inducing early for mono/di twins?

So I chatted with my specialist doctor today during my u/s, and he said for mono/di twins he wants to do an amnio to test lung function at 36 weeks, and if their lungs are okay at that point to induce, because there are higher risks of fetal morbidity in late term with monochorionic twins. If their lungs aren't ready yet then they wait a little longer. I'm curious what all your doctors have said/done for mono/di twins. He said they only do steroids to speed up lung development if at 32 weeks you're having signs of preterm labor or other complications. On the one hand, I certainly don't want them to die; on the other hand, I also want them to be full term and not have to go to the NICU, and I'm not sure how the risks stack up of keeping them in longer vs. having complications from early delivery. He gave me a copy of the journal article his recommendation is based on so at least I know where he's getting the numbers from.

Maybe it doesn't even matter because there's a decent chance I'll go into labor by 36 weeks anyway, but I'm kind of nervous about the whole thing and I'd like to hear about your experiences.

 

My mono-di girls came spontaneously at 34+1 but my doc had said she "wouldn't let me" go past 36 weeks. It didn't come to it, but I would have declined the induction. For me personally, the risks of elective induction (especially being a first time mom) outweighed the risks of continuing the pregnancy.

 

I had steroid shots at 25 weeks. My dr and I were always shooting for 38 weeks. I made it till 38 weeks 3 days. As long as the boys were growing together well, he saw no need to take them earlier than 38.

 

I had my girls a couple weeks ago at 36+3 weeks. My doctor also wanted to induce by 37 weeks because of the risk associated with twins. I told her my concerns with inducing so early and I got steroid shots at 34 weeks. She said normally she would not give them past 32 weeks but said it certainly wouldn't do any harm and would increase the chance I could take them home right away. I was induced with pitocin and my water was broken at 3 cm a few hours into the induction. I was on pitocin for 21 hours and would not dilate past a 3, and my water was broken for baby A over 12 hours. I ended up with a uterine infection that caused a high fever and my doctor chose to give me a csection because the girls heart rates were high. My girls ended up being just fine despite baby B having a slight breathing issue at first and baby A had some temp troubles. They were ready to be discharged after 3 days but I had to stay in for 5 days because of my infection.
Although they turned out perfectly healthy, next time around I would choose not to induce until 38 weeks. My delivery was very traumatic for me with the infection. It was obvious my body wasn't ready to go through labor yet, so I wish I would've waited awhile longer and given my body the chance to go into labor naturally.

Just wanted to share my experience, I wish you good luck!

 

Thanks for the info everyone. We did a little more research and it looks like the recommendation from all of the official OB groups (both ACOG and international) is to induce delivery at 34-36 weeks for monochorionic twins due to the risk of stillbirth increasing after that point. I still have not had a chance to talk to my regular OB about it, but I am waffling about whether to allow them to induce at 36 or to wait until 37. In either case the doctor said they would do a maturity amnio at 36 to make sure their lungs were ready before inducing, and would not induce if their lungs were not ready yet. From what I've heard and read babies born at 36-37 weeks tend to do very well and often require no NICU time.

This may all be irrelevant if I go into labor before 36 weeks anyway, so I'm trying to keep an open mind. I am feeling kind of like if I make it all the way to 36 weeks, I might want to wait until 37 before inducing to see if I go into labor naturally sometime during that week. It will probably also depend on the babies' positions -- if they're not in position for a vaginal delivery I might like to wait a little longer to see if they move. On the other hand I'm afraid that since there is a reason the recommendation is for 36 weeks that something will go wrong if I wait longer. This pregnancy business sure is stressful!

 

It is a hard decision to make! Know that there is no right or wrong choice, just the choice that feels right and best to you, for this pregnancy. :hug:

Something to keep in mind when evaluating risks/benefits also is the difference between relative risk and absolute risk. I haven't looked at the exact numbers in a long time so this isn't specific to mono-di delivery, but for example, hearing "the risk doubles" (relative risk) is really scary but hearing "the risk increases from 0.2% to 0.5%" (absolute risk) may be less so. It's still useful information to have but you may reach a different conclusion depending on which one you're presented with, KWIM?

 

How are their weights and fluid levels? After 34 weeks my OB had me doing weekly ultra sounds and non-stress tests in between, so we never went more than 3 days without making sure everything was okay. We made it to 37+ 3 with my mono/di boys.

 

Their weights and fluid levels are just fine as of our last u/s a week ago (2lb 6oz and 2lb 10oz at 29 weeks). Starting at 32 weeks I'll be doing weekly BPP's and weekly NST's, so they are going to be monitored pretty carefully (probably NST's on Mondays and BPP's on Thursdays). I'm actually kind of looking forward to all the doctor appointments because when I go a whole week (like this week) without anyone checking on them I start to get nervous.

 

I agree that it is a hard decision. I don't think there is 1 right or wrong decision. You have to do what is right for you and your precious babies. My mono/di girls were born 8 weeks ago at 35 2/7. They were born then due to my health. I developed an atypical HELLP syndrome. My doctor had said the longest I would have carried them was 37 weeks due to the mono/di. Then towards the end it switched to 36 weeks due to baby B not growing like they wanted her to. My girls were in the NICU for 2 weeks basically to grow and learn to eat. Good luck with everything.

 

I have monodi boys who are 7 months old. I did the same as yourself I researched and researched all I could. As I agree that you want to make the best choice, chances are you will go into labor on your own before 38 weeks. I chose against induction bc I had montoring and appointments three times a week and the boys were thriving. I went into spontaneous labor at 37+4 and had them at 5.4 and 5.7 and even at that weight and age they had some temp problems and eating problems, although, they had NO nicu time and went home with me two days later. If you are looking for ADVICE, I would say hold out. Most docs will induce by 38 and that is perfect time as I'm sure you will see most of us delivered around or before then. I know it's tough and you worry, just make sure you are being seen and monitored. Don't rush them babies!