29-year-old Nidhi Gill was advised by many to abort one or both of her monoamniotic twins due to the high risk pregnancy, but her boys survived the medical condition and the odds as they turned one this Diwali.
Veer and Shaurya, the first twins in the Gills family, were born at a city hospital through an emergency cesarean surgery, 33 weeks after the pregnancy due to chances of intra-uterine growth retardation or poor growth of foetus inside the womb.
Monoamniotic twins (sharing the same amniotic sac within the uterus) are rare occurring in approximately 1 in 35,000 to 1 in 60,000 pregnancies where serious complications could arise, especially for the foetus.
Usually termed as ‘Monoamniotic-Monochorionic’ or ‘MoMo twins’, they are always identical, monochorionic and share the placenta, but have separate umbilical cords.
“I had no idea about this kind of twins and many advised us to go for abortion of either one or both of the babies, saying their lives and mine, both would be endangered if I went ahead with the rare pregnancy. But I wanted to have them.
“And, on the day of the delivery, I was awake and felt nervous when I could not hear any voice. But, after a moment, the first baby cried and few minutes later the second one also did. It was the most amazing feeling,” says Nidhi, a working mother from Delhi.
Senior Consultant, Obstetrics and Gynaecology at BLK Super Speciality Hospital, Poonam Khera, who monitored Nidhi’s pregnancy, said, “I had to first counsel and mentally prepare her to undergo this. I told her about the complications that could have occurred, but the idea was to calm her.”
The hospital said this was the first case of ‘MoMo twins’ at BLK.
Nidhi responded well and successfully delivered two male babies, weighing 1.2 kgs and 1.59 kgs, they said.
Both the twins are healthy and doing extremely well. After celebrating their first birthday yesterday, they are now looking forward to their first Diwali.
But the entire pregnancy period was fraught with challenges, and in MoMo twins, Khera said, the birth was premature and through surgical intervention.
“It is a high-risk pregnancy and can lead to intra-uterine growth retardation or death of the twins, or one twin becoming big while other becoming very small, low weight of babies. For expectant mothers it can cause pregnancy-induced hypertension that leads to swelling of feet,” Khera told PTI.
Doctors at Delhi’s Fortis Le Femme, where 70 normal twin births have taken place this year, said, the expectant mothers should go for regular check-ups for any complications.
“After birth, the babies are kept in a nursery for some time, so it is of paramount importance that women must only go to such facilities which have nursery. Besides, other precautions must be taken before the C-section,” Senior Consultant, Obstetrics and Gynaecology at Le Femme, Madhu Goel said.
The complexity in such cases arises when the embryo does not split until after the formation of the amniotic sac which leads to monoamniotic twins, who share the same placenta.
On the other complexities involved in this case, Khera said, “There are chances of cord entanglement between the twins, which can lead to choking; cord compression which could stop the flow of nutrition between the twins, and twin-to-twin transfusion syndrome (TTTS).
“Under TTTS, one twin receives majority of nourishment causing the other twin to become severely undernourished,” she said.
The Gills read up on the internet about ‘MoMo twins’. Before coming to us, they were informed that this kind of pregnancy is rare and the expectant mothers in these cases are generally advised for termination, the BLK Hospital authorities said.
“Having a set of monoamniotic twins can be precarious and unpredictable and to avoid complications, most twins are delivered prematurely, often by c-section,” Khera said, adding, “Nidhi was advised complete bed rest for 80-90 days to reduce the risk during her pregnancy.”
Goel said other complications included “neonatal morbidities, bleeding in the brain, respiratory distress.”
“Routine investigation of the expectant mothers is necessary, from haemoglobin to blood level monitoring in MoMo twins cases,” she added.
Khera said, in case of Nidhi, “One baby was getting weaker and her blood pressure had risen that was causing swelling of her feet (oedema feet).”