Transcript: MoDi Twins: Monochorionic Diamniotic Pregnancy

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Twin Talks
MoDi Twins: Monochorionic Diamniotic Pregnancy

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Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

[Theme Music]

DR. WADE SCHWENDEMANN: MonoDi twins, what are they? How do you identify them? If you’re pregnant and carrying MonoDi twins your developing babies may be at a higher risk than others and require additional monitoring. Are you getting this level of care? I’m Dr. Wade Schwendemann, perinatologist of the San Diego Perinatal Centre in Caswell, here to talk about MonoDi twin pregnancies and you might expect for care. This is twin talks

[Theme Music/Intro]

CHRISTINE STEWART-FITZGERALD: Welcome to Twin talks, broadcasting from the birth education centre of San Diego. Twin Talks is your weekly online on the go support group for expecting and new parents of twins. I’m your host Christine Stewart-Fitzgerald. Have you heard about the Twin Talks club?

Our members get bonus content after each new show, plus special giveaways and discounts. Subscribe to our monthly Twin Talks newsletter and learn about the latest episodes available. And another way for you to stay connected is by downloading our free Twin Talks app available in the Android and iTunes marketplace.

Before we get started let’s introduce our panellist. So, let’s see, starting here in the room. And I’ll start introduce myself, so, I’m your host Christine Stewart-Fitzgerald and I’ve got identical twin girls. And I believe they’re MonoDi because they were sharing a placenta. We didn’t find out if they were. It was a fused placenta or if it was a shared placenta.

But I can say I’ve been pretty active in some MonoDi groups. And you know understand a lot of the concerns there. I also have a singleton girl, so we are an all-girl household. And now, she is now two years old. And let’s see here, let’s start with our panellist here Brandi

BRANDI WALLACE: Hi, my name is Brandi Wallace. I have MonoDi identical boys that just turned five. And I also have another set of twins that are DiDi fraternal, boy girl twins that just turned two

CHRISTINE STEWART-FITZGERALD: Woohoo yes! I know the two sets and I’m like, okay because you get your hands full

BRANDI WALLACE: So I’ve had both types of pregnancies

CHRISTINE STEWART-FITZGERALD: Yes. And on the phone with us today we have Amy

AMY BALCER: Yes, my name is Amy Balcer. And I have a MonoDi identical boys that will be three in January and I have a son who just turned six. So, I’m an all boy household.

SUNNY GAULT: And I’m Sunny. I am producing today’s show. And I’ve got four kids of my own and I kind of split it. You guys are, you know on different sides but I have two boys, they are not twins. I have a four year old, two year old and then I have identical twin girls who were MonoDi twins who just turned one

CHRISTINE STEWART-FITZGERALD: Yey!

[Theme Music]

SUNNY GAULT: Alright. So, before we start today’s show. We like to talk about different twin and triplet type news that’s making rounds on the internet. And this one I thought was really interesting. They came out a little bit earlier this year but it involves space and twins so I thought this was kind of cool.

CHRISTINE STEWART-FITZGERALD: Space

SUNNY GAULT: Space as in like the Final Frontier kind of thing. So, apparently there are couple of astronauts. Scott Kelly is the one of the astronauts. He’s an identical twin and he has, his other twin believe it or not is a retired astronaut.

Anyways, Scott is going to be going up on the International space station for a year which apparently is the longest single space adventure of any astronaut in history. But what I thought was really interesting about this is they are going to be studying him and comparing him, like they’re studying the long term effects of space and how it affects people.

And they thought the best way to do that was to compare it to his identical twin who’s going to, not be in space but back here on Earth. And then they’re going to, they devoted quite a bit of money to this research and yeah they just want to, I guess it’s one point five million that they’re going to spend on this. And I just thought it’s really interesting how they plan to kind of compare and do the whole thing but yeah identical twins

CHRISTINE STEWART-FITZGERALD: It seems like you know identical twins, I mean they do a lot of you know kids studies but then you know looking at adults and the effects on space. I mean it sounds like they’re going to be like maybe comparing you know ahead of time before he goes to space. So then when he comes back and . . .

