Monoamniotic Monochorionic Twins

monoamniotic / monochorionic twins

I am a mother of 2 BEAUTIFUL children, one who is almost 4/boy and one who is almost 2/girl, My husband and I decided the time is now to have another! We really love the idea of having children so close in age so we planned to get pregnant (did not take long) I watched my ovulation and after one Valentines weekend it was done.

Now I am a very Natural type of a mama, I took my prenatal's, didn't worry to much about getting an ultrasound until around17-18 weeks a long just so I could see the sex and get ready for whatever was to come my way. OF COURSE i was not expecting a surprise while getting this ultrasound, I was lying there kinda with a giggle I say "there's only one right" continued with a laugh. At that point there was silence, a small pause in the room,  "NO" the Ultrasound tech replied.... "I am seeing 2!"

At that moment I was not the happiest, just because I only planned on having 3 in my lifetime, and got a little emotional, and even more when she told me I needed to see an OB or specialist right away, I laughed as if she was silly, "I have a midwife that I see, we plan on doing a homebirth"  she looked at me like I was crazy, and told me that I need another ultrasound and to see an OB and talk to my "midwife" about mono/mono twins.

So like everyone in the world, I went home to google this mono/mono twin she spoke of, and it was like I was reading the obituary of my girls! YIKES!

FOR THOSE OF YOU WHO DO NOT KNOW what exactly MoMo twins are......

Monoamniotic twins are Identical, that share the same Amniotic Sac with mommys uterus. Monoamniotic are ALWAYS identical twins and always monochorionic as well, which means not only do they share the same sac, but the same placenta.

Monoamniotic twins are VERY rare, with an occurrence of 1 in 35,000 to 1 in 60,000 pregnancies,corresponding to about 1% of twin pregnancies.... this is where I was a little freaked out, and continued to read on......

The survival rate for monoamniotic twins previously reported as being between 50% to 60% BUT has been shown to be as high as 81% to 95% in 2009 with aggressive fetal monitoring...... right there I knew I was in for a bumpy ride!

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.

At this point I knew i would have MANY MANY MANY ultrasounds Further ultrasounds with high resolution imaging and  non stress tests  help to assess the situation and identify potential cord problems.

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..... (oh no I'm thinking), with continuous monitoring, preferably in the care of a  Pernitologist, an obstetrician that specialises in high risk pregnancies.

All monoamniotic twins are delivered prematurely by C-SECTIONS .... (at this point I am NOT LIKING THIS) , 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 births........... 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.(at this point I am crying because I know I will not be able to have my HOME BIRTH let alone my water birth) could this get any worse????

NOW! I am in a panic, asking my midwife, friends, facebook groups of momo twin mothers, Blog sites, calling other midwives in cities further away, asking if there is ANYWAY I could still have a home birth. I dont think a midwife would touch me with a 10foot pole!  everyone was telling me that for the benefit of the babies I would have to see a specialist and monitor the babies so nothing will happen to them, MOST of my doctors were surprised when I made it to 21 weeks! so at this point I knew this was going to be a difficult next few weeks of development!

I am now happily 24 weeks and 5 days! my babies can survive outside the womb at this point, but its a low chance, by 26-28 weeks there is more of a chance. I have been put into inpatient treatment here in MINNEAPOLIS Abbott hospital and its my 3rd night here. I am doing ok so far, but I will be keeping everything updated here, to let you all know ;)      here is a picture of  how my momos came to be...... I told my husband his sperm must have gotten LOST since it took 8-13  days! and I am glad not longer so we had conjoined twins, that would have just been a whole lot of stress extra for me. more power to women who can handle it.