Last growth ultrasound at 31w4d

It is hard to believe that in three days I will finally get to meet my girls after all this time. We had our last growth ultrasound this morning, and they looked amazing! Sophia and Cecilia were 3 lb 10 oz and 3 lb 11 oz respectively with only a 2% difference in all their measurements..which is absolutely perfect! They share well already! I am beyond relieved and excited (oh and anxious, nervous, kinda freaking out). They were a bit shy today so we weren't able to get any pictures of their pretty faces, but I will see them in three days so it isn't too big of a deal. We did, however, see a little bit of hair on each of their heads..so adorable. Looking back at the last seven months, and especially at the last 53 days I have spent inpatient, I'm amazed how far we have come. Since learning that we were having twins at 9 weeks, and at 14 weeks learning exactly what was in store for us having Momo twins, it has been an emotional roller coaster. In retrospect I'm not quite sure how I managed to get through it, but in the words of one of my favorite singer/songwriters Jackson Browne, "The only way through it, is through it". My husband and I are ready to be parents, and we are especially ready to return to a semi-normal way of life. I can't wait to sleep in my own bed! I know I have said that numerous times, but I can't stop thinking about how wonderful it will be. My c-section will be on Thursday at 8 a.m., and I will try to post information, updates, and pictures by that night or Friday at the latest. Thank you everyone for your support and encouragement throughout this whole ordeal!

31 Weeks! 7 more days to go!

Well we are down to one week before our girls join the world! My blood pressure is back down, and I am doing very well...except for the anxiety and excitement of going home. The preeclampsia was luckily just a scare. I know that we will make it through these next seven days, and my girls will be here at 32 weeks exactly as planned. The nurses say I should be able to finally go home next Sunday at the very latest. This makes me extremely happy! I can't wait to sleep in my own bed and see my kitty. I know it will be hard not to take the girls home, but this is the best place for them to mature and get big! My husband is excited to have me back home too. I hope everyone has wonderful and safe holidays. This will definitely be a different holiday experience for us, but we are so thankful that the girls have done so well for this long.

Just 11 more days

So it was bound to happen that there would be a scare. Everything just seemed to be going so well for so long. The nurses and I have been noticing that my blood pressure has been slowly going up for the last few days and yesterday it was high enough for the doctor to be concerned about preeclampsia. For those of you who are unfamiliar with preeclampsia, WebMd defines it as being marked by high blood pressure accompanied with a high level of protein in the urine. Women with preeclampsia will often also have swelling in the feet, legs, and hands. Preeclampsia, when present, usually appears during the second half of pregnancy, generally in the latter part of the second or in the third trimesters, although it can occur earlier. So yesterday I had a CBC which tested the liver enzymes and luckily those were perfect, which is a great sign. I have no major swelling issues and not many of the other symptoms of it besides the high blood pressure. They are doing a 24 hour collection of my urine to test it for proteins, and I probably won't know the results of that until tonight or early tomorrow morning. They gave me the first of the two Betamethasone shots (steroids) last night for the girls' lungs just in case we have to deliver before the 31st as the only way to stop preeclampsia if I am in fact diagnosed is to deliver the twins. All of this is precautionary of course, and I have faith that everything will turn out just fine, and this all is just a sign that my body is starting to get a little tired. I know that the twins and I can make it through these last 11 days, we are fighters!! The doctor was also concerned with blood clots in my legs, because I have been on bed rest for so long. Yesterday morning I was told that I was going to have to get two shots a day of Heparin (an anticoagulant) to avoid blood clots. I got two yesterday and one today before I told my doctor that I couldn't handle them anymore. They were absolutely awful and very painful, so I made a deal with my doctor to wear the T.E.D. stockings which are like very thick and tight pantyhose instead of getting the shots until delivery....YAY!!! I didn't think I was going to make it if I was going to have to get those shots everyday. I'm not good with shots, especially ones that burn so terribly. Luckily my doctor is pretty awesome and understanding. I will know more tomorrow about the possibility of preeclampsia, but the girls' heart rates are still doing very good which is a very hopeful sign that everything will be just fine. I don't even need the nurses to put the monitors on anymore, I am officially an expert at putting and keeping them on! I'm so glad that Tim was here during all this craziness, otherwise my stress levels would have been 10x as bad as they were already. It is very important that we keep these girls in until 32 weeks, because at this point every single day makes a difference in prematurity. I would like to say happily that Kelly, a momo mom that I met online before I went inpatient delivered her girls Brooklyn and Brienna successfully on Thursday and that everyone is doing well. I am so happy for her, and her family has given mine hope. I will update more later this week. I hope that everyone has a wonderful and safe Christmas holiday!!

