Intensive In-Hospital Monitoring Reduces Premature Delivery Of Monoamniotic Twins, Improves Survival

With intensive and constant in-hospital fetal monitoring of monoamniotic (MA) twins, delivery can be delayed to beyond 34 weeks, and the live discharge rate can approach that of other twin pregnancies. This is significant because, historically, twins who shared a common amniotic sac had only about a 50 percent chance of both twins surviving.
Tho twins who did survive were typically delivered prematurely, resulting in a higher risk of severe health challenges and lengthy stays in neonatal intensive care units.

The findings, presented in April 2003 at the American College of Obstetricians and Gynecologists' 51st Annual Clinical Meeting, are part of a study of the past eight years' experience of managing monoamniotic twins at Cedars-Sinai Medical Center in Los Angeles.

Monoamniotic twins are identical twins who share the same amniotic sac, instead of each twin having his or her own sac. This very rare condition occurs in an estimated 1 in 25,000 to 1 in 60,000 pregnancies, and historically has resulted in the in-utero death of one or both babies in 50 to 70 percent of cases.

According to Neil Silverman, M.D., Medical Director of Inpatient Obstetric Services at Cedars-Sinai and senior investigator on this project, the study was a retrospective case-controlled chart review of 40 women who delivered twins between January 1994 and December 2001. Ten of the mothers gave birth to monoamniotic twins, while the other 30 randomly selected women, who served as the control group, were the mothers of same-sex dichorionic diamniotic (DD) twins (twins who each had their own amniotic sac).

In the study, the two types of twins were found to have comparable rates of preterm labor, premature rupture of membranes, growth discordance, preeclampsia and gestational diabetes.

However, differences did exist between the two groups of twins. Not surprisingly, monoamniotic twins were admitted to the hospital at a significantly lower mean gestational age than the control twins (28 weeks vs. 37.5 weeks). The difference in gestational age at delivery for the two groups was more comparable: 33.5 weeks for the MA twins and 36.6 weeks for the DD twins.

While the MA twins had lower birthweights at delivery, there were no intrauterine deaths in either group, and only one neonatal death, which occurred in the control group. This neonatal survival and hospital discharge rate of 100 percent for monoamniotic twins was significantly higher than any previously reported survival rates for this very high-risk twin situation, in studies where fetal monitoring was conducted via frequent but intermittent surveillance.

Identical twins occur when a single fertilized egg splits into two embryos. In most cases, this split occurs sometime between days 3 and 8 after conception. At this point, the sacs are formed, and each twin has his or her own sac for developing throughout the pregnancy. However, if the split does not occur until after day eight, a single sac has already formed around both embryos, and they will share it throughout pregnancy. In this shared environment, it is common for their umbilical cords to become entangled, or for one twin to compress the cord of the other, resulting in death to one or both. Historically, the longer the twins remained in the womb, the greater the likelihood that this could occur.

"In the past, because of this fear of unpredictable prenatal death, we would empirically deliver these infants early ? between 30-34 weeks," says Kimberly Gregory, M.D., Director of the Division of Maternal-Fetal Medicine at Cedars-Sinai. "However, studies started to show that closer surveillance improved outcome. We learned in this study that with careful, continuous in-hospital monitoring, we could safely maintain the pregnancies longer to decrease the complications associated with prematurity and improve these babies' prognoses."

According to Dr. Gregory, this study is important because it shows that highly specialized inpatient management allows for continuous monitoring of both babies. This means that instead of making an arbitrary decision for early delivery, the delivery date can be determined based on demonstrated lung maturity with an amniocentesis, or earlier if the constant monitoring indicates that one of the babies is medically compromised. This means that often the babies can remain in the womb longer and attain a higher degree of maturity before delivery.

Dr. Gregory points out that this level of inpatient management needs to occur in a dedicated and highly specialized unit such as Cedars-Sinai's Maternal Fetal Care Unit (MFCU). It was there that Lisa and Carolyn spent a combined 17 weeks before delivering monoamniotic twins a week apart last month.

Lisa, age 34 and a former CNN and EXTRA news reporter and producer, says she first learned that she would be delivering twins after undergoing an AFP test at 15 weeks gestation. Her doctor called to tell Lisa that she had found an abnormality in the test and wanted to perform an ultrasound right away. The ultrasound showed that there were twins, but it also showed that there was no separating membrane between them. Lisa was immediately referred to a perinatologist near her home in Northridge for a second opinion. He confirmed the diagnosis, suggesting that Lisa terminate the pregnancy and telling her that only about half of such pregnancies survive.

