A ‘miracle baby’ in China that survived despite being born at just 23 weeks has managed to live through her first week of care. 
 
 The tiny baby girl, who is now eight days old, was born last week in Chongqing, southwest China, after doctors performed an emergency operation to correct a problem with her mother’s cervix. 
 
 Before the operation, doctors warned the child’s parents that the baby would be born severely premature and would have next to no chance of survival. 
 
 Yet despite the doctor’s bleak forebodings, the baby lived through the operation. Chief of Paediatrics at the Chongqing Southwest Hospital said that the fact the baby survived a “spontaneous abortion” was very rare, as it is almost impossible for a baby to live through something like this. 
 
 The baby, who weighs just 660 grams and measures 28 cm, was taken straight to an incubator after the operation and is currently receiving around the clock care. 
 
 Due to the baby being born so early, medical staff have said that the baby’s organs and veins have are yet to fully develop and this has caused some complications in giving the baby girl the correct medication and nutrients. 
 
 The ‘miracle baby girl’ has been named ‘chopstick girl’ by local Chinese media because she is the same height as she is the same height as a chopstick. ||||| Kansas City, Mo. -- (The Today Show) Healthy and thriving at more than 9 pounds each, they smile and wiggle, preemie twin boys whose mother feared the worst when she went into labor about four months early. But mom Elene Cowan calls their survival a miracle after her sons were born 39 days apart, another unusual instance of tiny twins arriving on different days. 
 
 "I didn't think miracles happen but I know they did," said Cowan, 30, an emergency room nurse who slipped her engagement ring around her firstborn son's wrist when he was about a week old. "When your ring can fit around your son's arm and now you're holding him and feeding him and playing with him on the floor, that can only be a miracle." 
 
 Cowan, who delivered Carl at 24 weeks on Jan. 20, and David Jr. at nearly 30 weeks on March 28, credits her doctor with making the right decision to delay the second delivery for as long as possible to improve David's chances despite the risk of infection or other complications. 
 
 The five weeks between vaginal deliveries at Research Medical Center in Kansas City, Missouri, were agonizing for Cowan, who was torn between tending to Carl in the neonatal intensive care unit and resting to protect her fragile pregnancy. 
 
 "It was awful being pregnant and going to the NICU and being worried about one baby inside of you and worried about one baby outside of you," Cowan said. 
 
 Her scary ordeal began in January, when she and her husband, David, flew home to Missouri from Saudi Arabia, where he works as an emergency room doctor. Within hours, she didn't feel right and wondered if she was dehydrated. 
 
 But doctors found that Carl's amniotic sac was entering the birth canal, Cowan's cervix was starting to dilate and she was having contractions. With medication and other treatments, her labor was stalled for about a week, when she gave birth to Carl, tiny at 1.4 pounds. 
 
 "I just thought there's no way he's going to survive," Cowan said. But in the silence of the operating room, she knew he was alive. "He had two little cries. That made me really happy." 
 
 Her obstetrician, Dr. Howard Schwartz, said in an interview that he believed that Cowan suffered from an incompetent cervix, a condition where weak cervical tissue can cause premature birth. He placed a stitch to hold her cervix closed, and ordered antibiotics and medications to stall labor. 
 
 "The opportunity to buy time was the reason for trying to do the procedure to separate their births," he said, noting that there is about a 50 percent chance of survival for babies born at 24 weeks. 
 
 Cowan's labor became unstoppable again in late March, when David was born, weighing more than twice that of brother, at 2.9 pounds. 
 
 "I thought, 'Oh my gosh. He is the biggest baby ever,'" she said, noting that her husband watched the birth from Saudi Arabia through a video call. 
 
 The boys stayed in the neonatal intensive care unit for weeks, finally going home in late May, about a week after their due date of May 11. Doctors told Cowan the fraternal twins, will be "perfectly healthy normal little boys," though Carl remains on oxygen. 
 