Official Date!

Woo Hoo!! We have the official date of the c-section scheduled and in the books. The Tice twins will join the world on Thursday, December 31, 2009. My surgery starts at 8 a.m. Is is such a relief just to have the date set so that I can start to mentally preparing myself for motherhood, and the next stage of NICU care. As long as these girls behave themselves for the next 16 days, we will have New Year's Eve babies. I can't think of a better way to close 2009! This next year is sure to be an adventure for Tim and me, and I am so excited! I talked to the doctors this morning, and they said that the cord dopplers looked good...so now it is the waiting game (not that it wasn't before)! Wish me luck in maintaining my sanity this last couple of weeks!

29 weeks 4 day Growth Ultrasound

Well we officially have approximately 17 days to go, a little over two weeks! Tim was able to stay for the ultrasound again this morning. Our girls are growing beautifully. Sophia was at 2 lb 14 oz and Cecilia was 3 lbs!! I was very happy to see that Sophia caught up a little bit from the last ultrasound. I was really hoping to reach 3 pounds so I can't complain at all. They were both active, although a little less than last time because of the lack of room they are experiencing as they grow. It really helps me to see them each time, because the hospital stay has really started to wear on me. At day 39 inpatient I'm extremely homesick and ready to get back to a semi-normal life. Although when I am able to see my daughters on ultrasound and be reassured that they are growing well, I am able to remind myself of why I am here. The doctor was a little concerned about the umbilical cords again. He thought that the knot was more on Cecilia's side than Sophia's. That makes a lot of sense because in the beginning of my hospital stay, it was obvious that Cecilia was a lot more active than Sophia considering how hard it was to keep her on the monitor. She is my little trouble maker. They worry that as she moves now she is pulling on the knot. Tomorrow I will talk with my doctor more and hopefully learn more about the status of the cords and the doppler on the cords, and I will update the blog then. I can say with all honesty that I'm so very impatient at this point. I am restless and so ready to see my girls. I know that it is important to keep in mind that they have already beat the odds by making it this far. We have little miracles on our hands here. Tim and I visited the NICU on Saturday morning. That was overwhelming to say the least. It is quite impressive though, and it made me feel at ease that my girls will be getting the best possible care in this area. We saw some of the other tiny babies fighting, and I know my girls will fight just as hard. There were babies in there that weighed less than the twins weigh now, which despite their desperate situation gave me hope. I know that our journey with the NICU stay will be just as trying as the time we are going through now, but I will be able to be with my husband and family more and that will give me strength. For now until that point we will just continue the constant monitoring and hope and pray that the girls manage to stay in just a couple more weeks. I will update soon with what the doctors have to say and an official date for the c-section when it is put on the books! I will also have the ultrasound pictures from today up this weekend. Thank you everyone for your prayers, thoughts, and words of encouragement. They mean more to me and my family than you could ever know.

