High Risk Identical Twin Pregnancy

Hello and Happy Friday!

I have had several questions from family and friends about why I’m going to the doctor so often during this pregnancy. Currently, we are being seen every two weeks by my OBGYN and a Maternal Fetal Medicine (MFM) specialist, which I mentioned briefly in my first trimester post. If you missed that, you can read it HERE. When I hit 28 weeks of pregnancy (today, ah!) we will start being seen once a week.

So, I figured a blog post on an identical twin pregnancy and why it is high risk might be in order. I hope you find this helpful!

A little background information: identical twins are formed when one embryo splits into two. This means both embryos have the same DNA and are literally copies of each other. It is a random event that occurs in nature and cannot be predicted. There is a 1-3% chance of this happening in pregnancy, whether that is a naturally conceived pregnancy or an IVF pregnancy likes ours.

Once an embryo splits and forms twins, it can become three different types of identical twins:

• Dichorionic Diamniotic Twins (Di/Di Twins): This is when the embryo splits between day 1 and day 3 and each baby has its own placenta and amniotic sac.
• Monochorionic Diamniotic Twins (Mo/Di Twins): This is when the embryo splits between days 4 and 8 and there is one placenta but a membrane between the babies forming two amniotic sacs.
• Monochorionic Monoamniotic Twins (Mo/Mo Twins): This is when the embryo splits between days 8 and 13 and there is one placenta and one amniotic sac.

We found out very early at 6 weeks that we were having twins. As soon as our fertility doctor realized our embryo split, he told Chris and I that this would be a high-risk pregnancy and we would need special care. Since we transferred one Day 5 embryo, we knew right away we were having identical twins and that they would be Mo/Do twins or Mo/Mo twins. At 6 weeks, it is too early to see if there’s a membrane between the babies, so he started seeing us once a week for ultrasounds to keep an eye on things until we graduated from the fertility clinic at 10 weeks.

At 12 weeks, we had our first appointment with my OBGYN. At this appointment, we saw a membrane between the babies and our twins were confirmed to be Monochorionic Diamniotic Twins (Mo/Di).

This was good news! Even though the membrane separating the babies is very thin and about the thickness of saran wrap, it makes our pregnancy somewhat less high risk. But we still need to be seen by a Maternal Fetal Medicine (MFM) specialist every two weeks so she can keep a close eye on our babies.

Basically, the reason a Mo/Di Twin pregnancy is high risk is because two babies are sharing one placenta. The main concern is a development called Twin-To-Twin Transfusion Syndrome (TTTS) where one baby receives more blood flow and nutrients than another. This is very serious and causes complications for both babies, the one that is the recipient and the one that is the donor. At every appointment with our MFM she checks fluid levels, blood flow through the umbilical cords, and growth to make sure both babies are sharing nicely and getting everything they need. By seeing us so often, if something were to change, it would (hopefully) be caught early enough to give us options for medical intervention to save both babies. We are so thankful that up to this point our girls are sharing nicely and growing right on track. We are hoping that continues through the rest of my pregnancy!

It also means a C-Section is the safest delivery for me and the babies. I know a lot of people have strong opinions on this topic, but after researching and speaking with our doctors, Chris and I feel confident in our decision to deliver via C-Section. Basically the stars would have to align on many fronts for a vaginal birth to be safe with Mo/Di Twins and those stars have not aligned in our case. The risks of a vaginal birth are not worth it to us and what’s most important to us is having our girls arrive safely.

Along with the risks of a Mo/Di twin pregnancy, we also have the risks of a twin pregnancy in general to contend with such as pre-term labor, pre-eclampsia, and gestational diabetes. All of this should explain why we are at the doctors’ office all the time!

It is incredibly nerve-wracking having a high-risk pregnancy, but I know that we are in good hands with our team of doctors. I am doing everything I have been instructed to do and I know that the rest is out of my control. The positive side is that Chris and I get to see the babies often which always makes us feel better! Each ultrasound that goes well gives us a boost of confidence that everything will be ok!

Thank you for reading this post and I hope you found it helpful! Keep us in your thoughts and prayers over the next several weeks as we await their safe arrival. We have 8 weeks or less to go!