SUNNY GAULT: Yes exactly

CHRISTINE STEWART-FITZGERALD: Looking at maybe all the physiological changes

SUNNY GAULT: Yeah just what it’s like to live in space and how that affects the body and mentally and all that kind of stuff. But what I think is interesting, these are grown men. I didn’t say that I think they’re fifty years old. And so they already kind of have their own, I mean I know they’re both astronauts but they already have their own life experiences which I feel like could manipulate the outcome already. You know what I mean? You know you don’t have as much of that when you’re dealing with younger children. But, anyways if NASA must be right, you know it’s NASA I don’t know

DOCTOR WADE SCHWENDEMANN: My question would be, if they’re going to eat the same food and drink the same things and you know, if really, if the one who’s staying on Earth is committed to doing something like that I feel bad for him

BRANDI WALLACE: Yes

SUNNY GAULT: Yeah. So they’re going to perform a full genome, is that right? Genome analysis of both men to study any epigenetic effects

DOCTOR WADE SCHWENDEMANN: Okay

SUNNY GAULT: There you go

CHRISTINE STEWART-FITZGERALD: Alright

[Theme Music]

CHRISTINE STEWART-FITZGERALD: Well today’s topic is MonoDi pregnancy and we’re talking with Dr. Wade Schwendemann who is here to help us understand how the diagnose of MonoDi twins requires additional care. So thanks for joining us Dr. Schwendemann

DOCTOR WADE SCHWENDEMANN: Thanks for having me Christine, I really appreciate it

CHRISTINE STEWART-FITZGERALD: Well, you know before we dive in, I think you know MonoDi, those of us who have MonoDi twins understand but let’s, can we get like a brief overview of what that is and how that fits in with just twinning so we have a basic understanding

DOCTOR WADE SCHWENDEMANN: Sure. There’s really two ways to end up with twins right? One is to have two embryos be fertilized and become and be fertilized at the same time and then go into the uterus and be carried together. That’s, those are definitely be fraternal twins.

They could be the same gender, they could be different genders. When you have one embryo that’s fertilized and then splits, you can end up with, you end up with twins as well of course or more if it splits again. But if it splits between the first, the day of fertilization and then the third day afterwards you’re going to end up with twins that have two placentas. And so we call those Dichorionic twins and so Chorion really refers to the placenta.

If it splits between day three and day seven or eight, you’re going to end up with what we call Monochorionic twins or twins that share a placenta, okay? And then if it splits after day eight from eight to day twelve you’re going to end up with twins that share the same placenta and the same amniotic sac. And so those are MonoMono twins.

All these twins are going to be identical right? Because they came from the same embryo, they’re going to have the same DNA. They’re going to have the same gender. They’re going to look the same pretty much. And then if it splits after day twelve or thirteen you’re looking at what are called conjoined twins. And those are the Siamese twins as they yeah were previously called

CHRISTINE STEWART-FITZGERALD: And for each of these different twin types, I mean what’s kind of the percentage of all the live births, I mean I think it’s, I mean identical twins are pretty rare to begin with right?

DOCTOR WADE SCHWENDEMANN: So, as of right now the most recent published data would tell us that the risk for twins especially given all the excessive reproductive technologies.

We kind of hit a peak maybe a couple of years ago about with that was at least as high as three percent, of all pregnancies that are going to be twins. And of those pregnancies two thirds will be Dichorionic and one third will be MonoChorionic, but that number is probably going to fall very soon because of the, because of the recent advances in single embryo transfer for assistive reproductive technology driving back down the total number of twins.

But it’s about one third of three percent, so it would be about one percent to have MonoChorionic twins and two percent to have Dichorionic right now

CHRISTINE STEWART-FITZGERALD: Okay. So that could be. Because a little bit of understanding, so it is, it is pretty rare. And then how does a practitioner identify that we got a lot of technology that can identify twins but how do we identify the specific twin type. And what are the different characteristics of MonoDi twins specifically?

DOCTOR WADE SCHWENDEMANN: So when you’re looking at the placenta, you need to, it’s generally done with ultrasound. Okay I mean I guess if you go through infertility treatments and you’re like putting one embryo when you have twins you know they’re going to be identical right?

In that regard, but if you put in more than one or if you have, if you get pregnant on your own and end up with twins, it’s a little bit more of a surprise. You have to do some work and investigation. Typically what we do is we look at the placenta and then we look at the membrane itself.