28 Weeks-Half Way Mark

This week has proved to be as frustrating as it has a success. We have made it to 28 weeks which is a pretty significant milestone. According to the March of Dimes, 96% of babies born after 28 weeks survive and are at a lower risk for developing long term neurological problems It is important, though, that the girls stay in as long as possible for the best possible outcome. Even if they make it to 32 weeks, which is our goal, they are still considered extremely premature and will need a lot of help in the NICU. Talking to my doctor, he is convinced by his 20 years of encountering Momo twins that constant monitoring and taking them at 32 weeks produces the best and safest outcomes, and I am inclined to agree with him from the extensive studying I have done in this area. During my ultrasound on Monday, I noticed that the technician didn't really spend much time looking at the cords. This raised a lot of concern in my mind, and I brought it up to one of my doctors on Tuesday. Wednesday the doctor took me back to the ultrasound to check on the status of the cords herself. We noticed that they were all tangled together, which made me nervous enough seeing it for myself. Today my other doctor told me that they did find one true knot in the cords, possibly two. What does that mean exactly? We keep doing what we are doing. I am on the monitors pretty much 24/7, and the nurses are diligent in watching the heart rates to observe any major decelerations or accelerations that would raise concern. The babies base line heart rates have in fact lowered since I was first admitted but not enough at this point to make the doctors too nervous. If they lower anymore though, I will be moved to labor and delivery to continue my monitoring there in case of an emergency that way I will be that much closer to the OR if God forbid that becomes a necessity. As well as the twins have been doing, we have to remember that this is an unnatural situation that has the potential to turn volatile at any moment. This reminds me and continually maintains my resolve in having the monitors on and laying here in bed. My girls and I are fighting a battle of inevitability, and we are determined to come out of it victorious. Right now I am just trying to maintain my anxiety and keep my stress levels under control. Keep us in your thoughts and prayers. I will update more soon.

27 week 3 day growth ultrasound

Early this morning Tim and I had our 27 week 3 day growth ultrasound on the twins. Tim stayed over last night so that he was able to come with me this time which was nice for both of us. They are very active little girls, and it is so amazing how much difference two weeks can make. They looked much bigger, and their faces were more filled out. We even got to see Sophia's face this time! She kept trying to cover her face with her arm, because she is my shy one. I will post pictures soon. She is beautiful, just like her sister of course. Sophia measured 2lb 1oz and Cecilia measured 2lb 5oz. I was hoping for a little more weight, but I was extremely happy that they were at the two pound mark. This week marks our half way point, and I couldn't be happier. I know that my time here in the hospital is extremely important for my girls, but I anxious for this part to be over so that I can be home where I feel the best. I am definitely very homesick. I can't wait to see my daughters and to take them home for good. Knowing that I am almost half way through this make me more hopeful and excited. Tomorrow is the first day of December and my girls are due to come out the last day of December. I have a feeling it might seem like a long month but really it is going to fly by. I'm hoping to have exact date for the c-section set in the next couple weeks. We ordered our first crib online today. I will feel better when Tim gets it set up at home. I was visited by both my brother-in-laws and their wives this weekend, and they surprised us with two car seats that Tim's side of the family all pitched in money for as Christmas gifts. We were so relieved! They are great car seats and will be perfect even for our tiny babies. We are so grateful to everyone for being so generous, more grateful than words can say. Our weekend was wonderful, and I got to spend a lot of time with Tim. We ordered out for Thanksgiving and although we missed our families, we took the time to be together and reflect on the ways our lives are soon going to change drastically. We are so excited to start our family together. More to come!

