Twin Talks
Identifying Twin Types During Pregnancy

[00:00:00]

Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

[Theme Music]

DR. SEAN DANESHMAND: After getting over the initial shock of learning that they’re carrying multiple babies. Many twin parents were anxious to find out if the babies are fraternal or identical and if they’re the same or different sexes. How can they determine what type their twins they’re carrying and are there any special concerns associated with each?

I’m Dr. Sean Daneshmand, a perinatologist at the San Diego Perinatal Centre. Here to talk about: “Identifying twin types during pregnancy.” This is Twin Talks Episode Number Seven.

[Theme Music/Intro]

CHRISTINE STEWART-FITZGERALD: Welcome to Twin Talks broadcasting from the Birth Education Centre of San Diego. Twin Talks is your weekly online on-the-go support group for expecting and new parents to twins. I’m your host Christine Stewart-Fitzgerald.

Have you heard about the Twin Talks Club? Our members get bonus content after each new show plus special giveaways and discounts. Subscribe to our monthly Twin Talks Newsletter and learn about the latest episodes available.

Another way for you to stay connected is by downloading our free Twin Talks app available on the Android and the iTunes Marketplace. So, let’s get started and we’ve got some panellist here in the studio with us today. Let’s start with Carolyn. So, tell us maybe a little bit about yourself, your twins and hear about you.

CAROLYN BENTLEY: Hi, my name is Carolyn and I have fraternal girls – Lauren and Kyla that are 19 months old now. I’m a stay-at-home mom with them and previous to that, I was a scientist. There are my only two children now.

CHRISTINE STEWART-FITZGERALD: That’s a handful. I got to say: “Definitely.” Sorry, scientist – I got to ask what type of scientist?

CAROLYN BENTLEY: I did cancer biology and a little bit of osteoporosis studies.

CHRISTINE STEWART-FITZGERALD: So, you know a lot of medical terminologies too.

CAROLYN BENTLEY: Yes.

CHRISTINE STEWART-FITZGERALD: Okay, well this is good. We can ask you as an expert as well. Okay and let’s see, Shelly?

SHELLY STEELY: Hi. I’m Shelly. I’m a high school history teacher. I’m 30 and I have two children, identical twin boys – Greyson and Sawyer and they are almost 15 months.

CHRISTINE STEWART-FITZGERALD: Awesome!

SUNNY GAULT: I’m Sunny. I’m actually pregnant with twin identical girls and due December 2nd – that’s our C Section date. I have two little boys at home already; Sayer who is three years old and Urban who’s about 17 months.

CHRISTINE STEWART-FITZGERALD: So, this is going to make four. You’re going to have your hands full. I got to say.

SUNNY GAULT: I’m learning from all of you guys and now, I’m taking notes on how to do this, right.

CHRISTINE STEWART-FITZGERALD: Amazing. I’m Christine as your host, I got a four year old identical twin girls. I’ve also got another little girl; singleton who will be one year in a week from now. So, all girls – I think we are done. Girls are great. We’re happy.

SHELLY STEELY: We have our annoying comments with Twin Moms Section today. This one comes from Melissa in Texas. She says:

“I have 12 years old, 7 years old, 3 years old and 18 month old identical sons.” When people say: “I don’t know how you do it.” I usually respond with: “I have a glass of two of wine after they all go to bed.”

The most annoying comment I hear doesn’t come from a stranger though. Whenever my mother in law sees the twins, she always asks which is which. When I tell her, her response is always: “Are you sure?” Hello, I think I know my own children.”

-Melissa
[Theme Music]

CHRISTINE STEWART-FITZGERALD: So, today’s topic is: “identifying twin types during pregnancy.” We’re talking with Sean Daneshmand, a perinatologist and an expert in maternal fetal medicine. As part of his practice, he often helps pregnant twin moms diagnosed their twin’s type and helps them manage a healthy pregnancy. So, thanks for joining us Dr. Daneshmand.

DR. SEAN DANESHMAND: Thanks for having me.

CHRISTINE STEWART-FITZGERALD: This is great. So, we talked in an earlier episode about just kind of the science behind twins. So, now we come and we see you. We want to know are our twins identical or fraternal and how did doctors know if the developing twins are fraternal or identical?

