Monochorionic twins and delivery question

So far so good for the girls and I. I'm 26 weeks 1 day today and still feeling fantastic. No complications. I've started to think about delivery options. Both girls are head down now, my doctor said that half of her twins are delivered via c/s but didn't say anything regarding c/s and monochorionic twins specifically. I've read up on the internet about the risk of acute TTTS during delivery and it scared me. We had thought that if everything looks good, we'll try for a vaginal delivery. No signs of TTTS now but the idea that it can happen without warning during delivery has me very scared. We have a MFM appointment and OB appointment this week so we'll ask then but....I was wondering if any of you twin moms have researched this, or your doctors had mentioned anything like this.

Becly
id girls dd 6/2

 

Are your twins in the same sac or do they share a placenta? The only way you can have TTTS is if they share a placenta. I had ID girls that shared a placenta and didn't have any problems with TTTS durning my pregnancy. I wanted to to have them vag but baby b had fliped and was breech so I had a c-section. The risk of TTTS is very small, and if there isn't a problem through out your pregnancy I would go with a vag delivery. Good luck and I wish you a happy and healthy nine months.

 

We had it happen to us. We knew ours were ID right from the beginning of the pregnancy and saw our peri every other week and had a level II ultrasound once a month. there was no sign of TTTS at anytime - the boys always measured close in weight and had no fluid discrepancies - I went into PTL and after 5 weeks of fighting it, had them at 29 weeks. After birth it was determined that our littler guy had 3x the blood volume of his brother - and that TTTS had developed. Our placenta was analyized and showed signs of classic TTTS...so it does/can happen. I gave birth vaginally.

When we talked to our Peri - who is a specialist in ID twins - and one of the handful of Peri's who can do the fetal TTTS surgery - before we had the boys or even knew I would go into PTL - he said that because of the risk of acute TTTS he would only let me carry to 37 weeks, if not 36. I know that some other moms of ID's twins have also had acute TTTS on this board - and that there is a study that was posted at one point on this board about it, and what you can do to prevent/lessen chances. One of them might have more information, as our discussion never touched on whether C/S or vaginal was better or lessened the risk - it was mostly based on length of gestation - and I ended up having PTL.

Like PP mentioned though, TTTS is not a common occurance - and most likely everything will be fine no matter what type of delivery you have!

 

I'm scared of this possibility as well. So far, my doctors haven't said anything about acute TTTS and delivery. They've just told me the different scenarios for delivery, depending on position of babies etc. I spoke to Dr. DeLia a little bit about this and he said if it's a vaginal delivery...and the babies are monitored well they would most likely be able to tell if some kind of TTTS was going on based on the babies' heart rates, etc. Be open and honest with your doctors about this concern and keep referring to your babies as "our monochorionic twin girls." Dr. DeLia really stressed that to me, because he said some doctors treat all twin pregnancies and deliveries the same...and they shouldn't!

There are varying opinions out there. It's good that you're researching it and getting information from your doctors themselves. Maybe ask how many monochorionic twins they've delivered before...and how did it go?

 

Evanly, I must have posted at the same time as you. So were there any signs of distress or anything while you were in labor? I know this sounds kind of bad, but sometimes I kind of wish that the babies' positions will warrant a C-section, although I'm scared of surgery as well.

 

Nothing that struck anyone as related to TTTS - I started a fever the night before, it went away, and then came back in the morning - which is when they decided it was time to stop trying to have me NOT have the babies, and to start trying TO have the babies (I had been in labor for three days at this point and nothing would stop it, so they were just trying not to do anythign to encourage it as I was only at 29 weeks) - we had a discussing regarding C/S v/s vaginal - but based on the babies age and positions (both were head down) - all dr's involved felt vaginal would be best...especially w/regard to their lungs.

Quite frankly - no one had any concernes regarding TTTS at all - they were just focused on the prematurity issue - and what that would mean for the boys. It wasn't until after birth - when they were born two very different shades of pink (or bright red in the recipiants case) and after finding out blood volume and that the donor needed blood transfusions, that they realized what was happening...

 

Ok, my twins share a placenta. I know that the chances of TTTS are low and I know I shouldn't have even been researching on the net, I find scary stuff whenever I do that. I've been thinking a lot about delivery options all of the sudden though. Thanks for the info.

Becky

 

Hi,

I delivered monochrionic twins vaginally without any complications.I was monitored closely once we found out we were having twnis and that they were monochrionic at 18 weeks. We had some minor fluid issues, but it didn't progress beyond that. I started bedrest at 25 week for PTL and delivered at just under 37 weeks. I agree with the PPs that you should discuss your concerns with your ob/peri, but try not to worry too much. You can deliver monochrionic twins vaginally without complications. Good luck!

 

Scooterrd, please give me the website were you got your info from. I'm very interested. I am carrying mono/di girls sharing a placenta and although I've been to the TTTS Foundation website, I read nothing about the problem developing during labor/vaginal delivery. I have been all for vaginal delivery since I've had two others easily and don't want to deal with csection recovery. However, I have never read that it is a risky. Please share your resources with me.

Thanks,
Jennifer

 

All you have to do is google "acute ttts" and you'll get many hits. Here's one from the ttts.org website.
http://www.tttsfoundation.org/what%20is%20ttts.html

Becky id grils dd 6/2

 

Thanks, I had read up more on chronic TTTS. But didn't realize that there were issues with sudden change in BP, which I guess can cause problems at delivery. Thanks for sharing.

 

I delivered my mono-di twin girls at 36 weeks vaginally due to pre-e, and mine also had acute TTTS. No signs prior to delivery, infact the U/S that was done 4 days before delivery indicated the girls were both 7 lbs each.....they were actually 4'13 & 5'4. Not so close.
Everything went fine and the girls only had problems sucking, so they needed feeding tubes.
I wouldn't worry about TTTS, I didn't even really know anything about it until they came out red & white. Your Dr. will hopefully be on top of things, and my best advice is don't read info on the web...try to relax and enjoy your pregnancy, what will be will be.
cheers, pam