Day 18

Well the twins and I are still hanging in there. Tim was here over the weekend, and it was nice to spend some time with him. His parents, Mark and Lavonne visited on Saturday as well and graciously brought me some non-hospital food which is always a nice retreat. Lavonne also started to teach me how to crochet, which I am working on and not doing too bad. I have plenty of time to practice so hopefully I will be able to produce something soon! The girls are still moving a lot making monitoring difficult, and it does get frustrating for the nurses and myself. Sometimes I have a hard time keeping my patience (especially after being prodded on my stomach for an hour at 3 in the morning), but they say it will start getting easier as soon as they get bigger. I am definitely getting very homesick at this point, and I have to often remind myself of the light at the end of the tunnel. There are times when this is more challenging than others. It will be difficult to be in the hospital over Thanksgiving, because it is my favorite holiday, and I haven't seen much of my family in a long time. Tim will be here though, and we will celebrate it to the best of our ability. I am thankful that I can spend it with him. The twins gave us a bit of a scare on Sunday. The doctor came in and said that she was concerned about an episode where one of the babies had a really high heart rate for an extended period of time, and the other's was very low. She did an ultrasound to check on the cords but found nothing to suggest that there was a knot. The cords are a little tangled, but they are not enough to concern the doctor. She said today that it is good when their heart beats are elevated for short periods of time, because it shows that they are active and responding well. She said that my twins are more active and responsive than some babies at 32 weeks that she sees. That made me happy to hear considering we are only 26 weeks and 4 days, although the "what if" is constantly in the back of my mind. I have another growth ultrasound on Monday at 7:30 a.m. I am excited to see their growth, and Monday marks my half way point in the hospital. I will update next week as long as there isn't any news before that time.

Day 10 and 25 week ultrasound

Here it is day 10. I can be proud of ten days completed, or I can dread the 46 or so days that I still have ahead of me. To be honest, I find myself doing both depending on the day or mood. Although I can say that the twins' continued well being and successful growth development has started to pick away at the more pessimistic parts of me. It is hard to be pessimistic when my daughters and I beat the odds every day that they stay inside me growing nice and big. I am trying to find creative ways to pass my time, and I have tried to learn knitting (status update: still learning). I am making my way through a crossword puzzle book that a nice volunteer brought me. I am reading two different books right now, and I spend way too much time on the internet. I don't know what I would do without my laptop. I am trying to get motivated to pick up some writing again. The first week away from Tim was very hard on me, and I don't really see it getting much easier. He brings me such happiness and being away from him I don't feel quite whole. Seeing him this weekend was wonderful though, and we continue to get very excited about the arrival of our girls and the start of our family. I had an ultrasound that mapped the twins' growth on Friday morning. It was amazing to see what a difference three weeks made. They looked like they had started to develop some fat, and they were extremely active. When we first started looking at them, Sophia had Cecilia's hand in her month. I guess they are learning to share from the womb! They were very close together with Cecilia pretty much on top of Sophia, and Sophia's body was turned away from us again. It was heartwarming to see them though, moving their arms and yawning, and looking precious. Cecilia was 1 pound 11 ounces and Sophia was 1 pound 12 ounces which is apparently good for their gestational age. The pictures are of only Cecilia, but we can assume that Sophia looks very much look her sister. The nurses all tell me that their heart rates are excellent and are measuring on average equivalent to what they would expect for babies of 30 weeks gestation. That is fantastic, but it does mean that they have to continue doing so well. I am hopeful for lots more growth the next two weeks, and I am crossing my fingers for at least 2 pounds each by the next ultrasound. I will update next week as long as there isn't any news before then...let's hope it stays nice and boring.

Day 5

So I have made it to day five! I am slowly settling in a routine that makes the days seem a bit less monotonous and easier to get through. I miss Tim a lot, and I know that the adjustment is difficult for him too, but we want what is best for our daughters. As they say the end justifies the means! It is funny how the simple luxuries in life are what you look forward to when you are confined to the bed for most of the day. I absolutely pine for my shower in the morning! It makes me feel human and refreshed. I also look forward to my meals (yes I'm getting accustomed to the hospital food), simply because they come at the same time everyday and helps split up the day. Each shift I have been here I have had a different nurse so I am getting to know the staff here well. The women are all very nice, and their dedication to my babies' well-being is incredible. Everyday one of my doctors check in with me and let me know how they think the girls are doing and the consensus thus far has been good! Even the nurses say that they are doing well for 24 weeks gestation. Despite some of the frustration of having the monitors on almost constantly, there is a certain level of reassurance that being able to hear their heart beats bring. Up until the hospital admission I was always worried about how they were doing and now much of that concern has been lifted from my shoulders. I can say without a doubt in my mind that this is the most challenging obstacle I have ever had to face. I'm learning so much about myself, and I have a lot of time to reflect on my past and plan for my future. I will continue to post pictures as I have them. I don't know for sure what day my next ultrasound is, but I am very excited to see them and find out their weights. Thank you to everyone who is thinking and praying for my family. It means a lot that so many people are supporting us through this journey!