DR. SEAN DANESHMAND: So, the best way to diagnose twins obviously is we talked about previously is by doing in an ultrasound. Fraternal versus identical – so fraternal or dizygotic twins is ovulation, fertilization of two separate oocytes. Identical or monozygotic is fertilization, ovulation or ovulation, fertilization of one oocyte and then divides.

It was really important Christine is: “Identifying whether there are two placentas or one placenta in the twin gestation.” So, about 1/3 of identical twins can have two separate placentas. So, it’s not really that important whether they are identical or fraternal while they’re pregnant.

We can obviously determine that after the babies are born. But, what’s really important with changes the management of the pregnancy is: “The number of placentas.”

CHRISTINE STEWART-FITZGERALD: Okay.

DR. SEAN DANESHMAND: That could be determined by ultrasound. The earlier the ultrasound, the better it is for us to be able to identify that.

CHRISTINE STEWART-FITZGERALD: So, you’re saying that: “The placenta is the main factor.” So, it’s not so important if they share the same sac?

DR. SEAN DANESHMAND: That’s also important. So, if they have two separate placentas; they will have two separate sacs. If they have one placenta in identical twins then 1% of the time, they may be in one sac and that carries a high risk. So, that’s called monochorionic – so one placenta, monoamniotic, one amniotic sac.

Those babies are at a higher risk of passing away and if one baby passes away; this is due to cord entanglement. So, 100% of the time – the cords are untangled because women are around in the same sac. So, what’s important is to admit this patients a little bit earlier.

So, these wonderful moms come in 24 weeks, 26 weeks, 28 weeks depending on their discussions with their doctor and a neonatologist, depending on how early they want intervention. Some parents say: “24 weeks, I want everything done here in the hospital in 24 weeks.”

Some parents say: “I want it at 26 weeks.” Then, deliveries anywhere between 32-34 weeks with those babies – so, that’s 1% of all identical twins are monozygotic twins. Fraternal twins, always two separate placentas.

CHRISTINE STEWART-FITZGERALD: So, it sounds like: “It’s pretty obvious for fraternal twins because there are the two sacs, two placentas.”

DR. SEAN DANESHMAND: In 1/3 of monozygotic identical twins still two separate placentas.

CHRISTINE STEWART-FITZGERALD: So, now if you’re performing an ultrasound and you see that there are two sacs and two placentas. So then, we still don’t know if it’s identical or if it’s fraternal. I know like in my case

DR. SEAN DANESHMAND: Unless, that’s different sex is.

CHRISTINE STEWART-FITZGERALD: These are different sexes.

DR. SEAN DANESHMAND: If the sexes are different then you know they’re fraternal. But if they’re the same sax; you’re right. You can’t tell them if 100% these are fraternal.

CHRISTINE STEWART-FITZGERALD: Usually, the sex unless if it’s done via ultrasound; that’s done with what the 26 or what’s the time period?

DR. SEAN DANESHMAND: As far as being able to tell the sex?

CHRISTINE STEWART-FITZGERALD: Yes.

DR. SEAN DANESHMAND: I mean early on. We can tell the sex maybe as early as sometimes 13 weeks, 14, 15 weeks – we can able to tell the gender.

SHELLY STEELY: I’ve had mine at 18 weeks. So, I have a similar situation. I had two separate placentas, two separate sacs. We figured fraternal and I had my – they call the anatomy scan make sure everything is all in one place.

They said: “Ideally between 18 and 22 weeks is when they have enough room to see everything and they’re developed enough and so mine was right at 18 weeks and they were able to tell us that they were both boys which then kind of in the back of mind I was thinking: “They could be identical.”

CHRISTINE STEWART-FITZGERALD: They sounds like at that point that as well they’re boys but you still don’t know if they were fraternal or identical.

SHELLY STEELY: We have no idea until after I delivered and they had the same blood type which we only found out because of AB and O compatibility. They normally don’t blood type babies unless there’s a reason too.

So, with the same blood type and two babies who looked exactly the same – we thought: “Maybe, we should check this out.” So, we actually had private genetic testing done when the boys were about four months old.

DR. SEAN DANESHMAND: So, when you see a wonderful mom early on in the pregnancy look for several sign; one is that: “You want to see a dividing membrane.” When the mother early on, you can see that much more to more clearly than the one that the babies are older, the membrane’s become much thinner.

