Because of the close proximity and interconnection of the fetuses, women with twins, triplets and other multiple gestations may have medical issues not as common to a singleton pregnancy. One such example is the occurrence of monoamniotic twins — when the babies share the same amniotic sac. Although this type of case accounts for less than one percent of all twins, a successful diagnosis is very important as there may be developmental and/or delivery implications. For example, as the fetuses grow, there is a risk of the umbilical cords tangling and cutting off the blood supply to one or both twins which may lead to injury or possible death. In addition, decreases in fetal heart rate may complicate delivery.
While the detection of twins is quite straightforward, it is not always easy to detect whether the babies are monoamniotic because the separating membrane is often hard to see. The Division of MFM has significant experience in diagnosing this condition having detected more than twenty cases over the last few years.
Unfortunately, there is no treatment for the monoamniotic condition. The only course of action is to institute extremely close surveillance of both babies in order to detect early signs that the babies might be getting into trouble. In Ms. Becker's case, Dr. Malone established a fetal surveillance program at 26 weeks. Through careful monitoring, she was able to carry the babies until the 31 week mark at which point she delivered two healthy twins by cesarean section.
This is how she describes her experience at New York-Presbyterian Hospital:
"I was pregnant with Monoamniotic Twins. What this means is that they shared the same amniotic sac. When two babies are together like this, there is a really high risk of cord asphyxiation. So, I was admitted to the hospital at 26 weeks. The doctors and nurses were excellent. I was there a month before my twins were born it's a long time to be in the hospital, but everyone from the person who brought me my food to transport to the nurses to the doctors...everyone was great. I came here because we believed in Dr. D'Alton from when we first met her along with Dr. Malone and Dr. Simpson and others. I was absolutely pleased with the care."