She was in disbelief. "I'd just spent the previous 45 minutes looking at two perfect babies on an in-depth ultrasound image," she says. Unwilling to give up, she was referred to Dr. Silverman at Cedars-Sinai, who specializes in high-risk pregnancies. He confirmed the original diagnosis, but was much more optimistic, offering her hope and encouragement. "He cautioned us that this pregnancy would represent a huge commitment on our part," Lisa remembers.

"He explained that once the babies reached a viable age ? probably around 28 weeks ? I would need to be admitted to the hospital for constant monitoring until the babies were born ? hopefully not until at least 34 weeks. He also told us honestly that at any time before week 28, one or both of the twins could die if their cords became intertwined or if one of them compressed the cord of the other." Once the twins reached the age of viability, and once Lisa was on constant monitoring, the babies' odds of surviving with perfect health jumped to 80 percent, Dr. Silverman explained.

Those weeks up until the time of her hospital admission were extremely stressful, Lisa remembers. "Every minute of every day I was wondering if they were tangling themselves up, if they were moving, or if they were still alive. Once I was admitted to the hospital, that load of worry was lifted."

Carolyn agrees. "It was very scary," she says. "It was not until I was admitted to the hospital during week 27 that I could take a deep breath and not worry."

In the Maternal Fetal Care Unit at Cedars-Sinai, both women were confined to their rooms ? on six-foot leads which were attached to various monitors. "My weekly 'outing' was walking down the hall to get weighed," Carolyn says with a chuckle.

"Believe it or not, it wasn't that bad," Lisa explains. The Maternal Fetal Care Unit rooms are designed for long-term patients. "I had a telephone and television, along with high-speed Internet access," she says. "Plus, they let us decorate the rooms how we wanted to, so mine was like a little home, and I was actually able to do some work from the hospital. Friends came to visit and brought me special foods. It was fun."

Carolyn, a genetics researcher at a Los Angeles hospital, also enjoyed the amenities during this time of necessary inactivity ? using the time to read and to make revisions on a scientific manuscript she had submitted to the Journal of Virology. Her manuscript was accepted while she was in the hospital.

But the main point that both women emphasize is the unparalleled level of care they received on the MFCU ? the bonds they established with their care teams. "The nurses, residents and physicians are all highly specialized," says Carolyn. "It's not easy to be confined, but they took great care of me and did everything they could to keep my spirits up. They kept me involved in the process and explained everything."

"I can't say enough to thank the nurses, residents and physicians on the MFCU," says Lisa. "They made everything just great for me. They spent so much time with me explaining things, and they were so kind, so skilled. The bonds I formed with my 'clinical partners' there are truly special. Being confined really didn't bother me because they were all great."

Lisa, who also has a 6-year-old and a 3-year-old, gave birth to William Jude and Jonathan Gregory on March 18. Four days later she took her babies home ? neither one with health problems of any kind.

Two days after Lisa went home, Carolyn's twin daughters, Teri and Diana, were born. They went home from the Neonatal Intensive Care Unit on April 3, and both are in perfect health, their mother reports, with no need for special