So, you want to see in two separate placentas – you want to see something called: “The Lambda Sign or Twin Peak Sign.” That’s when the fusion of two placentas so you kind of see this triangular shape with the dividing membrane extending from there. So, that’s one sign of two separate placentas. Again, forget about fraternal or identical; think about number of placentas.

CHRISTINE STEWART-FITZGERALD: Okay.

DR. SEAN DANESHMAND: So, that means two separate placentas also the thickness of the membrane that’ something we look at anywhere between 50 millimetres to 2 millimetres and thickness is more likely that this is a two different placentas. Again, with the gender but that’s a little bit later on. But those two signs are very important; the thickness of the membrane and that Lambda Sign.

If it’s a one placenta with two separate sacs, there’s something called the T Sign is basically the placenta and then you get this extension of the membrane right from the placenta so that you don’t have that Lambda Sign or the Twin Peaks on that we look for.

So, the sonographic features that we look for to identify where there’s two placentas or one placenta which as we talked about earlier in episode one determines how this, how are we going to manage these angels.

CHRISTINE STEWART-FITZGERALD: Okay, so you’re looking at the sonogram and then that you see that there are two placentas, two sacs. But, at that point we still don’t know fraternal there. I think that’s probably maybe it sounds like in a medical practitioner that’s really not so important but the parents are still dying to know.

SUNNY GAULT: You would think.

SHELLY STEELY: For us, we did want to know and the main reason that I was concerned because we talked about that in that other episode, if you have fraternal twins then your chance of having fraternal twins is high. Again, so I kind of wanted to be prepared for that but also, you want to be able to answer questions.

I spent the first three months of their life people will say: “Are they identical of fraternal?” I would have to say: “I didn’t know.” People look at you like they give you a side eye. Why don’t you know about your own children?

So, for us, we wanted to know so that we could tell people: “These are identical twins.” But also, going forward in the event that one would have something like if they ended up having some kind of genetic condition then we would automatically know that the other one had kind of the same situation. So, it helps a little for their medical history.

Also, in terms of just like how do you look at raising them? When you have twins that are virtually the same, you have to just different challenges I think.

CHRISTINE STEWART-FITZGERALD: Definitely.

CAROLYN BENTLEY: We had two placentas, two sacs. We assumed they were fraternal but then when we went into the hospital; we brought nail polish, how are we going to clean their toes. When my girls were born, they were a pound different and looked nothing alike and have continued to look nothing alike.

So, one has brown eyes, one has blue eyes. We did have some genetic testing done because they were part of a vision study at UCST. Of course, they came back they were fraternal. So, I’m not surprised.

SHELLY STEELY: Mine where within two ounces of each other. So, we had two 6 pound babies who looked exactly like we did tether. For me, it took me about a week and then I was able to tell them apart. They have a bigger size difference after coming home like 6 or 7 ounces.

It took my husband about three weeks, though we have the nail polish on them to tell them apart. We have family members that still can’t tell them apart.

SUNNY GAULT: We knew right away. When they and Dr. D kind of alluded to this earlier and that is: “When we found out when we are 14 weeks pregnant that they were twins.” They told us like right after they said: “You’re having twins.” That was the first question that came out of my mouth was: “Are they identical?” She said: “Well, let me look.”

Then, I later learned that because I was still early on in the pregnancy that they could see the placenta and everything much more clearly. In about a month later, I had another ultrasound and because I wanted to know if they were separate sacs or not because they didn’t tell me that. I didn’t know how to ask.

So, about a month later I’m doing all these research online. I’m like: “Are they in the separate sacs or is it the same sac and what is all that mean?” It was really hard for them to tell at that time because the sacs have become so thin.

CHRISTINE STEWART-FITZGERALD: So, how would you know if they’re fraternal? Are there any types of testing? During the pregnancy did you can perform to find out?

DR. SEAN DANESHMAND: I mean you could but it’s invasive testing. So, it’s best mostly it’s done after the babies are born. So, obviously it’s important to know if they’re fraternal or identical like Shelly mentioned but as far as the management of the pregnancy really boils down to the number of placentas and sacs.

CHRISTINE STEWART-FITZGERALD: So, during the pregnancies, is there any reason that parents should know or are there any medical reasons that it would be important to know if they’re mono or dizygotic?

