mono di twins / What is the survival rate ?
As a mother of mono di twins, I’ve seen the joys and challenges of this journey. Learning I was carrying identical twins was exciting yet scary. The thought of welcoming two tiny miracles was thrilling but daunting.
Their resilience and strength amaze me. Despite the risks, the survival rate for mono di twins is impressive, reaching 80-90%1. This shows how adaptable the human body is and how far medicine has come.
Table of Contents
Understanding Monochorionic Diamniotic Twin Pregnancies
Twin pregnancies come in different forms, each with its own traits and needs. Monochorionic diamniotic (MCDA) twins are a special case. They form when a zygote splits early, creating one placenta but two amniotic sacs.
Types of Twin Pregnancies
There are many types of twin pregnancies, based on the number of placentas and amniotic sacs. Dizygotic (fraternal) twins and about 25% of monozygotic (identical) twins are dichorionic/diamniotic (di-di) twins. Monochorionic/diamniotic (mo-di or mono-di) twins, which are identical twins, face a higher risk of complications like Twin-Twin Transfusion Syndrome.2 Monochorionic/monoamniotic (mo-mo or mono-mono) twins are also identical twins and share both a placenta and one amniotic sac.
Formation and Development
MCDA twins form when a zygote splits early. About 60-70% of all identical twin pregnancies are monochorionic/diamniotic (mo-di) twins. This unique formation means they share a placenta but have separate amniotic sacs.
Early Detection Methods
Knowing the type of twin pregnancy is key for good prenatal care. Ultrasound at 10-13 weeks can tell us about the pregnancy’s chorionicity and amnionicity. The “T sign” on ultrasound means a monochorionic pregnancy, while the “lambda sign” points to a dichorionic one.
Ultrasound checks every 2-4 weeks are needed for MCDA pregnancies. They help track the twins’ growth, amniotic fluid, and any issues. This close watch lets healthcare providers act quickly if needed.
“Monochorionic-Diamniotic (mo-di or mono-di) twins, which are identical twins, have an increased risk of complications such as Twin-Twin Transfusion Syndrome.”2
It’s vital to understand MCDA twin pregnancies for proper prenatal care. Knowing about the different twin types and how to detect them early helps healthcare professionals support families through the twin development journey.
Survival Statistics and Success Rates
The survival rate for mono di twins has greatly improved in recent years. This is thanks to better prenatal care and medical treatments4. Most MCDA twins now have a survival rate of 80-90%. However, this rate can change based on the presence and severity of complications.
One major complication for mono di twins is twin-to-twin transfusion syndrome (TTTS)5. TTTS affects about 15% of identical twin pregnancies. It can greatly impact the survival of the fetuses6. The survival rates for TTTS cases vary, from 85-100% for Stage I to less than 15% for Stage V if untreated.
Fortunately, a new treatment called fetoscopic laser photocoagulation has greatly improved TTTS outcomes6. In skilled centers, the survival rate of at least one twin in TTTS cases treated with this method can reach 85-90%6.
While survival rates for mono di twins have improved, it’s crucial to closely monitor these pregnancies. Being ready to address any complications is key. With careful prenatal care and timely interventions, the chances of a successful twin birth for monozygotic twins can be greatly increased.
Mono Di Twins: Essential Characteristics and Development
Monochorionic diamniotic (mono di) twins share a single placenta but have their own amniotic sacs7. They make up about 70% of all identical twin births. Knowing how mono di twins grow and develop is key for the best prenatal care.
Placental Structure
Mono di twins have a shared placenta with blood vessels that connect7. This setup helps them share nutrients but also raises the risk of twin-to-twin transfusion syndrome (TTTS).
Amniotic Sac Configuration
Even though they share a placenta, mono di twins have their own amniotic sacs7. This reduces the chance of cord tangles, unlike monoamniotic twins. It adds a layer of protection and keeps the twins separate.
Fetal Growth Patterns
The growth of mono di twins can vary, with one twin growing differently than the other7. This might happen because of uneven placental sharing or TTTS. It’s important to watch their growth closely and check for any issues early on.
“Careful monitoring and early intervention are crucial for managing the unique challenges of mono di twin pregnancies and ensuring the best possible outcomes for both babies.”
Common Complications and Risk Factors
Carrying twins comes with its own set of challenges and risks. Twin births accounted for 21.3 per 1000 live births in 2021. Triplet and higher-order births were 80 per 100,000 live births. One major issue is twin-to-twin transfusion syndrome (TTTS), affecting 8-10% of monochorionic diamniotic (mo-di) twin pregnancies8.
Other issues include selective intrauterine growth restriction (sIUGR), hitting 10-15% of mo-di twin pregnancies8. Twin anemia-polycythemia sequence (TAPS) occurs in 3-5% of cases8. Single intrauterine fetal demise can happen in 5-7% of mo-di twin pregnancies. Twin pregnancies face higher risks of almost every pregnancy complication, except for postterm pregnancy and macrosomia9.
