The extremely rare type of twin pregnancy, monochorionic/monoamniotic — more commonly called mono mono twins— would lead to a difficult and very high-risk pregnancy.
The expectant couple and their toddler Holden, moved from their home in Horsefly B.C. to Vancouver when Shelby was 26 weeks pregnant for close daily monitoring. “My care at BC Women’s Hospital was incredible,” says Shelby. “I went in every day, twice a day for non-stress tests (NST's) that were 12 hours apart, as well as every second day I went in for a Doppler ultrasound to measure the twins’ blood flow.”
Although mono mono fetuses share one amniotic sac and one placenta, they do have separate umbilical cords and frequently the cords and babies get entangled with each other.
“Entanglement and compression of the cords is what we’re really concerned about. The oxygen supply to the baby can be reduced or cut off entirely which can cause neurological damage, or worse,” says Dr. Ken Lim, head of the Division of Maternal Fetal Medicine for the BC Women’s Hospital + Health Centre. “We bring our patients to the hospital somewhere between 24 to 26 weeks so we can monitor their babies several times a day, because we know that the risk of one or both of the babies dying or other serious complications is fairly significant.”
When to deliver them is a delicate balance between the risks and benefits. “The longer you leave them in, the higher the risks of something bad happening; but on the other hand you don’t want to take them out too soon as you then incur the risks of prematurity which includes death and disability,” says Dr. Lim. “Our team decided a C-section was in order at 31 weeks because the monitoring showed the indications of cord compression, and that twin b would be at risk, it just became too dangerous to continue with the pregnancy.”
A highly skilled BC Women’s team — which included Dr. Blair Butler, Dr. Alison Thiele, anaesthesiologist Dr. Vit Gunka, as well as doctors and nurses from the neonatal intensive care unite (NICU)—quickly mobilized as soon as they realized the urgency. “Each baby had their own team from the NICU – there were probably 20 people in the delivery room,” says Shelby. On May 31, 2016, just days away from their 32-week goal, Shelby gave birth to Camden and Courtlen, both just three pounds, 11 ounces.
According to BC Women’s diagnostic radiologist Dr. Denise Pugash, approximately one to two per cent of pregnancies are twins, but monoamniotic twins are even more rare, occurring in just one in 10,000 twin pregnancies.
Dr. Pugash leads the recently opened Perinatal Research Imaging Evaluation (PRIME) Centre at BC Women’s. The new technologically advanced ultrasound centre provides exceptional and unique care, ideal for cases like the Goodvin’s.
“The expertise in PRIME is incredibly unique because all the research is based on taking photos of the fetuses using different techniques, not just ultrasound,” says Dr. Pugash. “By collaborating with specialists, we present [clinicians] with new expertise, pushing us forward and unveiling high-level research on pregnant women and their fetuses.”
The PRIME Centre is used by a variety of researchers, including biomedical engineers from UBC, physicists, pediatric surgeons, trainees, as well as a core group of perinatologists (obstetrical subspecialists who care for the mother and fetus who are at higher-than-normal risk for complications). Its breadth is far reaching. “The NICU for example, benefits greatly from PRIME’s research, such as investigating the potential for brain damage before birth.” This research is clinically relevant in very high-risk pregnancies such as the Goodvin’s,” says Dr. Pugash. “Ultimately, we want to discover new methods to treat babies before birth, and to optimally time the deliveries of babies like Camden and Courtlin.”
“The PRIME Centre is distinctive in Canada,” says Dr. Pugash. While there are a couple of similar centres across Canada, they don’t have the same focus on ultrasound imaging for research and training that the PRIME Centre does.
The PRIME Centre features four scanning rooms and a high-tech obstetrical ultrasound simulator. With the use of an interactive pregnancy-replication mannequin, doctors and researchers can advance their training using simulation-based learning that is just like the real thing.
The mannequin, explains Dr. Pugash, can mimic many high-risk scenarios that doctors and specialists encounter with real patients. This includes the different positions a baby may take throughout a pregnancy, as well as potential concerns in regard to fetal development.
Each year, more than 7,000 babies are delivered and 16,000 ultrasound exams are performed at BC Women's.
“The reason we see so many births, the most complicated ones, is because BC Women’s has a reputation as a top-notch hospital for high-risk births,” explains Dr. Pugash.
Today, Camden and Courtlen are thriving and happy. “They are perfect,” say the proud parents. “We feel so blessed. Their births couldn’t have gone any better and I can’t thank the team at BC Women’s enough for what they did for our family.”