DR. SEAN DANESHMAND: It’s a good question. If you wanted to do invasive testing, you, wanted the babies for example has some sort of a congenital abnormality let’s say has a heart defect. It will be important to know that’s why we’re not a 100% sure if they’re identical. Let’s say they have two placentas.

So, you’re not a 100% sure if they are identical or fraternal then you want to do an amniocentesis on both sacs, on both babies and amniocentesis as everyone knows is drawing some food from the sac and testing the chromosomes, testing the [inaudible] DNA. So, because of that reason we tap both. We don’t just assume.

CHRISTINE STEWART-FITZGERALD: So, when they’re doing, can also genetics is that a factor? Sometimes parents go through genetic counselling again, if there are two babies, let’s say they appear like they fine. It sounds like they probably want to test both of them or how does that play in?

DR. SEAN DANESHMAND: Genetic counselling or preconception counselling is very important. So, I was thinking one through the family history, going to the personal history all those things, anything that we can alter, going through diet, that you’re full of gas, it can take – rest can take; those things are extremely important.

Right now, everyone is offered non-invasive testing. If they want the invasive testing; so, that term of advance maternal age is really no longer used because everyone’s offered to these tests. But, we talked about in twins for example singletons 35 years of age and in twins 31 to 33 actually years of ages considered maternal age cause you’re carrying two.

When a wonderful mom is pregnant with twins, everyone is offered a Nuchal Translucency Screen and that’s looking behind the baby’s neck between the skin and the soft tissue. That is also associated with the blood test something that by chemical screen is that we do called PAPP-A or Pregnancy Associated Plasmic Protein A and Human Chorionic Gonadotropin.

So, those that blood work along with the measurement behind our baby’s neck, the mom’s age and the baby’s sizes give us an odds risk for example for the most common abnormality Down Syndrome which is the most difficult to diagnose as well on ultrasound.

So, most of the tri semis or more common ones are easier to diagnose because more than 90% of time babies have other abnormalities rather than just a one “soft marker” that raises a suspicion for it. But, Down Syndrome in about 50% of babies; if we have a hundred moms with babies with Down Syndrome will miss 50 of those babies. We’ll say everything’s looks normal at ultrasound.

So, these screening tests are really design to identify to help better identify which moms is maybe at risk for having babies those ages, those with Down Syndrome. One is a Nuchal Translucency Screen and then the second one that is the second trimester screening test which again, goes through another – that’s a blood test not associated with an ultrasound. Those results can combine and we get results.

There’s now non evasive testing as well. There are different competing companies such as Harmony or MaterniT21 part of Sequenom and these companies aren’t basically looking for fetal DNA maternal blood. The data is still not very strong with multiples but very strong in high risk women.

Then, there’s invasive testing which is Chorionic Villus Sampling which is then at the first trimester either vaginally or transabdominal and amniocentesis.

CHRISTINE STEWART-FITZGERALD: Are there any greater risks in doing those types of invasive for multiples?

DR. SEAN DANESHMAND: In multiples, there’s a higher risk – the amnio, its 20 ½ % of potentially use in the pregnancy, in the entire pregnancy. Many of the women that we seen are practice since we do more high risk and our patients that are coming from the infertility doctors and so, sometimes these patients have already had a pre-implantation genetic testing.

So, they already know for the most common chromosome abnormalities if these pumpkins have any at ease more the common one. So, that kind of eases our mind. The previous panellists that were here for example said that she had a triplet pregnancy but one of them didn’t take and she didn’t know that until after delivery. So, that for example would skew the numbers that she had none invasive testing.

CHRISTINE STEWART-FITZGERALD: So, the hormone levels would be off.

DR. SEAN DANESHMAND: Right.

CHRISTINE STEWART-FITZGERALD: Let’s see here. We’re going to take a break right now and when we come back, we’re going to talk about the reasons that it may be important to diagnose which type of twins you’re carrying or to better understand what options to have during the pregnancy.

[Theme Music]

CHRISTINE STEWART-FITZGERALD: Well, welcome back. Today, we’re talking about: “Identifying twin types during pregnancy with Sean Daneshmand and our discussion continues as we look some of the factors that may cause women to conceive twins.” In the case of higher order multiples; is it important to know their twin type?

