given me the courage to say this isn't right for me and I am moving on. Thanks again!