*Monoamniotic twins are always identical
*Monoamniotic twins are the result of a late splitting egg; one that split around 8-12 days after fertilization
*Monoamniotic twins only occur in 1% of twins
*Monoamniotic twins share a placenta and amniotic sac which means they have skin to skin contact
*Monoamniotic twins are considered extremely high risk because of the risk of cord compression leading to fetal death as a result of umbilical cord entanglement
*Monoamniotic twins are always delivered by C-Section
*Monoamniotic twins are usually delivered between 32-34 weeks gestation because the risks of staying in utero are greater than the risks associated with a premature birth
*75% of monoamniotic twins are girls
*inpatient monitoring at viability yeilds the greatest success rates
Thursday
Jacob and John
My monoamniotic adventure began when I was 17 weeks pregnant. I went to see a perinatalogist to make sure that my baby (I had an ultrasound at 9 weeks that showed ONE baby with a healthy heartbeat) had a normal umbilical cord since my previous baby had a 2 vessel cord. I was very excited to find out if we were having a boy or a girl. Right when the tech put the wand on my stomach I looked at the screen and saw what I thought was a deformed baby. The head and the stomach didn’t seem to be connected. The technician looked at the chart, back and the screen, at me and my husband and said, “I thought you were here about a 2 vessel cord”. I said, “We are”, and she said, it doesn’t say anything here about twins. So, that’s why the head and stomach weren’t connected….it was two heads! My husband and I were elated. It was shocking news, but exciting. I started crying. The perinatalogist came in and starting doing the scan, but after a while said she was concerned because she couldn’t find a dividing membrane. I knew that that meant the babies must be identical, but I had no idea what this truely meant. She said the babies looked great, and to walk around and get them moving so she could take another look to try to find a membrane. I walked around and went back in, very upset at this point because she said the babies only had a 50% chance of survival, that it was a high risk pregnancy, and if something happened between now and viability, there was nothing we could do. When she looked again, I saw the sweetest thing. My baby boys were holding hands. I knew then that we were not going to find a membrane. It was a very bittersweet moment. She looked at the cords and they didn’t appear entangled. We made an appt for a month later, and at that appointment a different perinatalogist looked for a membrane for a long time, couldn’t find one, and then looked closely at the cords. She pronounced them severely intertwined. At this point, 21 weeks, we knew we needed to decide what type of treatment plan we wanted to implement, and when we would start. Outpatient (5 times week NST) or inpatient monitoring (24/7), viability at 24 or 26 weeks. We met with a neonatalogist and decided that I would enter the hospital at 24 weeks. In the end, I just didn’t think I could live with myself if I didn’t do everything I could for these babies and something happened to them. So, at 24 weeks, I entered the hospital, and cried for 24 hours straight. Leaving my husband and 3 small children was the hardest thing I had ever done. My treatment plan consisted of 24/7 monitoring. I was allowed bathroom privileges and a 15 minute shower each day. If the strips were good, I could also have a 15 minute walk. My OB stopped in on rounds everyday. She followed the perinatalogists orders. At 25 ½ weeks we had a big scare. I went for a walk with my kids and husband, and when I returned, Baby B’s heart rate was in the 80’s and 90’s. They thought they were picking up my pulse, but it turned out they weren’t. They brought in the triage nurse who looked at the baby’s heart on ultrasound and she very matter of factly said, “The babies heart rate is very slow….look, it’s almost stopping”. It was terrible. So, we spent the next 10 minutes prepping me for an emergency C-Section and stimulating the baby so that he would move in hopes that his heart rate would return to normal. I will never forget hearing the nurse tell my husband over the phone that the neonatal unit had been alerted and that my OB and peri were ready to deliver if he didn’t recover. I remember praying and praying, “Please don’t let my babies be born this early”. Baby B did recover, and although he tended to keep us on our feet the whole hospital stay, he behaved enough that I was able to go to my scheduled date at 33 weeks 3 days. I was given one round of steroids at 24 weeks, and I had ultrasounds with the perinatalogists every 2 weeks while I was in the hospital. I was so scared about the C-Section and how my boys would do. Ultrasound had shown that Baby B had stopped growing appropriately in the last 2 weeks, so I was very worried about how he would do. The boys were born on a Wednesday, and that Monday they had said that if the C-Section was not scheduled, they would have taken them anyway because it looked like they weren’t growing well anymore. Jacob was born first and weighed 4lbs. 5 oz. John weighed in at 4lbs. 4oz. The doctor said there were 8 knots in the cords and additionally, John had the cord around his neck twice. She said she had to do quite a bit of untangling to get them out. Jacob started of on CPAP but had to be ventilated for a day and a half, but John stayed on room air. John was supposed to go home after 15 days, but I think he didn’t want his brother to be left behind, so he would get lazy and not nipple all his feedings. The boys came home together after 19 days and have just thrived. They are our little miracles, and we wouldn’t change anything if we could.
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