Risks include unequal placental sharing, velamentous cord insertion, and abnormal umbilical artery Doppler readings. For some conditions, one twin may be affected while the other is not, leading to different risks and benefits of intervention for each fetus. Early detection and proper management are key to better survival rates and outcomes for monozygotic twins.
“Careful monitoring and timely intervention are essential to ensure the best possible outcomes for mono di twin pregnancies.”
Twin-to-Twin Transfusion Syndrome (TTTS)
Twin-to-Twin Transfusion Syndrome (TTTS) is a serious issue in about 8-10% of monochorionic diamniotic (MCDA) twin pregnancies. It happens when there’s an imbalance in blood flow between twins through shared blood vessels in the placenta. This can be very dangerous if not treated.
Stages of TTTS
TTTS is divided into five stages based on the Quintero criteria. Stage I is seen in 11-15% of cases, Stage II in 20-40%, Stage III in 38-60%, Stage IV in 6-7%, and Stage V in 2%. Early detection and accurate staging are key to finding the right treatment and improving outcomes.
Early Warning Signs
Parents and doctors should watch for early signs of TTTS. These include rapid weight gain, abdominal pain, and ultrasound findings of low amniotic fluid in one twin and high amniotic fluid in the other. Spotting these signs early is crucial for timely treatment and better survival chances for both twins.
Treatment Options
Treatment for TTTS depends on the stage and when it’s diagnosed. Options include expectant management, amnioreduction, and fetoscopic laser photocoagulation. Fetoscopic laser photocoagulation is the best choice for Stage II-IV TTTS before 26 weeks, aiming to separate the blood supply and improve survival rates.
“Early detection and comprehensive medical care are crucial for improving outcomes in twin pregnancies affected by TTTS. With appropriate intervention, the survival rate for MCDA twins can be as high as 70-80%.”11
Research and advancements in fetal surgery are helping manage TTTS better. Regular prenatal checks and a team of healthcare professionals are vital for successful treatment of this complex condition.
Prenatal Monitoring and Screening Methods
When expecting twins, it’s vital to monitor their health closely. Ultrasound scans every 2-4 weeks starting at 16 weeks are key. They check on the babies’ growth and the health of their umbilical cords12. Fetal echocardiography can spot heart issues, especially in one twin with a rare condition13. Also, checking the cervix is important because twins are at higher risk of early labor13.
Screening for twin pregnancies includes tests like cell-free DNA testing. This test is very accurate and rarely fails. But, twins face a higher chance of birth defects, with twice the risk of singletons.
First-trimester screening for twin development is very effective, catching most issues12. Quad marker screening in singletons catches Trisomy 21 in 81% of cases, with a 5% false positive rate12. Cell-free DNA testing in singletons is even more accurate, with detection rates from 91% to 99.2%12.
Even with these advances, not all insurance covers cell-free DNA testing for twin pregnancy12. Also, the risk of losing a pregnancy after testing is higher for twins than singletons12.
Keeping a close eye on twin pregnancies is essential for their health. Healthcare teams can catch and manage problems early. This way, they can help ensure a healthy start for twin babies.
Medical Management Strategies
Managing a twin pregnancy, especially a mono di type, needs special care. This ensures the best outcomes for both babies. It involves watching them closely, acting quickly when needed, and a detailed care plan.
Hospital Care Protocols
For high-risk cases, hospitals may keep the twins under close watch from 24-28 weeks. This lets doctors see how the twins are doing and spot problems early. Issues like twin-to-twin transfusion syndrome (TTTS) can be caught early.
Emergency Interventions
If serious problems like TTTS arise, quick action is needed. Doctors might do amnioreduction or fetoscopic laser photocoagulation to fix the issue. Giving corticosteroids between 24-34 weeks helps the babies’ lungs mature if they’re born early.
New medical tech and understanding of mono di twin pregnancies have boosted survival rates16. With detailed medical plans, doctors can help ensure a successful twin birth.
“The key to managing mono di twin pregnancies is a multidisciplinary approach, where healthcare providers work closely together to closely monitor the development of the twins and intervene promptly when necessary.”
Delivery Timing and Methods
For uncomplicated monochorionic diamniotic twin pregnancies, the best time to deliver is between 34-37 weeks of pregnancy17. This period balances the risks of early birth with the dangers of staying in the womb too long. If there are severe problems or if the babies are in distress, doctors might need to deliver them earlier18.
Cesarean section is usually the best choice for twin pregnancies, especially when there are high risks like twin-to-twin transfusion syndrome (TTTS)17. The choice of delivery method and timing depends on many factors, including the health of the babies and any complications. It’s crucial to watch the babies closely during labor and delivery to ensure they both do well.
Most twin births happen before 37 weeks, with an average of 35-37 weeks. It’s important to work closely with your healthcare team to find the best delivery plan for your twins. Following their advice can help make your twin birth safe and successful.
For more information about twins, please click on the link below
https://www.mommyandwomb.com/all-about-twins