Day 1 of Inpatient Stay

Tim and I got to the hospital this afternoon, and I must say that I am slightly overwhelmed by everything so far. I was not exactly sure what to expect, but I have learned that I will have the heart monitors on almost 24/7. With the exception of taking showers I am bound to the bed with belts around my belly tracing the girls and their heartbeats. They have already started making things difficult for the nurses (and myself to be quite honest) by moving around quite a bit. Tim and I have discovered so far that Baby A (Sophia) is far better behaved than Baby B (Cecilia). While Sophia generally stays in her designated area (which is wedged up by my right hip bone), Cecilia is a little acrobat with an attitude. It will be interesting to watch these babies carefully and see how their personalities develop along with their little bodies. Everyone so far has been very nice to me here, and although this is bound to be a big adjustment for me, it will be easier with the staff that is here to support me and the babies. Tim is staying with me this weekend which is also very helpful to sort of ease me into this new living experience. I received the first dose of steroids this evening and will get another dose tomorrow. I don't like needles, so this was not fun for me. We got the chance to talk to one of my doctors today, it was nice to see him. While the girls are still so small, the monitoring will be a very difficult process for nurses and me. They informed me that they would be in about every half hour to hour all night, every night until they are bigger and can't move around so much. I suppose that this will help me practice for the sleepless nights I'm sure to have in the near future. I will continue to update as I get news and also as I need to vent..so be prepared!

Week 23

It is hard to believe that I am already six months into my pregnancy. So much has happened since Tim and I first discovered we were having twins, it is really hard to wrap my head around it all. In retrospect the time has really flown by, as I know it will continue to do. I can honestly say that despite the anxiety and worry that this pregnancy has brought me, I have enjoyed being pregnant. I feel like a completely different person than I was last year at this time. It is as if I have found a piece of myself that I had not realized was there. I feel more like a woman than I ever have before, and I am repeatedly impressed by what my body is capable of. I have always considered myself a strong and resilient person, and once again the circumstances in my life has reaffirmed this assertion. It is amazing to feel my tiny twin girls moving inside me, amazing and reassuring. Feeling them move tells me that they are strong and they are hanging on and so it gives me the strength to do that myself. Maybe they are like their mommy already! I am extremely nervous about being admitted into the hospital next week. Although two months in the big scheme of things is not a lot of time, I will miss being away from Tim and my kitty and my home. It is sure to be a challenging time for me, but I am ready to do what it necessary for our family. I am excited in a way to enter the next stage of this pregnancy and protect these girls the best way that I can. I can't wait to see their beautiful faces and hold them in my arms. I do have to say that the support that I have had from my loved ones and friends has been amazing. The generosity that has been shown to us already is overwhelming. It is hard to find words to thank everyone. I am truly blessed with family and a remarkably supportive and loving husband. Tim has shown me what marriage and love is, and I am so grateful to have him. Without these people in my life, I would have never been able to get through this. Next week will be here before I know it, and I can't wait to check on the status of the girls. More to come.

