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Monday, October 14

MCMA Twin :: Momo twin :: Kembar 1 kantung 1 Plasenta

Salam..

entry ni nak cerita sedikit sebanyak tentang kehamilan kembar satu kantung satu plasenta....di minggu ke 13...doc sahkan mama mengalami kehamilan ini atau dalam bahasa Inggerisnya MCMA twin (Monochorionic Monoamniotic) atau MOMO twin....pada mulanya ingat ia benda biasa bagi kehamilan kembar...bila balik rumah....mama google ......satu-persati artikel yang keluar benar-benar meruntun hati mama.....mula bertanya....Ya Allah...apakah dugaan yang Kau turunkan buat aku ini...sungguh berat....bagai tak mampu untuk memikulnya...........

dipetik dari about.com Twins and Multiples

There are many risks associated with a twin pregnancy, but some of them only affect certain kinds of twins. MoMo twins are monozygotic multiples that develop in a single, shared amniotic sac. The situation causes risk to the babies due to cord entanglement.

What are MoMo Twins?

The term describes twins that are monochorionic and monoamniotic, that is, there is a single chorion and a single amniotic sac. The amniotic sac is the bag of waters that contains the fetus, while the chorion is the outer membrane. These are monozygotic twins that develop from a single egg/sperm combination which splits into two. When the split is delayed, usually a week or so after conception, the process of growing a placenta, chorion and amniotic sac has already begun, and the two embroys will develop within a single, shared sac. Only about 1% of twin pregnancies will occur in this manner. The majority of monozygotic twins will develop with separate sacs, or sometimes with separate amnions within a shared chorion. (These are described as monochorionic-diamniotic or MoDi.)

How Are MoMo Twins Disagnosed?

Ultrasound is the only way to detect MoMo twins. During a twin pregnancy, most mothers are routinely monitored with ultrasound. Doctors will look for the presence of a dividing membrane to indicate that the twins are in separate sacs. The lack of a membrane, or a thin or vague line may prompt further analysis to confirm the situaiton.

What are the Risks of MoMo Twins?

The twin fetuses connect to the placenta via their umbilical cords. Resting together in the same sac puts them at risk for cord entanglement or cord compression. The umbilical cords provide a vital lifeline to the babies, supplying blood and nutrients that help them grown and develop. As the babies move around in the uterus, the cords can cross or press against each other, cutting off the supply. It can be a life-threatening situation. The longer the cords are entwined, the greater the risk of damage to the cords, and the risk of death for one or both babies increases.

What is the Treatment for MoMo Twins?

Fortunately, modern technology allows doctors to observe babies in the womb, and monitor the situation. High resolution ultrasounds, doppler imaging and non-stress tests help to assess symptoms and identify potential cord problems. Cord entanglement and compression are generally a slow process, so parents and medical caregivers have time to make decisions. Some situations will require such close monitoring that the expectant mother must remain hospitalized. There is no approved treatment or procedure to fix the situation. The only resolution is delivery of the babies. Virtually all MoMo babies are born prematurely. Doctors have to balance the risks of the babies' condition in the womb versus the consequences of prematurity. If cord compression occurs early in the pregnancy, the babies may not be able to survive. Some doctors elect to schedule delivery of MoMo babies at 32, 34 or 36 weeks, believing that the womb environment is simply too dangerous past that point in time. Sometimes steroids may be administered to boost the babies' lung development and improve their chances of surviving outside the womb. A cesarean section is mandated for MoMo babies to avoid cord prolapse, a situation that occurs when the second babies cord is expelled as the first baby is delivered.

More Information About MoMo Twins

  • MoMo babies are always the same sex: either two boys or two girls. Like virtually all monozygotic twins, they are the same gender because they derive from the same gene set. (No cases of the chromosomal abnormality that generates gender disparity in monozygotic twins has been identified in MoMo twins.)
  • MoMo twins are very rare. Only 1 percent of all twin pregnancies will be monoamniotic.
  • The survival rate of MoMo twins is estimated at about 60%.
  • A new treatment is being explored. Sulindac is a drug that reduces the amount of amniotic fluid and reducing the space in which the babies can move around.
  • Mothers of MoMo multiples should be cared for by a perinatologist (obstetrician specializing in high risk pregnancies), or should at least consult with an doctor experienced with MoMo twins.
  • MoMo twins are often misdiagnosed in the early weeks of pregnancy when the membrane is so thin as to be nearly invisble. Often a later ultrasound reveals a dividing membrane confirming that twins are actually MoDi (Monochorionic, Diamniotic).