The dividing membrane between the two babies will be thicker in a Dichorionic placenta than in a Monochorionic placenta. And the placentas itself will kind of form into a different shape near the membrane. If it’s two placental masses fusing into one versus one identical, one identical twin placenta

CHRISTINE STEWART-FITZGERALD: And is there a kind of a timeframe in which then you know expecting mom would find out what the twin type is?

DOCTOR WADE SCHWENDEMANN: It’s a lot easier to figure it out earlier in the pregnancy. The farther along you get the harder it is to tell the difference, the more two placentas can look the same. And so, you definitely want to find out before fourteen weeks if it all possible. Usually between like eight and fourteen weeks is the ideal time to identify it.

CHRISTINE STEWART-FITZGERALD: Okay. And now, and once they’ve been identified as Monochorionic. So, maybe can you share a little bit of you know, why is it considered a higher risk as opposed to Dichorionic

DOCTOR WADE SCHWENDEMANN: Well just like with children, anytime you ask babies to share a placenta they don’t always want to share it evenly. And so, unfortunately one baby can essentially the placenta can be not shared evenly. You can have what’s it’s called an equal placental sharing where one baby will grow bigger than the other.

Or you can have what’s called twin to twin transfusion syndrome which is a disease where one baby basically takes blood from the other baby through blood vessel connections in the placenta. And that’s extremely dangerous. There’s an increased risk for structural anomalies for identical twins above those of the risk for even for Dichorionic twins. And there’s an increased risk for structural heart defects as well for moms who carry twins that have one placenta and so you have to be very, very cautious about all those issues.

We don’t always know why that is in terms of why it’s worst to have identical twins versus fraternal twins for example. But it is riskier

CHRISTINE STEWART-FITZGERALD: Wow. Amy I want to ask you on the phone, when did you find out that you were having MonoDi twins and you know how did that process take place.

AMY BALCER: I found out very early actually and I want to say I was like, like gosh, I think like I was like, I would say between four and six weeks. I was then, we did in vitro and two days after implantation I had to go to the hospital emergency because I had horrible abdominal pain.

And my fallopian tube and my ovary wrapped themselves together. So I had to have emergency surgery at that time. There was only one baby, one embryo with heartbeat. And then after that they did a check on me four days later first opportunity and found out that it had split

CHRISTINE STEWART-FITZGERALD: It sounds like you found out early on that you were having MonoDi twins

AMY BALCER: Yes. I found out between four and six weeks

CHRISTINE STEWART-FITZGERALD: Very early. And I think you mentioned that you had to experience IVF so you were under constant care through your medical provider. And that’s kind of what precipitated finding out so early. I think it’s pretty early compared to a lot of women finding out about their pregnancy

AMY BALCER: Yeah

CHRISTINE STEWART-FITZGERALD: Yeah. And let’s go to Brandi in the studio here

BRANDI WALLACE: Hello. I found out and pardon me, my perinatologist and the group there called them Dimo instead of MonoDi. So, if I say, if I say Dimo . . .

SUNNY GAULT: So you’re not just [inaudible]

BRANDI WALLACE: No, no it’s a whole new phrasing for me. So those out there listening, DiMo is the same. But I had a normal spontaneous pregnancy. Called my care provider and said, I think I’m pregnant, I’ve taken four tests, and they said, you probably are. Come in around the eight week mark which you know is I think is typical for any standard pregnancy.

So I did and went in to eight week mark. Had an ultrasound, congratulations here’s your heartbeat. You know, the teardrop falls and yey we’re having a baby. And three days later I had a little spotting. First time pregnant, freaked out called the doctor and they said, you’re fine, I’m sure you’re fine. I can tell you’re a first term mom.

So why don’t you come in Monday morning. And I did, I came in Monday morning so they can prove to me everything was fine and actually proved to me that I was having twins during that appointment. So, around the eight week and it was during that second sweeping ultrasound where they were really investigating the entire area and that’s when they came across the twin. And the nurse very calmly said, well you know we typically like to see them in their own sacs, looks like you might not be, so I’m just going to forward you over next door to the perinatologist and instead of the OBGYN.