22 Week Appointment

Tim and I went to our 22 week appointment and ultrasound today. I was of course fairly anxious to see the girls and check on their status. They were so much bigger than four weeks ago! Baby A (Sophia) was 1 lb with a heart beat of 149 bpm and Baby B (Cecilia) was 1 lb 1 oz with heart beat of 158 bmp. I was slightly concerned over the difference in heart rates, but the doctor assured me that it was not uncommon. They were very active so it took the ultrasound technician a few minutes to check on the cords, but the doctor also said the cords looked great. This was such a relief to hear, because I had been worrying about it a lot lately. We were able to get a good shot of Baby B's (Cecilia) face which was beautiful! Unfortunately, Baby A (Sophia) was shy today and was interested in mom's back so we weren't able to see her face. Hopefully next time she will be more photogenic. It was decided for certain that I would be admitted in two weeks on November 6 for inpatient monitoring, which bring on a whole different set of concerns. We are trying to get as much as we can organized before I "move in" to the hospital for two months. I find it amazing that my mind and body is able to process so many things at once!

Monochorionic-monoamniotic twins: An overview to help you understand

I came across three really great journal articles containing very valuable information about monochorionic monoamniotic twins (which I will refer to as MoMo twins). I have read through these articles many times and decided to summarize them so that MoMo twins may be clearer to those who were unsure of exactly what is going on. Briefly, I would like to share our personal story thus far in this difficult journey, and then I will go on and provide some details from the journals about this particular type of twinning.

Tim and I found out that we were pregnant in early June of this year and needless to say we were very surprised. Little did we know at the time that there were many more revelations to come. Just as we were getting comfortable with the fact that we were going to be parents, we went in for our first ultrasound at nine weeks. We were excited to get the first glimpse at our tiny creation. The technician told us then that we were in fact having twins and that they looked to be in the same sac which usually meant they were monozygotic (identical) twins. You can probably imagine our reactions. Finding out we would be having two babies instead of one was exciting yet extremely overwhelming news to take in. Later the same day of our nine week ultrasound, the clinic called us to tell us that they were going to be contacting Rockford Memorial Hospital (RMH) for another opinion and to set up some ultrasounds with the Maternal Fetal Medicine Department. At twelve weeks we made the trip to RMH for another ultrasound. We learned for certain that day that we were pregnant with MoMo twins, which set us on a path that we are only now fully learning the implications of to this day. On September 25 we were delighted to find out that we will be having identical twin girls. We had a successful ultrasound with both heartbeats at 153 and 7 and 8 oz. So far so good!

