Twins & Multiples

A space to give you hints about what is happening in the pregnancy and birth world, it’s common problems, and how to solve them

HomeTwins & MultiplesMono Di Twins: What You Need to Know

Mono Di Twins: What You Need to Know

In This Section

Almost one third of twins start as just one egg, which then divides and leads to a pair of wonderful identical twins! But depending on how late the egg splits, can lead to very different situations for you and your babies.

In most cases the egg splits early, which leads to a standard and generally uncomplicated pregnancy, but if the egg decides to split later, it can lead to situations like mono di twins.

Monochorionic Diamniotic twins have their own amniotic sacs, but share a placenta.

Because they come from the same egg, they are always identical. Sharing a placenta can lead to complications in your pregnancy, but recent advances in medicine have limited the risks of mono di pregnancies, so now it’s only considered a medium risk, rather than the high risk it would have been even ten or fifteen years ago.

What Does This Mean for You and Your Twins?

Generally, learning that your twins are mono di is nothing to worry about. The mono di twin survival rate is around 97%, with only around 15% of mono di cases developing into a situation that requires close monitoring or hospital intervention.

This means it’s incredibly likely that your mono di pregnancy will progress exactly like any other twin pregnancy, with no complications or problems arising.

And even if problems should arise, scientific advances give your twins the best chance of survival, with a relatively simple and safe medical procedure that’s available now that can deal with the major problem that faces this sort of pregnancy.

two newborn twins

What Are the Mono Di Twins Complications?

Because they share a placenta, complications and problems occur with more frequency; the main ones being Twin to Twin Transfusion Syndrome, (or TTTS) and Twin Reversed Arterial Perfusion sequence, (TRAP.)


Twin to twin transfusion syndrome is caused when there’s an imbalance in the blood flow from the placenta to each of your twins. Put simply, one of your twins is getting more blood than the other one, and this means they are also getting more oxygen and nutrients.

This can lead to complications with both twins. The twin receiving the lions share of the blood will produce more urine, which leads to a larger bladder and potentially even heart failure.


Because they’re receiving more blood and producing more urine, this can cause an excess of amniotic fluid, which causes the womb to expand and can lead to premature labor and delivery, which could lead to the loss of one or both babies.

The twin receiving less blood will develop anemia through lack of red blood cells, as well as producing less amniotic fluid, which in severe cases can cause the amniotic sac to stick to the fetus, and the fetus to potentially stick to the inside of the womb.

Even if the twin receiving less blood dies, the surviving twin is still at risk, because the shared blood vessels can cause major complications in blood flow, oxygen and nutrient levels. Over time, this can lead to growth deficiencies and other problems.

TTTS is generally treated with one of two methods, with a third option being taken only in the worst circumstances.

The first is amnioreduction, in which excess amniotic fluid is drawn from the larger twin’s amniotic sac, which reduces the chances of premature birth, decreases the strain on the mother and normally equalises blood flow between your babies.

If surgery is needed, a procedure called laser ablation is used, in which doctors seal off some of the blood vessels in your placenta to even up the amount of blood going to both twins.

In the rarest and most severe cases, it’s possible for doctors to close off the blood supply to the twin receiving less blood completely, so that the twin receiving the most blood can survive. This option is only ever taken when there is no other choice.

Thankfully, all of these options have incredibly high success rates, and caught early enough, TTTS is a situation that can be managed and dealt with, no matter what complications might occur.

TRAP Sequence

In 1% of cases, mono di twins can develop into a situation called twin reversed arterial perfusion sequence, or TRAP.


What this means is that one twin develops without a heart, and normally many other internal organs, and is connected to the healthy twin with a large blood vessel.

Because they have no heart structure, the twin with no heart (called the acardiac twin) receives all their blood from the first twin, or pump twin. This causes the pump twin’s heart to have to work harder, because it is supplying blood to two bodies.

Treated properly, the survival rate for the pump twin is very high, with around 85% going on to live normal, healthy lives. Sadly, the acardiac twin cannot survive with no heart, and will not survive after birth.

Depending on how your twins TRAP sequence progresses, it may require surgical intervention, in the form of radiofrequency ablation. This procedure seals off the blood vessels in the acardiac twin, stopping the pump twin’s heart from having to work so hard.

Thankfully, even a procedure as delicate as this has a fantastic success rate, with a survival rate as high as 9 out of 10 for even the worst case scenario.

Can Identical Twins Look Different

Will Having Mono Di Twins Affect Your Pregnancy?

Because you’re having twins, you’re already at a higher chance of premature birth, lower birth weights for your babies, and it’s also likely that your doctor will recommend a caesarian birth.

Other than this, once you know you’re expecting them, it’s normal to face a barrage of scans and tests. This is just to make sure that both of your babies are developing normally, with none of the complications we’ve just talked about.

