Multiples

If you had/are having mono/di twins...

My MFM group has said in the past that the accepted standard of care is to deliver mono/di twins by 36 weeks due to concerns with the shared placenta failing.  Now I'm getting mixed messages -- the MFM nurse came in today and said they'd let me go to 36 (assuming I make it that far).  But then when the doctor was rounding, she mentioned possibly delivering around 34-35 weeks and I am nearly losing my mind.  I just don't see why that should be delivered so early.  Now, if I start having liver issues or signs of TTTS, that's a different story, but so far, so good.      

 So here are my questions:

1.  When did you/do you hope to deliver?  

2.  Did you have an OB or see an MFM exclusively?

3.  If you went past 36 weeks, were you monitored more closely, and if so, how (frequent NSTs, u/s?)?

Thanks!!     

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Re: If you had/are having mono/di twins...

  • I should note that I'm only in the hospital because my insurance won't cover my terb pump at home.  I'm not having any other medical issues.  
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  • I saw my doctor who had me monitored by an MFM.  I didn't have appointments with him, but I had all my u/s done at the hospital and he monitored them.  So I had weekly u/s for a while, and then bi weekly once we felt pretty confident that the girls had no signs of TTTS.

    My c-section was scheduled for 36 weeks 3 days, b/c of the risks with the placenta failing.  That's a very common practice.  Also, my u/s showed that the babies would be at a decent birth weight. 

    34/35 weeks sounds way to early to me, and assuming you have no complications, I would fight for 36 weeks. 

    (I should say I had weekly u/s from 18 weeks until about 28 weeks for fluid checks for TTTS, then took a break for 4 weeks (where I only went twice), and had weekly u/s from 32-36 weeks.)

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  • I delivered at 34w4d, due to TTTS combined with high blood pressure and borderline pre-e. Otherwise they would have let me go as far as 38 weeks.
  • 1.  When did you/do you hope to deliver?  37 weeks exactly - this Friday!

    2.  Did you have an OB or see an MFM exclusively? MFM exclusively

    3.  If you went past 36 weeks, were you monitored more closely, and if so, how (frequent NSTs, u/s?)? Not monitored any more closely than what I was doing before. Twice weekly NST's, once a week AFI's, every other week growth ultrasounds. I am having doppler flow checks this week since I have a high discordance again and an amino on Thursday before my section. All outpatient.

    I see no reason why you can't get to 37 weeks if everything looks great including all of your labwork.

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  • Both my OB and MFM were fine with me going to almost 38 weeks.  Actually, my OB was the more conservative one.  I was induced at 37w6d.  Was monitored at least twice weekly starting at 34 weeks.  Weekly biophysical profile u/s and twice weekly NST.

    34-35 weeks is much too early to deliver just because they're mo/di, without any signs of trouble.  I would definitely not be comfortable with that.

    ~Crystal~ SAHM to Sam (5), Hugh (3), Mary & Grace (22 months) : )
  • I had triplets sharing 1 placenta.  I was seeing just an MFM - no OB and I delivered  at 35 weeks, 6 days - scheduled c-section. 

    Not twins but I wanted to throw my experience in there.  We never had any TTTS issues.

  • 1.  When did you/do you hope to deliver?  I was induced and delivered at 37w 6d

    2.  Did you have an OB or see an MFM exclusively? I only saw my OB. No other specialty.

    3.  If you went past 36 weeks, were you monitored more closely, and if so, how (frequent NSTs, u/s?)? Nope. I had monthly growth u/s and cervical checks from 24 weeks on. My last u/s was at 37weeks. OB made the decision to induce based on that u/s. I never had an NST. My weekly appointments started around 32 or 34 weeks. Can't remember right now.

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  • image omgtwinsfeb11:
      

    1.  When did you/do you hope to deliver?  - went into labor on my own at 35.6 weeks

    2.  Did you have an OB or see an MFM exclusively? - yes an OB and a High Risk doc, due to my age (i'm 38) and multiples

    3.  If you went past 36 weeks, were you monitored more closely, and if so, how (frequent NSTs, u/s?)? - yes, every week and was asked to come in w/out an apt if I felt off or anything that wasn't "normal".  U/s every 2 wks towards the end.  

    Mine were in the NICU for 2 & 3 weeks due to breathing and feeding issues.  I wanted to make it to 38weeks.  Personally, I think that if you can go to 38wks, go as far as you can, the twins will only thrive.

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  • I just had this conversation with my MFM today. She recommended to my OB that I am delivered between 36-37wks due to issues with the placenta etc. However, my OB feels it is best to let me go into labor on my own, but would probably induce by 38 weeks. I would like to deliver 37-38wks (if I can make it).I currently have no complications/everything looks great with my girls! I started NST's and U/S twice weekly at 32 weeks and growth has been monitored every 3 weeks since week 20.

     

  • My dr's day 1 said expect a c-section and expect them earlier than 40 weeks. At 16-18 weeks our goal was to make it to 32 weeks. I had problems that occured at 27 that we had monitored since 16 weeks but it was TTTS and IUGR. I saw my OB Gyn bi-weekly until the last 2 weeks and then it was supposed to be weekly until 32 weeks.
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  • My girls were mono/di and were born at 38w6d.  I saw a MFM twice in the pregnancy to consult with my OB that everything was going well.  The MFM said that I should have ultrasounds every other week from 28 weeks to check growth/fluid levels and cervix length.  At 32 weeks I also started weekly NST's.  At 36 and 37 weeks I also had BPP's.  I had no complications during the pregnancy.  I had a scheduled c-section due to a previous c-section with my son. 

     Good luck to you!

  • Thanks, everyone!  U/S today showed that less than 3.6% discordance, and everything else looked good.  I'm in the middle of 24-hour urine and then they're doing more lab work tomorrow.  If everything is ok, I'm going to fight to keep them in as long as possible.    
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    Good questions! I have learned a lot reading the answers.

    1. My goal is to make it to 36-38 weeks. I really want them to be as close to 7lbs as possible. Thus far there is virtually no discordance between our little guys. Big Smile

    2. We had a midwife but once we found out we were having twins we had to find an OB. So I searched for an OB that was open to a natural birth. Luckily we found her and now we see her bi-weekly. Our OB referred us to an MFM that, barring any complications, we will only see once for my 20 week U/S. 

    3. My OB wants to see me weekly after 34 weeks but that will be the only major difference. I have already had 3 U/S and will probably have another 3 before the birth. 

    Thanks everyone! 

  • 1.  When did you/do you hope to deliver?  

    Because I am having so many complications due to excessive swelling, blood pressure, and possible heart issues (I see a cardiologist today), my doctors are making small goals.  24 weeks, 30 weeks, 34 weeks.  If I make it past 34, they'll be pleased and surprised.

    2.  Did you have an OB or see an MFM exclusively?

    I see both. 

    3.  If you went past 36 weeks, were you monitored more closely, and if so, how (frequent NSTs, u/s?)?

    I'm getting scans every 2 weeks right now.

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