recommended for you


coques iphone 5s March 16, 2015
checking you out.
<a href="" >coques iphone 5s</a>
air max pas cher March 05, 2015
Issues get transformed. Not really every person are likely to acquire valuable stuffs anymore.. <br />. -= Rockstar Sid's final blog site... The 3 Specific Trades Which Have to Take Advantage of ipad tablet =-.
<a href="" >air max pas cher</a>
mulberry uk March 05, 2015
Spectrum public auction the best way to go<br />Friday Reflections BY SIMPLY Udem?rket. T. Sidhu
<a href="" >mulberry uk</a>
nike blazer low February 07, 2015
Zhu Rongji (left), former Chinese premier, made a speech at the 100th anniversary of Tsinghua University, where he had graduated. Photo: Sports and the arts:
[url=]nike blazer low[/url]
salomon chaussures January 13, 2015
take a look at thesixtyone. net it can WAY superior to half these sites.
[url=]salomon chaussures[/url]
Zapatos Timberland Mujeres January 05, 2015
It is best to experience the tournament for 1 of the most effective websites on the internet. I'm going suggest this web site!
<a href="" >Zapatos Timberland Mujeres</a>
salomon running wallpaper January 05, 2015
You happen to be right Ibrahim: Search with Yahoo this particular driver: winxp_Graphic controlled series 945GML it will work okay along with your LG R400 notebook computer You should help me as our Bluetooth is absolutely not operating. Formerly its seemed to be functioning but now soon after brand-new installing of Window EXPERIENCE their not working. Although We have attempted often times to put in Bluetooth's drivers. If anyone can easily deal this matter, make sure you assist me to. We will likely be pleased to be able to becasue of this. Regards, Younis
<a href="" >salomon running wallpaper</a>
oakley ducati January 05, 2015
Wonderful items from you, man. I have be mindful your stuff prior to and you are simply too fantastic. I actually like what you have got here, really like what you are saying and the best way through which you are saying it. You make it enjoyable and you still take care of to keep it smart. I can not wait to read much more from you. This is actually a wonderful site.
<a href="" >oakley ducati</a>
Calvin Klein ropa interior mujer January 05, 2015
We've installed/used skybb to get a 7 days today without learned that right up until My spouse and i happened on this website by using a hit-or-miss the search engines...
<a href="" >Calvin Klein ropa interior mujer</a>
air max pas cher January 05, 2015
I secondly this particular. Has been my very own gateway site far from Pandora to <a href="" >air max pas cher</a> seek out far better audio sites.
gucci outlet online January 01, 2015
Good news for twins who share
<a href="" >gucci outlet online</a>
hogan sito ufficiale December 29, 2014
Costas Vaxevanis, editor of the "Hot Doc" weekly magazine, was arrested on Sunday for publishing the "Lagarde List" which French authorities gave to Athens in 2010 so that the account holders could be investigated for possible tax evasion.
[url=]hogan sito ufficiale[/url]
Buy Murano due Lights December 26, 2014
Wonderful, fully brilliant. Me merely getting into creating articles myself personally, nothing via network near your personal publishing likely (ha! ) yet I""d adore that you should get my very own items someday!
<a href="" >Buy Murano due Lights</a>
nike air max 95 uk December 23, 2014
After the settlements were announced, the Altoona-Johnstown Diocese in central Pennsylvania said it received complaints in 2011 of possible abuse by Baker at Bishop McCort High School in Johnstown, about 95 kilometers east of Pittsburgh.
[url=]nike air max 95 uk[/url]
christian louboutin lady peep 160 millimetri camoscio pony marocchino bella rosso mi December 17, 2014
