After a high-risk monochorionic monoamniotic pregnancy, Emily Tate delivered twins Lilith and Luna safely. They’re recovering well at The Birthplace at M Health Fairview Masonic Children’s Hospital.

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Safe and sound: Expert monitoring helps mother, twins through high-risk pregnancy

Emily Tate was three months pregnant when doctors discovered she had a rare monochorionic monoamniotic pregnancy. Thanks to comprehensive monitoring, twins Lilith and Luna arrived safely.

  • August 03, 2021
  • By Staff Writer

Emily Tate was almost three months pregnant when she found out she was having twins. It was her first pregnancy. Soon after, she was in for another surprise.

During an ultrasound at M Health Fairview Clinic – Wyoming, doctors discovered Tate was having monochorionic monoamniotic, or mono mono twins. Unlike typical twins, which have their own placenta and amniotic sac during pregnancy, mono mono twins share just one of each.

With the exception of conjoined twins, this is the rarest and highest-risk type of twin pregnancy. Mono mono twins face many potential health hazards, including tangled umbilical cords, which is a life-threatening situation. Because of the shared placenta, blood may also flow unevenly between the twins, causing developmental issues. In almost all cases, babies are delivered early.

Immediately after her ultrasound, Tate’s care team referred her to the M Health Fairview Maternal-Fetal Medicine Clinic for expert care.

“I would estimate that one in 35,000 to 60,000 pregnancies are mono mono,” said Maternal-Fetal Medicine Physician Sarah Cross, MD, medical director of The Birthplace at M Health Fairview Masonic Children’s Hospital. “Mono mono pregnancies require frequent, specialized ultrasounds to monitor the umbilical cords and the blood flow between fetuses.”

Conjoined Twins Separated At University Of Minnesota Masonic Childrens Hospital

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Connected at the heart

The potential for unequal blood distribution can also lead to structural heart problems in newborns, so our team brings in pediatric cardiologists to assist during mono mono pregnancies.

After the pregnancy reaches 22 weeks, patients are offered inpatient admission to The Birthplace. Mothers can stay until delivery, receiving three hours or more of daily monitoring. Tate chose to be admitted to The Birthplace’s unique Pregnancy Special Care Unit, where patients with high-risk pregnancies can receive pre-delivery care, when she was 24 weeks along. She ended up delivering twins Lilith and Luna Ilstrup at just under 32 weeks.

While it was difficult to be away from home for so long, Tate said it was an easy decision because of the compassionate care she received and the fact that monitoring could keep her babies safe.

“Emily actually delivered about four days before she was scheduled to, because the twins began showing signs of distress,” said Cross. “That’s why we admit mono mono pregnancies. We can see those warning signs and work quickly to prevent stillbirths.”

Maternal-Fetal Medicine specialists also gave Emily steroids, which helped the babies develop more quickly before birth. The twins were delivered by cesarean section. Vaginal delivery is too risky for mono mono pregnancies, because of the possibility for tangled umbilical cords.

After birth, the twins were cared for in the neonatal intensive care unit (NICU) at M Health Fairview Masonic Children’s Hospital. Our Level 4 NICU offers the highest level of care and comprehensive support to premature babies. This includes complex surgical care, dialysis, and life support, in addition to ventilator support. During mono mono pregnancies, the NICU team is on hand to assist with delivery at a moment’s notice.

“Ideally, patients can deliver as late as Emily did. However, many moms end up needing to deliver earlier,” said Neonatologist Erin Osterholm, MD, medical director of The Birthplace’s NICU. “When the monitor shows signs of distress, we can mobilize very quickly.”

Thanks to expert care before, during, and after delivery, the twins are doing well and are expected to be discharged in early August. 

“They both came out crying, which was remarkable,” Tate recalled. “They didn’t need much breathing support. Once they started bottle feeding, it only took them a day or so to get the hang of it.”

Tate and her husband, Geoffrey Ilstrup, have also been able to hold the girls – providing both parents and children with much-needed contact. They’re now looking forward to getting the twins home into a newly-decorated nursery.

“The babies are thriving, and we’ll continue to see them in our NICU Follow-Up Program,” said Osterholm. “This is part of a long journey. It started before delivery, and we’ll continue to support Lilith and Luna’s development for years to come.”