They specialize in this kind of thing. And she was very calm about the whole thing. And it wasn’t until I met the perinatologist that they actually did think I was having Momo or MonoMono twins because my separating membrane, I called it a spider web. It was super, super fine only the highest trained eye could ever find it. So, eight weeks is my very long answer, eight weeks

DOCTOR WADE SCHWENDEMANN: That’s not uncommon. It’s very, the membrane that you’re talking about is, its not very thick. A few cell layers only and you’re trying to identify an ultrasound and make sure that you catch it as its moving, flowing almost like a curtain that’s blowing in the breeze. And so it moves very freely it’s not like it’s fixed in one place and stays there the whole time. Two babies can push on and kick each other and do all sorts of different things through it so.

BRANDI WALLACE: They did

CHRISTINE STEWART-FITZGERALD: And Sunny, and did you know, you know pretty early on that you’re having MoDi

SUNNY GAULT: Well kind of like Brandi, they missed it at first. I went in at eight weeks, and you know, I mean they’re not looking for more than one usually, you know I don’t have a history of it, of twins or anything. But I did, it was kind of funny because I did ask my OB at that time and I’m just like, only one? Because I’m one of those crazy people that I always want twins

BRANDI WALLACE: I did, I said are you sure there’s just the one? She said, did you do IVF? I said no, and she’s okay it’s just the one.

SUNNY GAULT: And that’s what she told me, she was like, no just one. Okay, I guess we’re not going to have because it’s and we knew it was going to be our last pregnancy. So I’m like okay, I’ve always wanted twins; I guess it’s not going to happen. And then, at eleven weeks, I went back to do the first trimester’s screening stuff. And my husband wasn’t even with me; I thought this was a routine thing.

He was at home watching our other kids. And I go in there and it was the sonographer I’d never met before. And you know, they’re just you know doing basic testing make sure there’s no, you know abnormalities and the first thing she said, and she said it so casually it was like “oh, twins” like oh, like oh it was supposed to be a twin appointment, they didn’t book you for a twin appointment. I didn’t know I was looking for two babies.

CHRISTINE STEWART-FITZGERALD: That was it?

SUNNY GAULT: That was it.

CHRISTINE STEWART-FITZGERALD: Oh my gosh.

SUNNY GAULT: And I really thought I literally was looking for like the, you know, the cameras in the room like always on. Because I’d always wanted twins and someone just told me I was never going to have twins because I knew it was in the last pregnancy walk in and she and then I just and I literally thought she was looking at the wrong screen or there was something else out there that was not my body she was looking at.

You know, and so, that’s how we found out. I mean we thought it was just one. And then oh my gosh there’s tears started flowing and suddenly she became like my therapist because I like reach out to her to say the whole life I’d wanted twins, just the most magical moment ever. So yeah, eleven weeks I guess.

CHRISTINE STEWART-FITZGERALD: Wow early. Now in my case, I mean, I knew I was having twins from the first appointment from the get go. But then my OB thought that it was, they were fraternal. And so I was actually believing that up until my girls were born about eighteen months old and everyone kept telling me, no they’re identical, they’re identical. And then well okay and we had a DNA test. So, I actually didn’t go through the standards of care for identical. So, it was a different experience for me very much.

DOCTOR WADE SCHWENDEMANN: And that makes a lot more sense about your delivery timing though

SUNNY GAULT: Right

CHRISTINE STEWART-FITZGERALD: Yeah

SUNNY GAULT: You know, after we found out that we were having twins, I did have another regular appointment with my OB, not a perinatologist, just my OB because I really liked her. She had delivered my other son and I really wanted to keep having, you know pre-natal care with her.

And she went back, and she was like well it really depends if they’re MonoMono or MonoDi. And in my original report didn’t say, they didn’t classify but it wasn’t, I didn’t know enough about twin pregnancies to ask. I knew identical, fraternal and it’s the only real question that I asked about. And you know are the babies okay? You know, how did they not check, you know how did they not find this and does that mean you know, they’re okay? Do you see two heartbeats and everything looked fine?