Happily, as long as your babies are both healthy and don’t develop any of the syndromes we’ve discussed, you can expect a completely normal pregnancy.

Are you expecting mono di twins? Any interesting stories or encouragement for new mothers? Let us know all about it in our comments section.


  1. I just had my anatomy ultrasound at 19 wks and just found out we were having twins and monodi twins at that! They missed it at my very first ultrasound. Everything still measured right and all of their anatomy is good however I am still worried that I have not eating well enough or drank enough up until this point! I am afraid that the increase in water and an better diet won’t make a difference if something ends up being wrong!

  2. I am 26w4d with MCDA boys. Since 22w, the doctors started close monitoring by weekly scans as they noticed twin B is getting less blood flow than twin A and there was 100gms weight difference between them.

    Until now both are gaining weight consistently and growing well despite the blood flow discrepancy. My OB said so far they are growing well, but we need to watch carefully.

    However the frequent doctor visits, scans, discussions on preemies and NICU stay are very stressful and making me nervous.
    Has anyone had selective growth restriction, but still managed to deliver healthy babies.

  3. Hello to everyone, I just want to say be encouraged and stay encouraged! Believe in Gods reports and not the doctors!!! I’ve successfully delivered mono di twins on November 1st 2017. It was a journey! First I found out that I had a weakened heart ❤️ muscle then with a couple of weeks I found out that I was pregnant . Within a month I found out that they were twins! Mono di. My doctor ‍⚕️ for this pregnancy wanted me to abort, telling me that I could die and much more! I don’t believe in abortions, and not only that I truly believe in God. This doctor was the worst!! Every time she seen me, she wanted something to be wrong! Then we got another scare, them telling me that the babies lab test came back with extra chromosomes! I did cry then I prayed. So many people prayed! We retested and the results were normal!!!! I’m not going to say that it was a perfect pregnancy but we made it through! Towards the end of the pregnancy (35 weeks and 5 days) they twins started developing tts. They were born 4, 5 pounds, even though while I was pregnant they were almost 7 pounds. One of my dd (dear daughters) lungs had fluid in them and the other needed a little help breathing. I also had a c-section. I had a team of doctors because of my heart ♥️ situation, and when everything was said and done and doctors came to visit, that same doctor ‍⚕️ seemed very upset that everything went according to God’s plan! She made the comment, “well nothing happened, and she looks fine, so I don’t know why we are standing around here”… Even the other doctors looked at her weird! Another thing that that the doctors told me was that they were going to be in the hospital for over a month! I refused to believe them once again, we all left the hospital within one ☝️ week! With them being premature, we did have some scary choking incidents with the youngest/smaller one. Otherwise than that, they are thriving!!!! Only thing that I notice with them being premature is that they learn things one month slower. Of course I don’t care ‍♀️, how ever long it takes, I’m just happy their here and made it! They are now 8 months, both are sitting up without help, eating solids, rolling over, trying to crawl, and talk and weight almost 20 pounds each! God is too good! If he can do it for me, he can do it for you! If you have any questions please feel free to ask! God Bless you all!

  4. My daughter-in-lawnis a mono Di twin and is expecting mono Di twins now. Her first cousins and other cousins on her mother’s side are identical twins. She was surprised to find out she was having identicals herself

  5. I am a mother of mo/di boys..they came at 28 weeks for whatever reason I’m not entirely sure they didn’t have ttts
    or trap sequence ..they were respectively 3lbs 0.7 oz and 2 lbs 11 oz..They only stayed a month and a half in the NICU and are now 5 months 3 months adjusted..And now 12 lbs..They are breastfed and cloth diapered..

  6. Thank you for this article and thread of comments! I just found out last night at 20 weeks 3 days that I two am having Mono-Di babies! Completely surprised when the u/s tech saw 2 and still in shock! I know all will be okay but it’s still SO new and to find out half way through is just mind blowing. Good luck to all on this journey!!

  7. We found out during delivery that my twins were mono di. I was a high risk pregnancy due to prior complications with other pregnancies so I was getting ultrasound like once a week. They always thought they were measuring two different placentas. But when it came to the delivery my first twin came out. He was heads down. Then when no placenta followed my doctor jumped into action, breaking the amniotic sac of the second twin and pulling him out by his feet. He was born breech. There was not any time to delay because after my first twin was cut from the placenta my second was no longer receiving oxygen. They are 3 years old now. And a hand full, my twin tornadoes.

