Zhuzhou News Network, October 26 (Correspondent Cao Sudan) On October 23, a rare monochorionic monoamniotic sac (MCMA) with an incidence rate of about one in 30 million was successfully delivered by twin pregnant women at Hunan Provincial Hospital of Traditional Chinese Medicine, and a pair of "little princes" were safely landed.
Ms. Ling, 36 years old this year, already has a 5-year-old daughter. Due to fallopian tube factors, the second child plan has been hindered. IVF transplantation was performed. At that time, only one embryo was transplanted. An ultrasound examination one month after the transplantation showed that two heart tube pulsation germ appeared in the uterus. The ultrasound was confirmed again at 12 weeks of pregnancy, confirming that the fetus in her abdomen was a rare monochorionic monoamniotic sac (MCMA) twin, which accounted for 1%-2% of the single-epiped twins, which undoubtedly seemed like winning the first prize in the lottery, but it also means that Ms. Ling faced many challenges throughout her pregnancy.
Ms. Ling's entire pregnancy test was conducted under the careful and rigorous management and monitoring of Zhao Yongqian, an outpatient physician of the Hunan Provincial Hospital of Traditional Chinese Medicine, without any twin complications. According to the diagnosis and treatment guidelines of twin , the time for termination of pregnancy of cashmere single sheep is 32-34 weeks. For maternal and infant safety, Ms. Ling was admitted to the hospital for delivery at 32 weeks. Considering that there are no abnormalities, Ms. Ling and her family require strict monitoring to extend the gestational week.
In response to Ms. Ling's situation, the hospital's obstetrics director Tang Zhengyu presided over a discussion of difficult cases, conducting research on the timing of delivery of pregnant women and the precautions for perinatal period, striving to achieve the ultimate management of critically ill pregnant women and ensure the safety of mother and baby. Tang Zhengyu introduced that according to the latest twin pregnancy guidelines, single chorionic single amniotic sac (MCMA) twins like Ms. Ling are recommended for delivery at 32-34 weeks. However, in the face of the strong desire of both husband and wife to continue to expect pregnancy, she communicated with them in detail and full communication with them again after the multidisciplinary consultation, and at the same time made a careful monitoring plan. They finally decided to work together and continue moving forward.
On October 23, another week was successfully spent. Ms. Ling was 33 weeks pregnant. The fetal monitoring prompted that there was contraction . The obstetrics team of the hospital decided to perform surgery on the same day. With the cooperation of the critical maternity and obstetrics team (obstetrics, neonatals, anesthesia , operating room), Tang Zhengyu performed a cesarean section for Ms. Ling, and successfully gave birth to a pair of "little princes" of more than 4 kilograms for Ms. Ling, and the mother and son were safe.
"Fortunately, the pregnant woman was diagnosed early, and the pregnancy examination and management were also in place. Her entire pregnancy was safe." Tang Zhengyu breathed a long sigh after the operation and reminded such pregnant women to go to the hospital for prenatal examination early, diagnose early, and monitor closely. Under the professional advice of the doctor, choose the appropriate delivery time to reduce the mortality rate of single-feather single goat twins.
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What are monochorionic monoamniotic sac twins?
Single vesicle single goat twins are one egg split into two embryos, and the two fetuses squeeze together. To make an image metaphor, ordinary twins have their own rooms, while single-fetal single goat twins share a room and a bed, without any barriers in the middle.
Single vesicle single goat twins are very rare and very dangerous. Monochorionic twins may also be associated with special complications such as twin transfusion syndrome and selective fetal growth restriction . Therefore, twin pregnancy belongs to the category of high-risk pregnancy, and monochorionic single amniotic sac twins are the highest risk of all twin pregnancy. Since the two fetuses share one amniotic cavity , there is no fetal membrane separation between the two fetuses, and there is a high possibility of intrauterine accidents due to umbilical cord entanglement and knotting.
Reminder: How to standardize prenatal examinations for twin pregnancy?
1. Early ultrasound examination allows you to determine chorionicity through early ultrasound examination. The two gestational sacs are double veins and double sheep. One gestational sac and two yolk sacs are single vesicle and double sheep.
2. If this time is missed, 13 weeks ago, you can use B ultrasound to detect chorionicity when looking at NT. If you have single veins and double sheep, there may be complications such as TTTS (Twin transfusion) or SIUGR (Twins selective growth and development restriction). If there is no amniotic separation, it is a single vesicle and single sheep. There may be complications such as conjoined infant and umbilical cord around the neck , causing fetal stopping.
3. Determine as single-feather double-feather double-feather single-feather single-feather single-feather, Doppler ultrasound should be performed every 2 weeks after 16 weeks for prenatal monitoring (B-ultrasound). Pay attention to observing the biparietal diameter (BPD), head circumference (HC), femoral length (FL), abdominal circumference (AC), and amniotic fluid depth of the two fetuses.
4. Pay attention to abnormal situations. If you find that the fetal abdominal circumference gap exceeds 20mm and the fetal weight gap is more than 25%, pay attention to monitoring umbilical blood flow , abnormal amniotic fluid depth, etc. You must go to an authoritative hospital for treatment and diagnosis and treatment in time. If necessary, you need to exceed one week and two weekly. Targeted intervention and treatment will be carried out according to the specific development of the disease.
5. Other precautions, pay attention to the length of the cervix, whether the inner cervix mouth is closed, whether the placenta is prepositioned, etc. Prevent complications during pregnancy such as gestational diabetes and hypertension.