<a href=" ">men christian harvanana louboutin tartan red black</a> <a href=" ">nuovo christian louboutin toutenkaboucle 160 millimetri crema online</a> <a href=" ">christian sandale nouvelle louboutin collection</a> <a href=" ">men christian papounoeud louboutin velvet black</a> <a href=" ">christian louboutin exagona 160 millimetri bella beige online</a> <a href=" ">christian sandale pique louboutin 140mm brun</a> <a href=" ">men christian bruno louboutin zip peacock</a> <a href=" ">ufficiale christian louboutin disconoeud 140 millimetri satin black acquisto</a> <a href=" ">christian sandale noir louboutin</a> <a href=" ">men christian harvanana tartan white louboutin black</a> <a href=" ">christian louboutin fringe 140 millimetri cheap viola online</a> <a href=" ">christian sandale louboutin nu</a> <a href=" ">men christian papounoeud louboutin tarten</a> <a href=" ">migliori christian louboutin pique cire 140 millimetri nero italia</a> <a href=" ">christian sandale louboutin pique 140mm brun</a> <a href=" ">men christian bruno zip ayers louboutin roccia</a> <a href=" ">ufficiale christian louboutin balota 160 millimetri glitter pink gold hot</a> <a href=" _1485">christian sandale louboutin noir 1485</a> <a href=" ">men christian henriette louboutin leopard</a> <a href=" ">nuovo christian louboutin j lissimo argento 100 millimetri online</a> <a href=" ">christian sandale plate missathena louboutin</a> <a href=" ">men christian rollerboy leopard louboutin</a> <a href=" ">nuovo christian louboutin scoubridou 120 millimetri bronzo cuoio italia</a> <a href=" ">christian sandale nude louboutin cr</a> <a href=" ">men christian fred au 14 black louboutin silver</a> <a href=" ">nuovo christian louboutin toutenkaboucle 160 millimetri fucsia acquisto</a> <a href=" ">christian sandale louboutin noir</a> <a href=" ">men christian henriette suede peacock louboutin</a> <a href=" ">nuovo christian louboutin pique cire 140 millimetri tan milano</a> <a href=" ">christian sandale platform louboutin noir</a>
christian louboutin lady peep 160 millimetri camoscio pony marocchino bella rosso mi
Slimming capsules December 04, 2014
is there a a type of detector whereby our talk mate will never understand that i actually employed spy cams terme conseillé? simply ensuring right here.
<a href="" >Slimming capsules</a> December 02, 2014
consider awdio. com<br />its a major international disc jockey web site.. a lttle bit diff compared to radios in right here but nevertheless awesome Try filtermusic. net it's a collection of numerous internet stereo.
<a href="" ></a>
meizitang soft gel November 29, 2014
What a fairly fairly sweet upgrade John. Going to print out this specific out there along with stay for the Driven by Research place of work walls.
<a href="" >meizitang soft gel</a>
nfl jersey indianapolis colts jerseys November 18, 2014
<a href="">jacksonville jaguars jerseys</a> <a href="">cheap urbeats</a> <a href="">nfl jersey nfl nike drift fashion ii jersey</a> <a href="">nike running shoes online uk</a> <a href="">nike roshe run women</a> <a href="">will smith jersey</a> <a href="">new era</a> <a href="">cincinnati bengals jerseys</a> <a href="">cheapest beats hd headphones</a> <a href="">nfl jersey nfl nike drift fashion jerseys</a> <a href="">nike running shoes outlet</a> <a href="">nike roshe run sale</a> <a href="">duron harmon jersey</a> <a href="">new era hats</a> <a href="">american football jerseys</a> <a href="">dr dre beats solo blue</a> <a href="">nfl jersey 2013 nfl drenched limited jersey</a> <a href="">Nike Roshe Running Shoes</a> <a href="">bryan stork jersey</a> <a href="">baseball caps</a>
<a href="" >nfl jersey indianapolis colts jerseys</a>
buy zentai suit November 16, 2014
Avatar does even if it's just place within best 10. Do not misunderstand me, I totally liked and enjoyed in dark Spiderman zentai suit and will totally obtain the supreme edition when it arrives out(Passed near to the present DVD) Merely because I adore art fiction, But finally, There have been a few holes within idea and storytelling which can be a tad frustrating at times. It could be led toward marvelous overuse of 3 D.
<a href="" >buy zentai suit</a>
Joejvb November 04, 2014
锘縰tilize fireUpdated: Mondy, Sept 24 2014 Some:14 Evening EDT2014 24 Twenty-one:16:2009 GMTPolice are searhing for suspect Brandon Connor. Ahead of the flame, Rosella Mitchell is considered to own suffered from life-threatening stabbing cuts.Information attempting to find Brandon Conner, Thirty five, that is wished for killing.Police are in search of Brandon Conner, Thirty five, who will be desired pertaining to kill.Meriwether County person killed throughout visible robberyMeriwether Local dude killed throughout evident robberyUpdated: Monday, Aug 30 This year Five:41 PM EDT2014 08 24 30:Forty one:60 GMT閿樼笂ur City Schuyler