  8. I have mono – di boy twins. They are now 3.5 years old.
    There was complications with pregnancy as twin b had gastroschisis (intestines developing on the outside) and bout twin a and b club foot which club foot is common in twins because of cramp space. The gastro is due to something that’s on a rise in Alberta and unknown what’s causing it. They thinking something in the water/food.
    I delivered naturally at 33weeks. And to this day both boys are a blessing.. growing tall stronge and own personality. Being mono di they are classed identical but with my boys you can tell them apart. I get mixed stranger opinions .. some can see that they are identical and some say they are not identical and try to correct me! Lol…

  9. Good Morning. This is my first pregnancy and I am having mono di twins. They share the same placenta and I am currently 5 months pregnant. This has been a lot for me. I found out at 16 weeks that they have TTTS I had the surgery early and it was risky due to my boys. The bigger one would have went into heart failure and my baby boy would have passed away. Now I’m dealing with my baby boy is not growing as fast as he should. All I can do is cry. I don’t understand what can go wrong and pray.

  10. Oh my word! What a whirlwind! We are having mono di twins! We found out on December 14th that we were pregnant, and on January 7th we found out we were having twins!!!! This is my first pregnancy and I gotta say, what a miraculous and joyous time! So far we’re at 14 weeks and are excited to find out sex of the babies. When did everyone find out sex of the babies? So excited to see what the Lord has in store! Any words of encouragement and advise are welcome!

  11. Mono Di twins may also have Siugr – selective intrauterine growth restriction- where one twin has a better connection to the placenta than the other twin and is very high risk for both babies. My friend had this and ended up having an emergency csection at 27 weeks, 5 days. Both twins survived and are doing well. The smallest one was only 1.5 pounds.

  12. I just delivered mono/di twin boys one week ago. Initially they thought that they were fraternal but after going to MFM weekly they realized there was only one placenta and the membrane between the two was very thin. I was 36 weeks and 3 days pregnant when I had them, which is almost full term for twins. My doctor was shooting for 37 weeks but I was diagnosed with preeclampsia. They diagnosed me with this while I was in the hospital because I thought that my water broke, but it hadn’t. After they ran the tests they said that I would be leaving the hospital with my babies. Baby A was born 4lbs, 13 oz and Baby B was born 5lbs,3 oz. Thank God both babies weee cleared to go home. There were so many scary moments throughout my pregnancy wheee I had to get a cerclage to help keep me pregnant, testing that leads docs to believe my babies had spina bifida, etc…. People will project their fears and doubts onto you. Stay positive, picture holding your babies and pray. Good luck!

  13. I’m almost 11 weeks with Mono Di Twins. Very excited but fear any complications. Will continue to eat balanced meals and drink lots of water and pray everything turns out ok. Had an easy first pregnancy and hoping for the same outcome but still trying to prepare for the worst.

  14. My first set of mono di twins we realized that baby B was developing a lot smaller than her twin A. Approximately 20% difference. I was closley monitored from 18 wks to term 38 weekswhere I was induced. Each week we had an ultrasound to see how much baby B had grown. There was a chance that if she stopped it would be a danger to her sister. They reffered to my smaller baby B twin as a doner twin. ( still not too sure what that means exactly). She continued to grown steadily on the same curve as her sis just lower. After a natural delivery and looking at my placenta they saw that my baby B twin had a velamentous cord insertion. She was born at 38 wks 4lbs 6oz and her twin about a pound bigger 5lb 5oz. She stayed in the NICU for about a week. She’s absolutely perfect, string willed, a fighter. We named her hope.

  15. We also found out yesterday that I am pregnant with mono di twins, it is a shock but such a blessing! I am 12 weeks & 3 days and praying for a healthy pregnancy with 2 healthy twin babies. I can’t lie though, I am freaking out! But trying to remain positive

  16. I read these types of articles at the start of my pregnancy and would often feel very reassured that things would be okay. Listen, being anxious and scared is not the way to spend your pregnancy. However, it’s important that articles outlining how rare the complications are also outline that it’s so so important to know the signs and remain vigilant. TTTS can be fast and fierce. I was at stage 3 the first time I was diagnosed and it blindsided me. My donor suffered significant brain damage either before or as a result of the laser ablation surgery and I now have a one year old surviving twin. We may be rare, but it absolutely happens and it is so important to be careful.

  17. My situation was a very unusual and scary one for anyone to go thru. I found I was pregnant with mono-Di twins at just 4 weeks along in October of 2013. January 4th of 2014 baby A’s water broke. The head of perinatology told me there was nothing they could do and if baby A passed I had 50% chance of losing baby B. I got sent home and put on bed rest and all I did was drink a lot of water and pray to god that both babies survived. Me and my doctor where trying for the 24 week mark so both babies would be viable. Ever since my water broke I was going to doctor appts 3 times a week and every time I went to doctor the babies were fine thank god. My doctor in his 33 years of practice never seen a case like mine. He said he seen it happen with a single gestation and the outcome wasn’t good. I thank god everyday my beautiful boys were born at 34 1/2 weeks and healthy. They had to stay in NICU for 2 weeks though because they didn’t have the sucking sensation to eat on their own. my twins are miracle babies and I wouldn’t trade anything for them. they are my life and I couldn’t imagine life without either of them.

Most popular