 Schwartz said he has treated at least six women carrying multiple fetuses with an incompetent cervix the same way as Cowan over the last 15 years. It is not commonly done, he said, because doctors are taught to deliver multiples at the same time. The delayed approach, he said, is "outside the normal mindset." 
 
 But, Schwartz said, with the right conditions and willing parents, it can work. "Thirty-nine days apart with both babies surviving is unusual, and yes, beats the odds," Schwartz said. 
 
 Read more: http://on.today.com/1pdwIsH 
 
 Photo courtesy of Elene Cowan. 
 
 39 days apart, born, miracle, preemie twins 
 
 Copyright KOBI-TV. All rights reserved unless otherwise stated. This material may not be published, broadcast, rewritten, or redistributed without written permission. ||||| Birth defects in monochorionic twin 
 
 A birth defect or anomaly is a medical term meaning irregular or different from normal. Anomalies occur more frequently in identical twins than in other pregnancies. 
 
 What are the different kinds of twins? 
 
 Monochorionic twins are identical twins who share one placenta. This occurs in approximately 70 percent of pregnancies with identical twins. 
 
 Monochorionic-monoamniotic twins are identical twins who share both a placenta and an amniotic sac . 
 
 Monochorionic-diamniotic twins are identical twins who share a placenta but not an amniotic sac. 
 
 Dichorionic twins each have their own placenta and amniotic sac. This occurs in approximately 30 percent of pregnancies of identical twins. All fraternal (non-identical) twins also are dichorionic twins. 
 
 Problems that can affect the health of monochorionic twins include: 
 
 Prenatal diagnosis of monochorionic twin anomalies 
 
 Doctors typically detect monochorionic twin pregnancies during a routine prenatal ultrasound. The best images are visible when ultrasounds are conducted prior to 14 weeks of pregnancy. This is when the structures of the placenta and amniotic sac are most visible. The ultrasound will show a single placenta supplying blood flow and two fetuses with a single, thin dividing membrane if they are monochorionic twins. 
 
 At this point, the ultrasound may also show if there is one amniotic sac or two. If there are two, physicians will look to see if there are differences in the amount of amniotic fluid present in each. 
 
 What happens after diagnosis? 
 
 Depending on the ultrasound findings, your obstetrician will likely refer you to a maternal-fetal medicine specialist (a doctor who specializes in high-risk pregnancies). Additional maternal and fetal tests may be required to screen for anomalies, such as TTTS and TRAP sequence. One screening test is a fetal echocardiography. This specialized ultrasound of your babies’ hearts and blood vessels shows the flow of blood between the twins. 
 
 To monitor the size of your babies, along with their blood supply and amniotic fluid, your doctor will order repeat testing and ultrasounds throughout your pregnancy. 
 
 How do monochorionic anomalies affect my babies? 
 
 Twins in general are more likely than single fetuses to face challenges with development and delivery. These chances increase for monochorionic twins. Some concerns are: 
 
 Low birth weight 
 
 Birth weight is a factor for nearly all monochorionic twins. All twins are 10 times more likely to have a lower birth weight than babies from single pregnancies are. For monochorionic twins, the risk of low birth weight is four times higher than in pregnancies in which each fetus has its own placenta. 
 
 Weight inequality between your twins 
 
 Weight inequality also can be a concern. A significant difference in the weight of the babies is more common among monochorionic twins. When there is not enough nutrition for one or both fetuses to develop at a normal rate, intrauterine growth restriction (IUGR) can occur. 
 
 Differing amniotic fluid levels 
 
 Unequal amniotic fluid levels can affect your twins. Twins deprived of a blood supply will produce too little amniotic fluid – a condition called oligohydramnios. This condition limits their movement and bladder size, among other consequences. A larger than normal blood supply will result in excess amniotic fluid (polyhydramnios), enlarged bladder and the possibility of hydrops (heart failure). 
 