So my OB, you now, she tried to look you know, in at the appointment just a regular, I guess there’s different levels of equipment that they can use. And she’s like, she basically said the equipment wasn’t high enough grade to be able to see if it was MonoMono or MonoDi. And so she had to make a phone call over and they had to do some research and but you know, I guess with that next appointment which was still my first trimester sometime they probably actually pretty quickly after they find out that I was having the twins that they were able to say they were MonoDi

CHRISTINE STEWART-FITZGERALD: Well, we’re going to take a break with that and when we come back we’re going to talk a little bit more about the risks of a MonoDi pregnancy

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CHRISTINE STEWART-FITZGERALD: We’re just talking a little bit about some of the risks associated with a MonoDi pregnancy and maybe you can elaborate a little bit more

DOCTOR WADE SCHWENDEMANN: Sure, I addition to the increased risk for structural malformations for the babies even beyond of that Dichorionic twins. And increased risk for structural heart disease there’s a big risk for what’s called twin to twin transfusion syndrome, and that risk is about somewhere between ten and fifteen percent for that to develop.

What happens is that one baby is essentially donating blood to the other baby through the placenta and so one baby has less blood available, one baby has too much blood available. And the baby with less blood than necessary ends up smaller than average with less fluid and can start to see some abnormal blood flow patterns through the placenta.

The second baby or the larger baby ends up with too much blood, too much fluid tends to grow bigger and can end up with excess fluid in the heart that can cause congestive heart failure. So, there are multiple stages to twin-to-twin transfusion syndrome and that’s one of the reasons one of the major reasons we do so frequent ultrasound screening at least every two weeks for moms carrying identical twins.

We should be looking at blood flow through the umbilical cords. We should be looking at size, we should be looking at fluid levels for both babies at least every two weeks

CHRISTINE STEWART-FITZGERALD: Wow. And how common are these conditions in the MonoDi pregnancies?

DOCTOR WADE SCHWENDEMANN: So twin to twin transfusion syndrome basically carries a risk of about ten to fifteen percent on all MonoChorionic twin pregnancies. So it’s not that rare unfortunately. TAPS which stands for Twin Anemia-Polycythemia Sequence is less common. It’s about two to five percent of all pregnancy of all MonoChorionic pregnancies. Unless they’ve already had treatment a laser treatment for the twin to twin transfusion syndrome in which case TAPS can occur in about ten, fifteen percent of those pregnancies. But that’s a small number to begin with

CHRISTINE STEWART-FITZGERALD: And is there a certain timeframe within a pregnancy that the babies are more susceptible to it or. I mean because I think we’ve heard about, you know different standards of care and when they should be monitored and delivered

DOCTOR WADE SCHWENDEMANN: Less than sixteen weeks is extremely unlikely to develop it. So that’s when we start doing our every two week ultrasound is beginning at sixteen weeks. We continue those until delivery. Although the chance to develop twin to twin transfusion syndrome or TAPS if it hasn’t developed before twenty eight weeks.

The chances of all that after twenty eight weeks if it hasn’t developed before is pretty low but we still recommend that routine screening every two weeks and it’s nice to check on growth every two weeks for these babies. Check on their blood flow patterns on the umbilical cord as well and make sure that things are safe

CHRISTINE STEWART-FITZGERALD: And I was curious, Amy, were you monitored on a bi-weekly basis for TTS?

AMY BALCER: I was yes

CHRISTINE STEWART-FITZGERALD: And I think, and that would just include the ultrasounds from your perinatologist or . . .

AMY BALCER: It was.

CHRISTINE STEWART-FITZGERALD: Yes. How about here in the room?

BRANDI WALLACE: My appointments were every two weeks.

SUNNY GAULT: Yeah mine were too. And I think that was immediately after I was assigned a perinatologist, yeah.

CHRISTINE STEWART-FITZGERALD: So, I mean that’s good to know that we’re getting frequent check-ins.

BRANDI WALLACE: Well then I know that I was only with a perinatologist and I think some practices go, I mean does it depend on the type of pregnancy doctor?

DOCTOR WADE SCHWENDEMANN: Well it depends on the, on the OB’s some general OBGYN’s are comfortable taking care of women with twin, with MonoChorionic pregnancies. But not necessarily handling the complications then referring those to the perinatologist. Some of them would rather just have the perinatologist do the whole thing. And it depends on your OB. Sunny was talking about.