Yang ini pula di petik dari wikipedia

Monoamniotic twins are identical twins that share same amniotic sac within their mother’s uterus. Monoamniotic twins are always identical, and always monochorionic as well (sharing the same placenta), and are sometimes termed Monoamniotic-Monochorionic ("MoMo") twins. They also share the placenta, but have two separate umbilical cords. Monoamniotic twins develop when an embryo does not split until after formation of the amniotic sac,at about 9 days after fertilization.Monoamniotic triplets or other monoamniotic multiples are possible, but extremely rare.Other obscure possibilities include multiples sets where monoamniotic twins are part of a larger gestation such as triplets, quadruplets, or more.
Occurrence
Monoamniotic twins are rare, with an occurrence of 1 in 35,000 to 1 in 60,000 pregnancies, corresponding to about 1% of twin pregnancies.

Complications

The survival rate for monoamniotic twins has been shown to be as high as 81% to 95% in 2009 with aggressive fetal monitoring, although previously reported as being between 50% to 60%. Causes of mortality and morbidity include:
  • Cord entanglement: The close proximity and absence of amniotic membrane separating the two umbilical cords makes it particularly easy for the twins to become entangled in each other’s cords, hindering fetal movement and development.Additionally, entanglement may cause one twin to become stuck in the birth canal during labor and expulsion. Cord entanglement happens to some degree in almost every monoamniotic pregnancy.
  • Cord compression: One twin may compress the other’s umbilical cord, potentially stopping the flow of nutrients and blood and resulting in fetal death.
  • Twin-to-twin transfusion syndrome (TTTS): One twin receives the majority of the nourishment, causing the other twin to become undernourished. TTTS is much more difficult to diagnose in monoamniotic twins than diamniotic ones, since the standard method otherwise is to compare the fluid in the sacs. Rather, TTTS diagnosis in monoamniotic twins relies on comparing the physical development of the twins.

Diagnosis

Ultrasound is the only way to detect MoMo twins before birth. It can show the lack of a membrane between the twins after a couple of weeks' gestation, when the membrane would be visible if present.
Further ultrasounds with high resolution doppler imaging and non-stress tests help to assess the situation and identify potential cord problems.
There is a correlation between having a single yolk sac and having a single amniotic sac.However, it is difficult to detect the number of yolk sacs, because the yolk sac disappears during embryogenesis.
Cord entanglement and compression generally progress slowly, allowing parents and medical caregivers to make decisions carefully.

Treatment

Only a few treatments can give any improvements.
Sulindac has been used experimentally in some monoamniotic twins, lowering the amount of amniotic fluid and thereby inhibiting fetal movement. This is believed to lower the risk of cord entanglement and compression. However, the potential side effects of the drug have been insufficiently investigated.
Regular and aggressive fetal monitoring is recommended for cases of monoamniotic twins to look for cord entanglement beginning after viability. Many women enter inpatient care, with continuous monitoring, preferably in the care of a perinatologist, an obstetrician that specialises in high risk pregnancies.
All monoamniotic twins are delivered prematurely by cesarean section, since the risk of cord entanglement and/or cord compression becomes too great in the third trimester. The cesarean is usually performed at 32, 34 or 36 weeks. Many monoamniotic twins experience life-threatening complications as early as 26 weeks, motivating immediate delivery. However, delivery around 26 weeks is associated with life-threatening complications of preterm birth.Steroids may be administered to stimulate the babies' lung development  and decrease the risk of infant respiratory distress syndrome. Natural birth rather than cesarean section causes cord prolapse, with the first baby delivered pulling the placenta shared with the baby being left inside.