For the parents, we all want to know and I guess we’re king of continue the discussion that from a medical perspective, how important is it to know and it’s particular a type of care the prenatal care that we’re getting?

DR. SEAN DANESHMAND: You’re fabulous; I completely understand that I think that’s the question that always parents ask. Are they identical? Are they fraternal? Again, as far as the management of the pregnancy whether the fraternal or identical, it really boils down to the number of placentas. That’s where complications begin.

If like Sunny for example, these angels have one placenta in separate sacs but many times these babies share blood amongst one another because they’re sharing the same placenta. But, in 10 to 15 % of the time, they can have one of the most unfortunately bad complications with monozygotic twins or monochorionic twins which those babies are identical which is called Twin to Twin Transfusion Syndrome. There are other abnormalities as well.

But, that’s the one that we fear about the most. Depending on how the early that’s diagnosed then the prognosis can change, can vary if there are diagnosed very early in the pregnancy then these babies are most likely are going to require surgery. So, if you know laser surgery to basically burn for example those communicating vessels because these are communicating vessels where one baby is given a lot more blood to the other than it’s receiving back.

So, one angel gets so much blood that this baby just pops up and gets bigger. He’s a lot more and then so there’s a lot more fluid. There’s a lot blood. The bladder is much larger and the baby is so much puffier and then the other one is called Stuck Twin because all of a sudden this baby is not peeing as much more because it’s given a lot more of blood supply than the other angel is not growing as well. So, it kind of gets stuck in the corner of the uterus.

So, that’s why it’s important. Again, when you have one placenta; you can just imagine there is going to be a higher risk for one of them not growing as well. So, you’re worried about growth restriction issues, you’re worried about Twin to Twin Transfusion.

So, you’re also have an increased risk for congenital abnormalities with one placenta, the risk of congenital abnormalities goes up. But, mainly really it’s heart. So, we talked about early on the earlier episode – we do echo cardiogram with all of these beautiful babies.

CHRISTINE STEWART-FITZGERALD: On the babies?

DR. SEAN DANESHMAND: Yes.

CHRISTINE STEWART-FITZGERALD: Monitoring those babies, so let’s say they share either a placenta since that seems to be the most critical factor there. So, in terms of the care – what is that care? Let’s just say we haven’t seen any high risks yet. But, how does the care differ once you diagnosed that they do share a placenta or a sac?

DR. SEAN DANESHMAND: If there’s monochorionic, monochorionic – one placenta then these babies get monitored every two weeks. So, once we see them they get scheduled for a Nuchal Translucency Screen. That’s again, looking behind baby’s necks. That’s also a screening factor for cardiac defect.

Then, they get their anatomy scan but starting at 16 weeks, we start looking at these angels but kind of the anatomy from head to toe. Then, at 22 weeks they get an echo cardiogram to take a look at their hearts. Then after that, every two weeks we look for again, signs of Twin to Twin transfusion which is again one not much fluid, smaller, the other one much bigger fluid increases, no bladder versus bladder, a larger bladder.

We look for growth restriction as well. So, every two weeks they have an ultra sound. Once they reach about 32 to 34 weeks of gestation, they started going to the non-stress test which is based on the recliners and basically, think.

SUNNY GAULT: Eat ice chips.

DR. SEAN DANESHMAND: It’s a lot of work, my goodness. They come in twice a week to monitor the baby’s heartbeats and look at the amniotic fluid. Now, with two separate placentas though – we don’t do that as intensely; so, every four weeks.

CHRISTINE STEWART-FITZGERALD: So, not as frequent. So, four week ultra sound

DR. SEAN DANESHMAND: Four week ultrasound but the biggest issue is again, educating parents about sizes, symptoms of preterm labour so every four weeks when they come in if they need to meet sooner, obviously we will. But, if they are stable, they’re doing well like Shelly was. We looked at their cervix every four weeks, look at the baby’s growths. Those babies do very well.

So, now they do have a higher risk of developing diabetes. They do have a higher risk of developing hypertension such as gestational hypertension or preeclampsia. So, we do watch this. I tell my parents: “Get a blood pressure monitor.” Every twin mom I told them: “Get a blood pressure monitor starting at 20 weeks just to check your blood pressure.”

Now, I talk about diet, I talk about their vitamin intake. So, be more proactive.