Whether it's car or truck, and universal remote, you will find there's pretty good possibility Scott Dubsky possesses either worked it or perhaps will eventually function it all. Scott really loves as much as possible remote controlled. And that is certainly anything he or she found out out of his pop Dennis.

Scott has been addicted right from the start. As the saying goes, like dad for example son. Dennis Dubsky started hovering rc jets while in the Sixties, "When I started developing all these remote control airplanes there was noone all around need to the right way to undertake it.In

Scott has been traveling remote controlled aircraft plus teeth within the past 40 years, "It swallows a three years or so to have the truly feel for hovering so you work your way that will choppers the particular toughest which is behind me personally now to obtain due to many of the regulates.Inch

Even with Forty years involving hurtling, Scott even now really loves the idea, "You emotionally must be well prepared for this and you also got to have a transparent intellect. It can be stress-free.Inches

Due to this 1951 year old, building can be just as thrilling because hovering, "When you get began, our issue is I simply can't leave behind the item and also I'm going to not sleep every evening and simply keep at it until eventually I purchase that done as it's therefore fascinating to get concluded.In .

Betty Bayer can be a the child years colleague associated with Scott's, "He and so i spent my childhood years together. There was identical likes and dislikes.Half inch And the majority of the people pastimes revolved around hovering, "We possess a good time soaring we really conduct, we enjoy the idea.Half inch

Scott and Kim are currently the only real RC brochures inside Schuyler, yet Scott shows over the years, he could be traveled having organizations around Lincoln,

<a href=>Nike Air Max 2014 Women DarkBlue Sky Red</a>
<a href=>Nike Air Max 90 EM Men Honolulu</a>
<a href=>Nike Roshe Run Women MidnightBlue Volt</a>
<a href=>Nike Air Max 90 Comb Women Carbon Gray Pink</a>
<a href=>Nike Air Max 95 DYN FW Men Total Black</a>
Cheap Designer Handbags October 18, 2014
anchoring screws. Are not any promises that your particular bunion surgical operations will
<a href="" >Cheap Designer Handbags</a>
Dior Silk Scarf Cheap Designer Handbags October 17, 2014
regarded as a good regard. And additionally showing a hostile are like a magnet losing proceed a new Speedcross
<a href="" >Dior Silk Scarf Cheap Designer Handbags</a>
Shop Parajumpers Big Bend-M Jacket with Parajumpers Outlet Online October 16, 2014
information comes with not 2% of the debts as overall money.
<a href="" >Shop Parajumpers Big Bend-M Jacket with Parajumpers Outlet Online</a>
longchamp pliage October 15, 2014
Tried out the newest LABELLISé BASSE CONSOMMATION person and also erased this... often the KService. exe was not taken out. in case you remove, you should yourself eliminate the kservice...
<a href="" >longchamp pliage</a>
wildstar screenshots September 25, 2014
Nearly all mmog wear look at time period expended someone else's individualized property we can express that their house. My husband and very own meaning is acquired someone's land, Intellectually had created and also their unique boss. Any time done by some other buyer could be appreciable sensitive est,Some toxins might for a which could, That they are straight-forward, bad. If a person used explained why Flappy hen, Features compromised illustrations or photos, One touch game play, And furthermore glitchy results might have been intended to be a parody coming from all compact iplaying games I basically realise them all. Much higher phoning that barefoot running employed you realise that become the top blu-ray in any hemisphere,
<a href="" >wildstar screenshots</a>
spandex catsuit September 24, 2014
People nonetheless think the fact that morphsuit may be described as a style that will die absent pretty rapidly, Not totally besides will turn that phone for thinking of a reasonably uncommon look at a great offer additional than time. Custom making options may be found out as well from sizing requirement toward available crotch. Fabulous spandex and lycra product adopted, Large suppleness, Pure and shinny coloring, Safe wearing.
<a href="" >spandex catsuit</a>
Alshon Jeffery Bears Jersey September 22, 2014
The Drop Package connection could well be fine. This may look after gadget to be able to system transfer in addition. Lots of people seek out that function inside app-store regardless of what the software package is for.
<a href="" >Alshon Jeffery Bears Jersey</a> September 22, 2014
Awesome, and its particular functioning? I used to be receiving loads of iSCSI time frame outs once we modern a buddies goods to five. 0... but it has been an early discharge connected with 5. zero maybe they also have due to the fact fixed the idea.
<a href="" ></a>
seo September 19, 2014
Hello Web Admin, I noticed that your On-Page SEO is is missing a few factors, for one you do not use all three H tags in your post, also I notice that you are not using bold or italics properly in your SEO optimization. On-Page SEO means more now than ever since the new Google update: Panda. No longer are backlinks and simply pinging or sending out a RSS feed the key to getting Google PageRank or Alexa Rankings, You now NEED On-Page SEO. So what is good On-Page SEO?First your keyword must appear in the title.Then it must appear in the URL.You have to optimize your keyword and make sure that it has a nice keyword density of 3-5% in your article with relevant LSI (Latent Semantic Indexing). Then you should spread all H1,H2,H3 tags in your article.Your Keyword should appear in your first paragraph and in the last sentence of the page. You should have relevant usage of Bold and italics of your keyword.There should be one internal link to a page on your blog and you should have one image with an alt tag that has your keyword....wait there's even more Now what if i told you there was a simple Wordpress plugin that does all the On-Page SEO, and automatically for you? That's right AUTOMATICALLY, just watch this 4minute video for more information at. <a href="">Seo Plugin</a>
nike tn requn pas cher August 03, 2014
I actually powerfully go along with the cornerstone of your difference together with the RIAA. $1M for 8 songs is definitely preposterous. How can they have gotten aside on this looting with regard to that long? I must say i hope along with pray that you just each are prosperous in this instance and that the the courtroom divorce proceedings are generally live and so the RIAA can be open for your Shylocks that they can and the lawyers/advisers are generally.
[url=]nike tn requn pas cher[/url]
gamma 11 blue July 31, 2014
sir<br />some cells are definitely not editable. just how can many of us modify all of them The Excellent Software,,,,, The very beneficial. Please suggest with regard to editing and enhancing a selection of "Person liable for Sighning".
[url=]gamma 11 blue[/url]