untuk sehingga minggu ke 19...mama dilayan sebagai hamil momotwin/MCMA twin sebab tiap kali scan...memang tak nampak membran pemisah sehinggalah doc noraini suh buat 3d scan...baru dapat detect membran pemisah tersebut...itupun sangat-sangat halus dan nipis.........sepanjang kehamilan ini...memang banyak dugaan....sesungguhnya Allah swt sertakan dugaan tersebut agar kita lebih menghargai nikmat yang dikurniakan....walauapun adakala mama juga kalah dengan emosi dan peasaan.....tiap malam menangis kenangkan nasib anak2 dalam perut ni.......bayangkan apa perasaan anda bila berjumpa doc pakar o&G di salah sebuah hospital kerajaan....doc ni dengan muka tanpa perasaan cakap kat mama " you just get ready mentally because you gonna loose one of your baby or both.....jangan mengharap sangat...."...luluh hati Tuhan sahaja yang tahu...opkos kita yakin dengan apa yang doc tu cakap.....dia kan pakar...cuma sensitiviti doc ni perlu diperbaiki.....sampai satu tahap papa jadi ustaz dok nasihatkan mama...papa selalu kata...doc bukan Tuhan....dan dia hanya boleh meramal...yang menentukan hanya Allah.....dalam cuba menerima takdir......tiap malam berlinang airmata sebelum tido......sehinggalah status MCMA twin telah beruba menjadi MCDA (Monochorionic Diamniotic)...walaupun risiko telah berkurangan...hadir pula dugaan lain.....kita cerita di entry lain pula ya.......


MCMA twin sangat rare di Malaysia...bila mama refer hospital serdang pon...mama adalah kes yang kedua 4 years back....layanan memang special la......kehamilan seperti ini di luar negara memang ada sampai ada kumpulan sokongan ....banyak cerita sedih dan gembira yang mereka coretkan dan boleh di baca di sini.....baca blog ni memang banyak mengubah persepsi mama terhadap kehamilan yang sedang mama bawa ni.....mama kene kuat demi anak2 mama....

di bawah ni antara jenis-jenis kembar dan sekurang-kurangnya mama bersyukur yang kehamilan mama bukan kehamilan kembar siam/bercantum.....memang soklan pertama bila doc bagitau mama hamil kembar adalah " baby saya dah fully seperated tak doc?"



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Wednesday, September 11

2013 :: SEDIH SEBELUM GEMBIRA ::


Salam...setelah sekian lama.......baru menjenguk blog ni.....perasan atau tidak, mood untuk blogging hanya hadir waktu pregnant....sigh!!!
Apapun tak pe lah...nak wat macam mana...azam bagai nak rak tapi kalau kekuatan dalaman takde nak buat, kita nak kata apa...ye tak????hehehehehehehe....alasan sangat.....

ok le...mari kita bukak buku baru.......nak citer pasal pregnancy yang latest...wah!!!cam banyak kali jer......opkos!!!...ini kali yang keempat......tapi sebelum cerita gembira....meh ingat balik sebelum tibanya cerita gembira nih......bukan apa...sebagai kenangan...la ni mana nak tulis diari.....stok esok2 kalo nak kasik tau anak cucu...leh le cakap..."kalo kome tak percaya...pi baca blog opah....."...hehehehehehehehehe


Sepatutnya mama ngan papa bajet untuk tambah ahli keluarga baru pada tahun 2012....tapi kita hanya merancang....Allah yang menentukan...rezeki dapat beli umah dan ia siap tahun 2012.....bincang punya bincang...we decided untuk tangguh setahun sebab kalo boleh nak concentrate hal umah......opkos banyak pakai duit dan mama pon tak mampu nak berpindah dengan perut boyot or ada baby kecik...leceh plus kesian kat baby......
So kami pindah 25 Disember 2012......Alhamdullillah...puas hati...semua kami handle sendiri tanpa ID (quo ID ni bukan murah wehh!!!!).....cat sendiri, cari lampu cari kabinet, cari perabot dan electrical stuff semuanya sendiri....sesuai dengan kemampuan......memang seronok....

So bulan januari , berita gembira.......ada orang dalam peyut mama.....opkos happy....rumah baru.....anak pon baru.....sickness toksah cerita....hari2 lembik......mabuk kereta.....malam bila nak tido akan dimulakan dengan tangisan......makan semua tak lalu......heartburn memang 24 jam......ketara sangat la kali ni.....tapi mama tetap keje cam biasa...time tu banyak lak event....nak tak nak kene setel........