CHRISTINE STEWART-FITZGERALD: Yes, in the monitory. So for our panellists, tell us a little bit about your experience.

CAROLYN BENTLEY: So, I was one of those people that always had high blood pressure in time that I went to the doctor just from the fear of everything. We had a miscarriage previously. So, going in you’re so nervous that it was sky high. So, I did exactly bought a blood pressure monitor and then track it morning and night.

That was how we caught I ended up developing preeclampsia and then I caught it at home the blood pressure suddenly one week is 10 points higher. Then the next week another 10 points higher. So, I brought my little book every time I went in to the doctor to show them.

They sent me down and I ended up being on bed rest in the hospital for a couple of weeks before developing help syndrome. Then deliver the girls early. But, tracking my blood pressure at home made me feel a lot more confident that everything was going okay.

The doctors felt better to knowing that it was just my nerves coming in to the doctor and not something else until it did become a problem.

DR. SEAN DANESHMAND: That’s excellent because that’s what happens. The patient comes in and their blood pressure is elevated and they’ve been checking their pressure it’s like in the past four days, it has been creeping up take a look. So, it definitely helps.

SHELLY STEELY: My husband got high blood pressure when I was pregnant.

SUNNY GAULT: Is that because he knew that the twins were coming because that maybe my husband right now.

SHELLY STEELY: I monitored and I would have that every four weeks appointment and I have like textbook perfect blood pressure. I did anytime that I would get swollen because I did developed really like some abnormal swelling. My legs would get really big at one point like they were like almost purple looking.

So, anytime that I would get that; my husband would make me go over to the pharmacy and use the blood pressure cup there. So, it’s not the most accurate but at least to give us an idea if it was and it was always super low so I had just kind of admirable swelling. Then, just monitoring like how you were feeling and not being afraid to go in especially with the twin pregnancy like I almost pass out at an indoor mall.

It was just from not being dehydrated and not trying to do much. 28 weeks just I wasn’t keeping enough food and water in my system and the same thing too with twins here. That’s the time I was preterm labour. You want to really be aware of baby movement and any contractions and I went twice to labour and delivery with increased contractions and they just gave me water.

I lay down for three hours, it was fine and then they sent me home. But, just a lot of women with a singleton low risk pregnancy, if you’re having bracks and hicks; it’s really not that big of a deal but with the twin pregnancy, you really have to be more. I hated the idea of going in and just having them sent me home.

When I got to the hospital, the first time they said: “No, we would love to send you home.” Our favourite kind of patient is when that they comes in and get sent straight home. We wish that you guys would come in more just being aware of.

CHRISTINE STEWART-FITZGERALD: I think that’s just great advice to be just watching and sensitive to different changes. I know in my case – so, I had identical girls but we didn’t know they were identical, we thought that they were fraternal. So, I was getting just the monthly ultrasounds.

So, I would go to my OB and then two weeks later, I would go to the perinatal centre and then get the detailed ultrasound. Then, two weeks later; it ended up being every two weeks. So, a lot of coverage

SHELLY STEELY: Yes, it does come out that we did the same thing. We’d go to Fetal Genetics and Testing for the Ultrasound and then a week later, I would see my OB and he would go over it with me. Two weeks back to fetal genetics and then a week later, see my OB. So, I’ve got a stack of ultrasound coming in, four inches thick.

SUNNY GAULT: That’s how they originally schedule me then when I started seeing the perinatologist, she said: “You don’t need to do all those other ultrasounds.” I’m testing you every two weeks. So, it doesn’t matter. Then, I get to cancel in all of those. Well, I still go every two weeks if I really got out of anything.

CHRISTINE STEWART-FITZGERALD: It’s definitely a lot of testing. I think compared to a singleton pregnancy. We all know it’s much more common to have twins earlier as far as the overall gestation period. I’m always trying to say it correctly. A mono chorionic or a mono amniotic pair, does that affect the overall gestation period?

DR. SEAN DANESHMAND: Yes, those babies definitely get delivered sooner. So, those babies are hospitalized and usually we have them meet with the neonatologist at the consultation as far as, “Okay, what are the complications as far as seated with preterm delivery at 24 weeks? 25 at 26 weeks and parents make a decision.

They say: “We want to do everything possible. If you see decelerations at the baby’s heart rates while you monitor these angels then we want to get delivered at 24 weeks at the stage of liability.”