SUNNY GAULT: Yeah. Well so I was first seeing the OB and then, I wanted like I said to continue to see her but it was the perinatologist that made the decision. She, and they’re actually friends, you know, the same group and stuff like that and so, I thought I was going back. And I was so bond and it turned out that the perinatologist was great too but she kind of made the cost. She’s like oh no no no no, you’re not going back to see her. Your mine now! I’m like, okay. But it turned out to be good

AMY BALCER: I saw both too until I was put on home bed rest at twenty-six weeks. I saw my OB every month and then I saw my regular doctor or the perinatologist every two weeks. Because if I went far enough I would have delivered with my OB.

CHRISTINE STEWART-FITZGERALD: Oh.

SUNNY GAULT: Oh well.

CHRISTINE STEWART-FITZGERALD: Yes. So maybe at some point there’s a transfer of caregiver depending on the situation.

DOCTOR WADE SCHWENDEMANN: Some perinatologists don’t do deliveries, they just provide consultation services and so it depends on where you are. It did varies from region to region across the country.

CHRISTINE STEWART-FITZGERALD: And you know I think another point and I want to read a lot of the online blogs. Sometimes it sounds like, you know there aren’t always perinatologist that are close by. So when it comes to the actual delivery, you might be located much closer to you know hospitals than your OB and your perinatologist is you know you’re driving a bit further to get that specialized treatment. So, something to consider anyway.

So, you know and Doctor Schwendemann you mentioned that there are some treatments for the twin to twin transfusion and you mentioned laser surgery. Is that kind of the best standard treatment for this condition?

DOCTOR WADE SCHWENDEMANN: At this point, yeah, I’d say that laser, the laser surgeries is the standard treatment for twin to twin transfusion syndrome if it’s severe enough.

On the other options, things that we’ve done in the past would include some people who have tried to making a whole in the membrane to kind of normalize the fluid levels but that actually leave you with essentially a Mono Amniotic gestation. Both babies end up in the same sac by doing that. So we don’t do that anymore.

Before the advent of laser surgery we would do repeated amniocentesis and remove fluid from the bigger baby to try and decrease some of that pressure as well but it wasn’t as effective. And so, if twin to twin, there are multiple stages of twin to twin transfusion syndrome and once you reach that critical stage, you’d be referred to someone who could do a laser surgery for the pregnancy.

But the other option is to consider an early delivery. And it really depends on how far along you are when we pick this up whether or not that would be laser surgery would be an option. Laser surgery is not without its own risk. It carries quite a bit of risk actually. And you can end up losing one or both babies just from the procedure. And so, you weigh very carefully whether or not to do that

CHRISTINE STEWART-FITZGERALD: And from a, when we’re talking about treatment standpoint, what about prevention? Is there anything that can be done to help prevent it or is it just, it is what it is

DOCTOR WADE SCHWENDEMANN: Unfortunately there’s not. At least we’re not aware of anything that can be done right now to prevent twin to twin transfusion syndrome at all.

CHRISTINE STEWART-FITZGERALD: So, taking, I know were kind of talking about the frequency of seeing our OB’s and perinatologist. I mean, are there other standards of care that should be addressed within a MonoDi pregnancy?

DOCTOR WADE SCHWENDEMANN: Well, I think yes, there are. I think, for sure we talked about identifying the pregnancy and identifying the placenta as early as you can. I think that really should be done as soon as possible. As soon as, I mean, by fourteen weeks if it all possible it should have been done.

You want to do ultrasounds every two weeks like we’ve talked about and those ultrasounds should at least include fluid levels for both babies and checking of their blood flow through the umbilical cord and checking their growth. Some people would advocate for checking another Doppler called the middle cerebral artery peak systolic velocity, I don’t think that’s quite reached the standard of care across the country yet so I don’t think that if you’re not having those done, that’s a failing.

But I also think that there should be what’s called the fetal echocardiogram done for each baby at about twenty two weeks of pregnancy or so. That’s because there’s an increased risk for structural heart disease for both of these MonoChorionic twins. And you know and then the question is timing of delivery.

I also think that’s an important question. I think for twins that share a placenta, you’re really looking at thirty six to thirty seven weeks as ideal time for delivery with what’s called the antenatal testing or a non-stressed test every being done twice a week. And that should probably start around thirty two weeks of pregnancy or so.

CHRISTINE STEWART-FITZGERALD: Well I remember those non-stressed test.