To start out it is important to distinguish between monozygotic and dizygotic twinning. Monozygotic twins are derived from a single (mono) egg (zygote). Monozygotic twins form when a single fertilized egg splits into two embryos. Because the twins share the same DNA set, they tend to have similar features and are commonly known as identical twins. Dizygotic twins, on the other hand, are derived from two (di) eggs (zygotes). Dizygotic twins form when two separate eggs are fertilized by separate sperm and are more often known as fraternal twins. Every year 4 million infants are born in the United States and approximately 130,000 of them are twins. Only one-third of all twins are monozygotic, but 75% of the monozygotic twins are monochorionic. Among monochorionic twins, about 2% are monochorionic monoamniotic. It might help to define those main terms that I keep referring to. Monochorionic twinning happens when monozygotic twins are contained in a shared chorion (placenta). The chorion is the outer membrane of the sac surrounding a fetus in utero. Monochorionic twins can be either monoamniotic or diamniotic. Monoamniotic is a rare type of monozygotic twinning where the twins are enclosed within a shared amniotic sac (the inner membrane) in utero. Because there is no membrane separating the babies, they are at risk for cord entanglement. I will go into more detail about cord entanglement shortly, and I have attached images of what all four cases of twinning looks like to perhaps make this easier to see. (See attached images) MoMo pregnancies happen in about 1/25,000 to 1/60,000 pregnancies. The exact reason this happens in unknown, but it is known that it occurs as a result of late splitting of the developing embryo. The blastocyst is a thin-walled hollow structure in early embryonic development that contains a cluster of cells called the inner cell mass from which the embryo arises. Monoamniotic twinning is the result of splitting of the blastocyst between 8 and 13 days after fertilization, and occurs in approximately 1 to 2% of all monozygotic twin pregnancies. There has been a lot of research within the last twenty years that has changed outlook of the high fatality rate thought to be characteristic of MoMo twins. Mortality rates have been reported as high as 47%, but a recent review of the literature revealed a value of 10.8%.2 In much of the literature I have read the mortality rate of 10.8%-20% is a more accurate rate. This, however, is dependent on many factors which I want to go over in some detail. To begin it is important to understand some of the reasons that a MoMo pregnancy is at such high risk for fetal demise. Among these risk factors are umbilical cord entanglement and/or compression, twin-to-twin transfusion and preterm birth. It is known that uncomplicated twin pregnancies have a higher incidence of premature birth than singletons and that MoMo twins are at an even greater risk of being born before 32 weeks of gestation. The most serious and frequent complication that is seen in these specific pregnancies is fetal death due to umbilical cord entanglement. Cord entanglement, a condition unique to MoMo pregnancies occurs in 42-80% of the cases. As a result of the high probability of complications with MoMo pregnancies there is a lot of controversy in the type of management that should be applied during gestation. The most debated within the last twenty years, is whether there should be inpatient versus outpatient monitoring. This is, in fact, the basis of study in all three journal articles I have read. We have chosen to take the inpatient route for many reasons. After our consultation with the doctors and midwife at RMH, and my own research on the subject, I believe that being admitted into the hospital at 24 weeks is the best option to achieve the successful birth of our babies with the least amount of complications. Each of the studies showed a 100% success rate (success defined as babies who lived) in the patient groups that decided to be admitted as inpatients at 24-26 weeks gestation. The most recent and largest sample group was the study done by Heyborne, which is the one I would like to outline briefly. These professionals looked at 96 monoamniotic twin pregnancies from January 1993 to December 2003 that took place at eleven different universities and private perinatal practices. The primary outcome measure was intrauterine fetal death, in other words which babies died before delivery. They were moreover looking at whether the type of treatment could affect such outcome. They also measured gestational age at hospitalization (how many weeks pregnant the mother was), how many days the mother was in the hospital, gestational age at delivery, combined birth weight of the twins, combined neonatal intensive care days, combined days on the ventilator, and how many babies died. In this study 134 (of the 192 total babies) were female and 46 male infants. This is in agreement with the known predominance of female babies among monoamniotic twins. Of the 87 pregnancies (excluding those that were taken out of the study because of anomalies) there were 43 women admitted electively for inpatient fetal monitoring, and the remaining 44 were monitored as outpatients and admitted only for routine obstetric indications. I know that some of this may seem confusing, but the part that is most important to convey is the results of the study. No fetal deaths occurred in patients who were hospitalized electively for fetal monitoring. Among women followed as outpatients, there were 13 fetal deaths. The electively admitted group had a later gestational age at delivery, a high combined birth weight, and a decreased composite neonatal morbidity. Although one might expect that cord accidents occur abruptly and without warning, the data suggests otherwise. The improved outcome in the pregnancies with more aggressive fetal surveillance suggests that fetal deaths because of cord entanglement in monoamniotic twins are subacute events that can be predicted and prevented with monitoring 2 to 3 times a day. Although the optimal time for delivery is still controversial, most management strategies favor delivery no later than 32 to 34 weeks of gestation. The doctor informed us that they have seen in MoMo pregnancies that waiting too long past 32 weeks permits a more dangerous environment for the twins because of lack of space. Also, in each of the studies all the twins born successfully were delivered by c-section.
I tried to summarize my findings in such a way to make it easier to understand. I also felt strongly about trying to educate family and friends about monochorionic monoamniotic twins, because they are so uncommon. I will be admitted as a patient at RMH at 24 weeks, which is tentatively scheduled for November 6. Although this will be a very trying time for us, being away from each other, but we are willing to do anything in our power to bring these two tiny babies into the world kicking and screaming. As I am pretty much an expert in all things MoMo twins feel free to contact me if there are more questions.