Kalo perasan...semua gambar kat bawah ni, kandungan baru 5 minggu...tapi perut dah buncit macam 4 bulan kekdahnyer...tertanya gak dalam hati...awat cepat perut ni naik......then pujuk balik hati....owh!!!mungkin anak yg no 3 so perut memang dah berlapis lemak so bila preggy naik cepat.....


 waktu ni buat show untuk wedding ummi hafilda (adik beradik azwan ali propa tu)...taktau preggy lagi time ni bebudak mama dah byk kali kata "kak sha ada isi nih...lain macam jer....."

 ni agm untuk pelitawanis....diapit mak buyung....time ni dah tau preggy...4 minggu kot....mama dah macam lebih kurang jer ngan diorang...huhuhuhu

 piknik staff usk.....perut makin boyot....5 minggu...mabuk masih lagi tapi mama still leh marinate + bakar membakar ayam....

 ulangtahun kelahiran yg ke 32.....6 weeks dah....muka ketara pucat..perut obvious sangat dah cam 4 bulan...

6 weeks 2 days....17 Februari 2013....event di TNB bangsar......pada hari inilah kesedihan bermula......

pada tarikh tersebut....mama memang rasa penat sangat tapi bajet sebab ke sana ke mari....uruskan show 3 hari .......balik dari last day punya show....umar ngan safi minta mainan...so mama ngan papa layankan...yer la....dah dekat 3 hari tak layan diorang....sibuk dengan latihan etc....ondaway balik umah, singgah nilai...kedai mainan kat situ memang kitorang suka sebab murah dan ada diskaun lagi........sampai jer kedai....mama suh umar ngan safi pilih sendiri.....mama rasa penat sangat sampai terus duduk bersila atas lantai sementara tunggu diorang memilih....

Tetiba rasa cam..."eh! naper rasa basah kat bawah ni...lantai basah ker???"
mama rasa lantai...tak basah pon...hati tetiba berdebar....terus mama rasa bontot mama..."BASAH!!"
bila tengok tangan....DARAH!!!!

terus pandang papa.......papa pon muka terkejut....mama terus blank...nak nanges ke...nak jerit ke...nak tenang ke.....taktau nak pikir apa...terus papa laju2 suh safi ngan umar pilih....pi bayar dan terus naik keta......papa kata nak terus ke Az zahrah.........mama dah mamai.......angguk sajer.......perjalanan lebih kurang setengah jam......papa bawak keta memang laju.....tapi tak selaju degup jantung mama time tu......

sampai Az zahrah terus inform kaunter dan mama terus dihantar masuk bilik scan....tunggu punya tunggu....datang MO untuk scan......hati mama masih berharap hanya bleeding biasa....bila scan , MO cakap baby dah tak ada....incomplete abortion termanya........punya dok tahan air mata....akhirnya tumpah jua......mama perasan yang papa pon mengalirkan air mata...tapi kami nak kata apa.....cuma dalam hati masih kuat mengatakan yang MO tu tak check betul2.....memang baby tak kan nampak...baru sebulan lebih...masih peringkat di peringkat embrio.....kalau nampak pon kantung jer.....tah mana datang kekuatan terus minta nak buat detail scan ngan doc mama...sebab hati masih berharap si dia ada lagi dalam rahim mama.....so MO suggest pi jumpa pakar dan warded dulu...mama terus setuju....MO kata dia akan hantar naik tingkat atas untuk buat detail scan dan vaginal scan......masa ni kalau tak salah, papa pi hantar safi ngan umar pi umah mama ani...kesian diorang penat...

sampai wad, mama diberi baju hospital...dalam dok kalut tu terpikir juga...nape MO tak minta pon nak tengok bleeding banyak mana?....seluar dalam mama pon dia tak minta.....takper...kita ikut jer....kata diorang ni pakar......nurse kasik tau doc akan datang petang.....tapi tak sampai 10 minit...nurse datang balik bawak wheelchair kata doc dah ada.....

so mama pon ditolak turun ke tingkat satu....eh! labour room????naper labour room.????......pujuk hati kata mesin2 scan tu ada kat dalam labour room.....huhuhuhuhu....masuk jer LB room , terus nurse suh baring atas katil....katil tempat mama pernah bersalinkan umar dulu....seram seh!!!!ada dua nurse dah siap pakai apron plastic.....keliling mama ada meja penuh dengan alat yg dah disteril......dah macam nak kene operate lagaknya........hati dah mula tak tentu arah......