 Cord entanglement or compression 
 
 Cord entanglement or compression is a risk for all monochorionic-monoamniotic twins who share the same space in a single amniotic sac. Umbilical cords are the lifeline to blood and nutrients for all fetuses. Like a garden hose, if the cords flatten or bend, the supply line can be damaged or cut off, impacting fetal development and increasing the risk of death. 
 
 TTTS and TRAP sequence 
 
 Two conditions called TTTS and TRAP sequence may develop in rare circumstances. These conditions, caused by inequalities in the blood supply, have serious implications for the fetuses and require highly specialized care. If TTTS is not detected and treated, it is likely to result in the loss of both babies. In TRAP sequence, one twin will not survive because it does not have a developed heart and brain structure. The survival rate for the healthy twin is 25 to 50 percent when TRAP sequence is not detected and treated. 
 
 How do anomalies in monochorionic twins affect the pregnancy? 
 
 Care guidelines for monochorionic pregnancies with anomalies are similar to those for mothers carrying all twins. Depending on your babies’ needs, your doctor will make adjustments in your care plan. For example, your doctor may change guidelines for: 
 
 Nutrition 
 
 Rest 
 
 Prenatal visits 
 
 Other factors 
 
 Your doctor will also want to closely observe your babies and monitor their health through ultrasound and other tests. 
 
 Your doctor may also recommend: 
 
 Bed rest 
 
 Tocolytic medications (medications to stop contractions or labor) 
 
 Other measures to prevent early delivery 
 
 There is a possibility you will have to be hospitalized for constant monitoring. This is the case for babies with cord entanglement, TTTS and TRAP sequence, for example. 
 
 What to expect during labor and delivery 
 
 There is a good chance your labor and delivery will be early. Premature delivery is the most common complication of twin pregnancy. This rate does not increase significantly when the pregnancy is monochorionic, but the rate of very early delivery (before 32 weeks) is nearly twice as high when compared with dichorionic twins. Even without major complications, most doctors will recommend that monochorionic twins be delivered at least three weeks before the official due date. 
 
 There is also a greater incidence of cesarean section deliveries in monochorionic pregnancies, especially when they are monoamniotic and at risk for cord entanglement at birth. 
 
 How are abnormalities and complications in monochorionic twins treated? 
 
 Treatments for complications of monochromic pregnancies vary depending on the condition of the babies. 
 
 Cord entanglement 
 
 In the case of cord entanglement, physicians may recommend delivery of the twins as soon they are mature enough to survive, which may be as early as 24 weeks. In these cases, your doctor may give you corticosteroid medications to accelerate lung development in your twins so they have a greater chance of surviving outside of the womb. Many cases of cord entanglement need extensive monitoring of the twins in the hospital to help determine the best time to deliver them. 
 
 Amniotic fluid issues 
 
 If excessive amniotic fluid is a concern, your physician may perform an amnioreduction to reduce the amount of amniotic fluid. This procedure will: 
 
 Make you more comfortable 
 
 Reduce the chance of premature labor 
 
 Better equalize the flow of blood between your twins 
 
 Your physician may need to repeat this procedure throughout your pregnancy. 
 
 TTTS 
 
 In the case of TTTS, an increasingly successful approach involves disconnecting part of the blood supply between the twins using a technique called fetoscopic laser ablation of the shared placental vessels, otherwise known as laser ablation. 
 
 This procedure is only offered at select treatment centers, like Children’s Hospital of Wisconsin through the Fetal Concerns Center. In 80 to 85 percent of laser surgery procedures, at least one twin survives; both twins survive in 65 to 70 percent of cases. The survival rate of both twins with TTTS without laser ablation is 10 to 20 percent. 
 
 TRAP sequence 
 
 If your doctor has diagnosed TRAP sequence, he or she may recommend delivery of the healthy twin if your pregnancy is far enough along. In other cases, your doctor may recommend prenatal treatments to stop the extra pumping between the twins. These procedures, performed using highly specialized techniques within the womb, may include radiofrequency ablation. RFA is usually performed between 17 and 24 weeks of pregnancy. 
 
