Mono Di Twins and early delivery necessary?

[EonJourney]

I am pregnant with 2 identical boys and currently 34 weeks and 4 days and was diagnosed with boderline TTTS at 19 weeks.  I never had any interventions. According to some studies, the risk for carrying identical twins who share 1 placenta is death to 1 or both twins during vaginal deliveries or later term (past 35 weeks pregnant) is about 4.6%. I have always wanted a vbac natural birth but my high risk ob says I should deliver at 35 weeks via c-sect. I will be closely monitored during labor in case this were to happen but the studies say even with closely monitoring 1 or both twins could die during labor or during weeks 34+. What would you do if you were in my shoes? Is it worth the risk to wait until my body goes into labor on its own and then perhaps consider a csect if warranted? Has anyone experienced acute TTTS during labor and/or weeks 34+?

[rinap]

Congratulations on getting this far! Awesome work.

I have mono-di twins who were born in June at 36 weeks 2 days, vaginal birth, with prostoglandins to induce. The research we did suggested that it's safest to get mono-di twins born before 37 weeks.

This was based on a large-scale Dutch study (their conclusions say 36 weeks, but the data suggests 37) http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2007.01556.x/full

In this study, outcomes got worse starting at 37 weeks.

However, we had no traces of TTTS, so that is an additional factor.

I would suggest bringing the study to your doctor, and/or asking them what their sources are so you can look at them. We had to do some pushing back on our doctor to get the birth we wanted, but we also wanted his support and knowledge, as twins are risky. As it turned out, it was his good work that kept me from getting a c-section when I started to bleed after the first baby was born.

[EonJourney]

Thank you Rinap for that study and your experience.Your post was extremely helpful for me. Could you tell me how you induce with prostaglandins? Is it a pill or cream? How long did it take to work?

[rinap]

This is something they do in the hospital. In my case, I checked into the hospital, and they put Cervadil as an insert against my cervix and we all went to sleep (around eleven). If it hadn't worked we would have had a second dose, then moved on to pitocin the next day. But my girls were ready to come out with just a little push. At 4AM I was in active labor, and the girls were both out by a little after three the next afternoon.

The thing I liked about using the cervadil was that it put me into normal labor, so everything else was able to just proceed.