AMY BALCER: Yes. Can I ask some question?

CHRISTINE STEWART-FITZGERALD: Sure

AMY BALCER: With TAPS how do you diagnose that and is that only if they have twin-twin or can they have TAPS and not have twin twin?

DOCTOR WADE SCHWENDEMANN: The answer, so the question is, how do you diagnose TAPS and the answer is it’s done through what’s called the middle artery Doppler peak systolic velocity and so you have to basically use an ultrasound technique on each babies brain to assess the blood flow and the speed of the blood flow. And you compare that to normal standards okay for just particular gestational ages.

Depending on how fast it is or how slow it is relative to that gestational age, if there’s a particularly large difference between one baby and the other, that’s how you can make the diagnosis for TAPS before delivery.

The great majority of TAPS is actually diagnosed after delivery. After the babies are born and when they check the blood counts for baby they diagnose them in the neonatal period. I don’t think it’s again, I don’t think it’s routine to screen for TAPS in all babies because the chance for non, for without for our babies without twin to twin to have TAPS is only about two to three, maybe five percent range at the most.

The chance for TAPS after a laser to occur however is somewhere in the, in the anywhere from five to fifteen percent. And so you do want to check the babies after they’ve had a laser to make sure they’re checking for TAPS

AMY BALCER: One of my twins, I was never told that they had TAPS. But one of my twins came out like very red. And they told me he had more haemoglobin than the other baby. But he didn’t need a blood transfusion or anything. And my singleton was very red after delivery too and they told me that’s haemoglobin. Is that just haemoglobin, that doesn’t mean that’s TAPS right?

DOCTOR WADE SCHWENDEMANN: Well, when it comes with your twins it could have been TAPS. Now the baby that comes out particularly red is going to need a blood transfusion. They may actually need excess fluid to kind of thin their blood a little bit if it’s too thick. The other baby, the anaemic one may have needed a blood transfusion if they had, if they actually had TAPS. And for the singleton, it’s just you happen to have a baby that was not particularly anaemic.

CHRISTINE STEWART-FITZGERALD: Alright. Well with that I’m just going to, were going to wrap this up. And we’ll say thanks so much everyone for joining us today and for more information about a MonoDi twins or for more information about any of our speakers or panellist, you can visit our episode page on our website. And this conversation continues for members of our twin talks club. And after the show, Doctor Schwendemann will talk about how expecting parents and practitioners can weigh the decision for early induction. For more information about the twin talks club visit our website www.newmommymedia.com .

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SUNNY GAULT: hey twin talks, it’s time for a special segment on the show, it’s called we’re expecting what? And it’s where we as twin parents get to share what we were feeling and what was going through our minds when we first found out we are pregnant with twins. And this comment comes from one of our listeners Britney.
Britney says, my husband and I have a twenty one month old daughter and five month old twin girls. I found out we were having twins when I went to the ER with bleeding at thirteen weeks pregnant. They did an ultrasound and a little while later, the nurse came in and told me I was having twins, I nearly fell off the bed.
The pregnancy progressed okay until my water broke at thirty three weeks pregnant and went to the hospital and I tried to stop the labour but were unsuccessful. The nurse that I had, kept thinking that I wasn’t having contractions but I was in very bad pain and I had no clue why she kept putting a stethoscope to my stomach. A few minutes later the doctor came in and said I was dilated nine centimetres.
They rushed me back for a C section and a few minutes later my twin girls were born weighing three pounds eight ounces and three pounds twelve ounces breathing on their own they installed the steroid shots I’d had previously. The girls were in the NICU for seventeen days just to gain some weight and came home three days after Christmas. Good luck to everyone having twins they’re truly a blessing as are all kids. Absolutely well thank you so much Britney for sharing your amazing story
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CHRISTINE STEWART-FITZGERALD: That wraps up our show for today. We appreciate you listening to Twin Talks.
Don’t forget to check our sister shows:
• Preggie Pals for expecting parents
• The Boob Group for moms who breastfeed their babies
• Parent Savers, your parenting resource on the go.

This is Twin Talks, parenting times two or times two, times two. However many you have.

[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

SUNNY GAULT: New Mommy Media is expanding our line up of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or organization interested in joining our network of shows through a co-branded podcast, visit www.NewMommyMedia.com

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