 RFA is a procedure performed by our team of experts in the Fetal Concerns Center and at a very limited number of neonatal centers across the country. The procedure uses heat energy to stop the blood flow to the umbilical cord of the underdeveloped twin. RFA has been shown to be extremely successful, with a 90 percent or higher survival rate for the normal twin when delivered at least 35 weeks into the pregnancy. 
 
 Are there risks of treatment? 
 
 Procedures such as amnioreduction, laser ablation or RFA, like any surgeries, pose a risk of bleeding and infection that can lead to complications for both the mother and baby. 
 
 Other potential complications related to fetal surgery include injury to the baby and premature labor and delivery. 
 
 If you have one of these procedures, you will most likely be admitted to the hospital for monitoring for two to three days. After your stay, your doctor will discharge you for ongoing care by your obstetrician. You may have to be on bed rest and you may have to take medications to prevent premature delivery. 
 
 If your babies are born prematurely or with special needs, they will be cared for in a special care nursery called a neonatal intensive care unit. At the NICU, expert physicians and staff can quickly respond if your babies need specialized care. 
 
 Will I be able to help care for my babies? 
 
 Yes. Ask your nurse about ways to interact with and care for your babies. Babies that are healthy at birth may need only a brief stay in a special care nursery. Others may need more time in the NICU to resolve health issues. 
 
 Breastfeeding and pumping/storing 
 
 Many mothers are able to successfully breastfeed their twins. Lactation specialists can help mothers of multiples learn techniques for breastfeeding their babies separately and together and increase their milk supply. 
 
 Mothers whose babies are unable to breastfeed because they are sick or premature can pump their breast milk and store the milk for later feedings. 
 
 Getting help with your babies 
 
 Families with more than one baby need help from family and friends, especially if the pregnancy was complicated and there are other siblings at home. Having help will allow you more time to get to know your babies, take care of feedings and rest and recover from delivery. 
 
 When can my babies go home? 
 
 Most monochorionic twins with anomalies will need to be cared for in the NICU. How long your babies remain hospitalized will vary depending on their conditions. Once babies are able to feed, grow and stay warm, they usually can go home. 
 
 What is the long-term prognosis for my babies? 
 
 The long-term prognosis depends on the types of complications caused by the monochorionic pregnancy, including birth weight and prematurity. Low-birth-weight babies have an increased risk of long-term problems, such as: 
 
 Mental retardation 
 
 Cerebral palsy 
 
 Vision loss 
 
 Hearing loss 
 
 Babies born between 24 and 32 weeks have a high risk of death or severe handicaps if they survive. Babies born after 32 weeks often face feeding and breathing problems, but they nearly always survive. 
 
 What about future pregnancies? 
 
 Having a previous monochorionic pregnancy does not influence whether or not you will have another one. The incidence of identical twins is not influenced by family history, so the chances of having them are the same for all women – approximately 1 in 285 pregnancies. 
 
 The chance for any woman to have a monochorionic pregnancy with anomalies is approximately 1 in 5,816 pregnancies or less than 0.05 percent.
– They call her "chopstick girl," which provides a sense of her size: all of 11 inches long and weighing just 23 ounces. The Independent reports that a girl in southwest China has survived after being born last week at just 23 weeks. She came along after doctors had to perform an emergency procedure on the mother's cervix, which triggered what the lead pediatrician at Chongqing Southwest Hospital called a "spontaneous abortion" (though most definitions seem to frame "spontaneous abortions" as occurring before the 20th week). Shanghaiist reports the 24-year-old mother-to-be was experiencing complications from placenta previa, in which the placenta obscures part or all of the opening of the cervix. Doctors had told the parents the procedure would trigger the baby's birth and gave the infant almost zero chance of survival. But she remains on 24-hour care in an incubator. One complication: She's so young and tiny that her veins are not yet fully developed, making it trickier to provide her with nutrients. Xinhua has photos. (Click to read about a Canadian mom who gave birth in the US and got a bill of nearly $1 million.)