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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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2 comments:

affe said...

congrats kak sha...

bang fenn said...

kak sha...ni nak tunggu yang single pun dah berdebor...anyway tahniah...

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