So, those patients get hospitalized at 24 weeks. Other mom says: “We’re not going to do anything. I don’t want any kind of intervention until 28 weeks.” We’d hospitalized them at 28 weeks.

Those babies usually get delivered via 32 to 34 weeks depending on if they are stable, usually about 34 weeks. Again, this is the fear that something can happen with that consequences are usually bad.

So, they get hospitalized, they get frequent monitoring, they get Betamethasone which helps the babies [inaudible] to their lungs make up Surfactant or produce them make a Surfactant which allows these babies to breathe a little bit easier when they were born.

They were in the hospital because mainly because of the fact that they are close to the NICU and they will be close to an operating room.

CHRISTINE STEWART-FITZGERALD: So, this is really – it’s a consultation with a neonatologist.

DR. SEAN DANESHMAND: Neonatologist and the perinatologist and they make decisions. But, they were going to be hospitalized for the duration of the pregnancy.

SHELLY STEELY: The mono chorionic, mono amniotic

DR. SEAN DANESHMAND: Mono amniotic so in one sac; so, one placenta, one sac both twins.

CHRISTINE STEWART-FITZGERALD: This is a fairly rare occurrence.

DR. SEAN DANESHMAND: One percent of all mono zygotic placentas are like that with identical twins. I know it’s rare.

CHRISTINE STEWART-FITZGERALD: I think what you want to say is: “This is not the case for most of the twin moms out there.”

DR. SEAN DANESHMAND: No, so that’s why parents always ask: “Are they in the same sac? Do you see a membrane?” Sometimes you see patients because they cannot identify a dividing membrane. It’s very thin for example because it is completely the management of the pregnancy.

CHRISTINE STEWART-FITZGERALD: Okay, so that’s good news. Okay, thanks so much Dr. Daneshmand for joining us today. So, for more information about: “Identifying twin types during pregnancy or for more information about any of our experts or panellists, visit the episode page on our website.”

This conversation continues for member of our Twin Talks Club. After the show, Dr. Daneshmand will talk about: “Some unusual twin pregnancies he’s seen.” For more information about the Twin Talks Club visit our website www.TwinTalks.com .

[Theme Music]

SHELLY STEELY: Here’s a question from one of our listeners. This comes from Leslie of Chicago.

“My husband and I just found out we were pregnant with twins. We have a singleton already which was able to nurse for at least nine months. But I have to say, I’m quite nervous about nursing twins considering my milk supply came in a little late with my first.

A milk supply always seems to be an issue. I know you have another series focuses on breastfeeding but will Twin Talks also be providing specific information about breastfeeding twins?”

-Leslie

SUNNY GAULT: Hey Leslie, this is Sunny. I’m one of the producers on Twin Talks and answer your question. Yes, we are going to be doing specific episodes focused on breastfeeding. It’s a topic that’s very important to all of us here at New Mommy Media. We were going to be launching a series called: “Breastfeeding twins.” That’s going to be coming up here shortly.

The other thing that I want to let you know too even though it’s not specifically focused on twins is that we have a sister show called: “The Boob Group” which is all about breastfeeding. It’s a weekly podcast just like Twin Talks and it’s hosted by an International Board Certified Lactation Consultant.

They have some amazing guests on that show all of which are lactation consultants in the industry of breastfeeding and have helped a lot of women. So, that’s another great resource I would point you too. The website for that is www.TheBoobGroup.com but, yes we will be having episodes focused on breastfeeding right here on Twin Talks.

CHRISTINE STEWART-FITZGERALD: So, that wraps up our show for today. We appreciate you listening to Twin Talks. Join in our discussion by posting your comments on the Twin Talks Facebook Page or by calling our voice mail at 619-866-4775.

Don’t forget to check our sister shows:

• Preggie Pals for expecting parents
• The Boob Group for moms who breastfeed their babies
• Parent Savers an online support group for the new parents.

Next week, we’ll be starting are series: “The twin baby year essentials and talk to experts about double strollers.” This is Twin Talks, parenting times two.

[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

SUNNY GAULT: New Mommy Media is expanding our line-up of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or an organization interested in our network of our shows through a cobranded podcasts, visit www.NewMommyMedia.com .

[00:38:28]
[End of Audio]