terus tanya "kita nak buat apa yer??" nurse tu jawab "eh!takde sesapa bagitau puan ker???"
kita tanya dia....dia lak tanya kita balik......
at the same time masuk sorang lagi nurse bawak kerta suh mama sign.......mama tak baca habis....mata mama just tangkap kat perkataan Dilation & Curettage (D&C) procedure....
"ok....saya hanya dimaklumkan doc kat bawah untuk naik atas dan buat detail scan untuk make sure yang saya hanya bleeding atau dah gugur...dia tak kasik tau pon apa2 pasal D&C?"
Nurse yang berdua tu pandang sama sendiri....kata diorang arahan yang diberi adalah buat D&C.....bila mama kata mama taknak wat terus diorang bagitau doc di bilik preparation sebelah (tengah bersiap sedia nak kikis perut mama le tu).....owh! bukan doc noraini...sedikit kecewa di situ......doc ni agak kasar siap marahkan mama sebab taknak wat procedure tu.....masa ni papa masuk LB room....member terpinga-pinga tengok bininya bertegang urat dengan Doc......boleh doc tu kata yang MO kat bawah kata  patient unhappy with the pregnancy dan nak get rid of it as soon as possible........wahhh!!!masa ni memang mata mama dah buntang dah....terus kuar ayat " don't you dare to say that i'm not happy with my prenancy....I've never unhappy with any of my pregnancies.....!!!"...macam2 jugak lak ayat yang tak sedap didengar keluar...end up...mama refused untuk continue the procedure dan request nak jumpa doc noraini.......terus keluar LB room...PANAS!!!!naik ward cek bawah....ok bleeding dah takder......hangin satu badan buat dia terbantut kot....terus minta nak kuar wad......tapi sempat juga buat temujanji nak jumpa noraini esoknya....sign surat discharge bagai....petang tu balik umah....dengan hati yang masih berharap.......si kecil masih ada dalam perut........

Esoknya mama terus jumpa doc noraini........tapi dah ketentuan.....dengan detail scan, kami terpaksa terima hakikat si kecil dah tak ada.......siap ngadu ngan doc noraini apa yang terjadi smalam...doc noraini berkerut-kerut dengar mama cerita...kata doc noraini....tak perlu pon D&C.....kandungan masih di tahap awal...belum ada heartbeat pon lagi.....kalau buat D&C...mama kene tunggu dalam 6-12 bulan untuk mengandung balik...lagipon bleeding tu kuar just macam period dan insyaallah akan bersih sendiri......see!doc smalam tu memang takda etika...main tarah atas info saja...bukan nak check bebetul......doc noraini kata kalau nak buat aduan, dia kata buat la....memula mama memang nak buat...tapi dok lama bertangguh....la ni dah malas...takper la ...biar doc tu...lagipun ramai yang komplain pon pasal dia....ramai takmau pegi kat dia.....Allah dah balas pon.....

So Doc Noraini pon buat vaginal scan bagai siap check darah itu ini.....akhirnya kami dapat detect puncanya.....appendiks.......menda alah ni yang kacau daun...dan because of it...perut mama buncit dari kadar biasa..so selagi tak buat treatment...selagi tu mama ada masalah nak conceive......kalau conceive pon, susah nak bertahan....then doc noraini refer mama pada doc hasan ....yg ni tak yah la citer....bosan pon...end up tak undergo for operation pon....baik dengan ubat...Alhamdullillah...Allah Maha Kaya dan Maha Mengasihani..........

Sejak kes tu...mama ngan papa takdak nak stress2 pasal nak conceive...pada kami..ada rezeki...ada la....life must go on......walau jauh di sudut hati....sedih tetap ada sebab kami memang berhajat sangat...namun kami perlu redha dengan ketentuan Allah......dan mama tetap anggap...mama pernah mengandung untuk kali ketiga walaupun ia tak menjadi......mama anggap anak mama adalah 5 (safi umar dengan yang gugur ni termasuk twinny ngan twinkle)........

ok...pasal twinny ngan twinkle....di entry lain yer..... 




Friday, April 5

lamanya tak jenguk....

Itulah dia......lama sangat.......padahal banyak betul gambar dan banyak betul cerita.......tapi masa memang sentiasa cemburu..........dengan baru pindah, dengan safi ngan umar masuk sekolah,dengan kerja makin bercambah.......harap dapat disiplin kat diri lepas ni...azam 2013...kalo penat  menaip...update gambar pun jadi....janji 1 hari satu entry......doakan azam saya terlaksana.. :)







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