Cords

As we know, most, if not all, momo twins have some knots and twists in their cords. It is these knots that is the cause for great concern. If the knots tighten too much or their cords get compressed it could be fatal.

Here are pictures of our little ones cords. Their was one very distinguishable knot and a twist beneath it. Later I was able to touch and examine the knot. It was very tight. I'm not sure how blood and nutrients traveled through it, but it did. It is truly a miracle that my babies not only survived, but thrived with their cords like this.

Cord Entanglement

The biggest risk for momo twins is cord entanglement and compression.  By the end of the 1st trimester or the beginning of the second, momo twins will usually have some sort of entanglement due to the amount of space each twin has to maneuver in utero. At my 13 week appointment, cord entanglement was visible in the ultrasound.  At each one of my follow up appointments, blood flow between the cords is monitored to ensure the the tangle has not tightened or worsened cutting off vital nutrients to either baby

To give you and idea...below is a picture of the cords of another set of momo twins who were born at 32 1/2 weeks.  Many thanks to Momma Kate  and her beautiful girls for sharing your picture.

Sulindac

The perinatologist would like to start me on a drug called Sulindac.  Sulindac is non stereodial anti-inflammatory drug.  While not its primary role, it has been used to help treat pre term labor and in decreasing the amniotic fluid level in mom pregnancies.  

Not being much of a "drug" user, the decision on whether to go on Sulindac is not an easy one to make.  Because there are so few momo twins we are basing our decision on the limited information we have and the experience of my health care providers.  By decreasing the fluid, the babies would have less room to maneuver in therefore limiting their ability to further tangle their cords.

Initial Stages of Planning - 15 weeks

It's very early to set anything in stone, but our initial plan is home monitoring to begin between 24 - 26 weeks.  In addition to home monitoring I will go in several times a week for ultrasounds.  My peri is agreeable for me to continue home monitoring to 30 weeks if the babies look great.  At that point I would be admitted into the hospital for 24/7 inpatient monitoring.  

During our initial planning we did not discuss delivery.  Delivery for mom twins is typically between 32-34 weeks.  I would love to aim for more towards 35 weeks, but there is not guarantee that I will make it that far.  The bigger the babies get the more danger they are face in compressing their cords so that's typically the reason for 32-234 weeks delivery. 

Here are the twins at 15 weeks facing each other.  TOO CUTE!

The Shock & Reality

Now that you know the nuts and bolts, how are I am feeling?  Initially, I was in a 100% state of shock.  Shock that I have been blessed with twins and shocked that learning the difficulties I face in this pregnancy.  The pregnancy of my 1st born was very smooth.  Minor problem here and there, but nothing that prevented me from carrying to term or enjoying my pregnancy.

I cried for several days straight.  Crying for the a loss of innocence and enjoyment of my pregnancy, crying for what might happen, crying for cryings sake.  I was pretty devastated and scared.

I spent hours online learning all I could.  Reading as many studies as I could, learning from others experiences they shared on online forums, and soaking every piece of information I could

I had a follow-up appointment with the perinatologist two weeks later and was in a much better place about the twins and my pregnancy.  I had a whole host of questions for him.  It was the first time I didn't feel fatalistic about the pregnancy and really felt like everything would be ok.  That the twins would be ok.  That I and my family would be ok.

Monoamniotic Monochorionic - Nuts & Bolts of MoMo Twins

At our first visit with the perinatologist we learned that as my OB suspected, our twins did not have a separating membrane. They are monoamniotic monochorionic (MoMo Twins).  MoMo Twins are pretty rare counting for 1 in 25,000 to 1 in 60,000 births.  If there was no doubt before, they are special!

What are MoMo Twins?

MoMo twins are by definition identical.  Identical twins are formed when a single fertilized egg splits in the womb.  If the egg splits prior to the placenta being formed each embryo has its own placenta, chorionic sac, and amniotic sac.  If the split occurs after the placenta has begun to form (typically 7-9 after conception) the twins begins to form in the same placenta and sacs. 

Identical Twins

 Monoamniotic Monochorionic Twins

Why are MoMos special?

Besides being a rare occurrence (less than 5% of identical twins pregnancies), momo twins are at risk for health complications due to the close proximity of their umbilical cords in the amniotic sac.  

What are the concerns for the twins?

Momo twins are at risk for cord entanglement, cord compression, and twin to twin transfusion.  

Cord Entanglement - Because the twins have no membrane separating them their umbilical cords can be easily tangled.  Actually, most MoMo twins cords are tangled at some point in during the pregnancy, but severe entanglement can cause fatal complications

Cord Compression - Without a membrane separating them as the twins move around in their sacs, one can compress the other's cords cutting off nutrients and blood flow.

Twin to Twin Transfusion - This occurs when one twin receives the majority of the nourishment in the womb causing the other undernourished and sickly.  

What can be done to help ensure a healthy babies and mom?

First recognizing that carrying multiples is different from carrying a singleton.  May seem obvious, but the needs are different and not always proportional.  Secondly, very little until viability (24 - 26 weeks).  Intensive monitoring of fetal movement, blood flow between the cords and development prior to viability and then increasing post viability.

How does this affect your pregnancy?

My pregnancy is officially considered high risk.  I see my doctor's on average of every 2-3 weeks during the 1st part of pregnancy increasing to 2-3 times a week as my pregnancy progresses.  I get to see the twins often with ultrasounds at every appointment.  Once the twins reach viability I will start with home monitoring 2-3 times a day and multiple weekly ultrasounds to monitor blood flow and development.  At some point yet to be determined, I will enter the hospital for 24/7 monitoring.

What about delivery?

MoMo twins are typically born between 32-34 weeks barring any complications.  Due to cord entanglement they are born via c-section.  Due to their premature arrival, most spend  period time in the Neonatal Intensive Care Unit (NICU).