MoMo is short for monoamniotic-monochorionic and refers to identical twins who are monozygotic which means they develop in a single amniotic sac and share a placenta.
Identical twins develop from one egg and one sperm combination that splits into two. If the split happens 8 to 13 days after conception, the processes of growing a placenta, chorion, and amniotic sac are already underway. The two embryos will then develop within a single, shared sac, resulting in MoMo twins.
The below photo is taken from wikipedia
MoMo twins are very uncommon, representing approximately 1 per cent of identical twins and less than 0.1 per cent of all pregnancies.
When I was 11 weeks pregnant, Harry and I went for the Non-Invasive Prenatal Screening (NIPS) test. To our surprise, we found out we are blessed with Identical twin girls. I always wanted twins and when I heard we are going to have two girls I was over the moon!
We haven't heard about the MoMo term before, we have been told it's a rare type of pregnancy.
After seeing our doctor and the twin specialist recommended to us plus reading medical papers we realised we are on a roller coaster ride! There might be some complications and not much can be done to prevent them!
Here is a list of complications that could happen
- Twin-to-twin transfusion syndrome (TTTS): One twin receives the majority of the nourishment, causing the other twin to become undernourished.
- Cord entanglement: The close proximity and absence of an amniotic membrane separating the two umbilical cords make it easy for the twins to become entangled in each other's cords, hindering fetal movement and development.
- Cord compression: There is nothing to separate MoMo twins, which means their umbilical cords can become tangled over time and clog the cords.
- Selective intrauterine growth restriction (sIUGR) is a condition that occurs in twin pregnancies when one of the babies does not receive enough nourishment through the placenta to grow at a normal rate
Our doctor recommended us to see him every two weeks for antenatal visits as well as having a thorough ultrasound every two weeks.
As life is always complicated, these doctor visits weren't easy too! When covid-19 lockdown started in Sydney last year, Harry and I moved to the small village called Coomba park near Forster to be close to my parents. It's almost four hours drive from Sydney.
To have ultrasounds and seeing specialists we had to get one day off or sick leave every week, driving to Sydney and going back! Apart from the stress of getting off from work, imagine being pregnant with a small blader and being in a car for 4 hours!
On the scan of week 14, our twin specialist explained his observations and it wasn't easy to hear
1- Twisted cords, however, It wasn't a big deal!
2- Baby A's stomach was smaller than baby B's and It was concerning
3- Baby B is missing one Kidney, it wasn't life-threatening and she can live happily with one kidney
4- Baby A cords have a smaller diameter than baby B and It was concerning
Baby A and B cords are twisted, MOMO twin cord at week 14:
Baby A and Baby B's comparison, MOMO twin at week 14:
When the doctor's explanations finished, he allowed us to digest the information and ask our questions. At the end of the session, he dropped a bombshell and mentioned if our doctor spoke with us about the termination option!
Both Harry and I are rational people but hearing this option wasn't easy, given Baby A is only 5 days behind, we found this option not acceptable! We asked if having termination this week makes any different than waiting to get more data points and have a few more scans. The answer we got was, till week 22 you can have an elective abortion if it's necessary. You may need to get approval from 2 doctors which won't be an issue given our case.
Although we had passed our 3 months mark and we were on week 14, we didn't feel comfortable to share our news. After having a long conversation on our 4 hours drive back home we decided to stay positive, enjoy life and cherish our twins while we have them and speak with few friends who have twins or ended up delivering their babies preterm to get more information. It was obvious for us our girls needed to be delivered on week 32 if it's not earlier.
I'm not much a fan of gender reveals parties, but really liked the idea of sharing news by photo than words!
We shared the news with our families and a few close friends. We also decided to move back to Sydney, since getting a day off at work each week and going back and forth to Sydney wasn't a sustainable solution.
On our 16 weeks scan, we could see although baby A is a bit fall behind she is growing at the same rate!
MoMo twin ultrasound at week 16
Baby A at 16 weeks,
Baby B at 16 weeks
Comparison of Baby A and B at week 16th
Our Twin specialist mentioned as long as the difference is less than 30% we don't need to be concerned and he recommended I started taking half an Asprin every night so it may help with blood residence they observed on Baby A's cord.
When we found out we are pregnant, we agreed to move back and grow our baby in Sydney. We bought a new place online on the northern beaches to call it home. When we bought the place we didn't know we were expecting twins! If you look at the floor plan Bed 3 and Bed 2 are identical! When we found out we are having twins we were super pleased with our new home even more!
Monday, first of Feb 2021, was our settlement and we got few days off to sort out our move from Coomba park to Sydney. We stayed at our friend's place on Monday night and officially moved into our new home on Tuesday 2nd.
We extended our leave and got Wednesday 3rd off to go for our week 18's scan without stress! While I was daydreaming and thinking about how lucky we are on the ultrasound bed. I heard the ultrasound lady nervously said "I'm sorry! I cannot see Baby A's heartbeat!" All of sudden, my heart sank! My tears were silently coming down and all I could come up with to say was "Can we save the second baby!" I couldn't stop the train of thoughts in my brain!
No heartbeat in one of MoMo twin's ultrasound
Before I become pregnant I was sleeping on my back or right side! After reading some blog posts and watching youtube videos, I have been trying to sleep on my left side to make sure babies get blood and nutrition better! Given the baby A was on my left side! I was feeling the guilt of maybe me insisting to sleep on the left side was the reason! Maybe it happened a few days ago after a few Back to Back meetings when I quickly jumped off my chair to have a bathroom break and felt a sharp pain on my left side! All of these thoughts and guilts were coming into my mind and tears were quietly coming off my eyes. The ultrasound lady asked if we want some moment and we appreciated the offer. She left the room and allow me and Harry to hug each other and cry! While I was crying I messaged my managers that I won't be able to come back to work till the end of the week! I was determined to save Baby B! Then, we continued with scanning baby B.
Momo twin at week 18,
Our twin specialist was on leave, but he kindly spoke with us over the phone to explain the situation
Based on their observations
1- Baby A passed away a few days ago
2- Baby B looks normal but there is a high chance of sudden death in the next 10 days
Then he peeled all other layers of an onion for us! If baby B survives in the next 10 days.
Brain damage and disabilities: It's unknown how much damage her brain might have. We can have an MRI on week 20 or 24 (I cannot remember which week) however with MRI we can only find out massive issues like a hole in the brain and there is a good chance some of the brain damages not detected by MRI!
There is a chance of Baby A become infectious and some of the infections going to baby B's body! It could make baby B handicapped. Because of infection in amniotic fluid, the chance of preterm born (under 26 weeks) is highly likely! 50 % of premature babies born before 26 weeks of gestation will have some sort of disability.
There is also still a chance of Baby B entangled by baby A cord!
For those who don't know me, I have a make it works personality. I always try my best to get the best outcome of what happens and try to save sinking projects! My heart was beating so hard and all I could think was how we can get the best outcome from this depressing situation!
We booked the next ultrasound session for the next week to see if Baby B survive. In the meanwhile, I was trying to get it together to minimize stress on baby B. Harry was trying his best to calm me down and also managing his emotions. We got home started reading medical papers on the survival rate of momo twins when one fetus dies! There weren't many solid pieces of research available and what we were reading wasn't really helping. The data sets for research were very small, one research was based on 5 observations, and another one was based on only one case.
After speaking with our doctor, having a chat with each other we realized unfortunately we have to go through the path of elective termination! we lost the battle and lost our baby B! It was one of the hardest decisions we have ever made! I couldn't tell you the magnitude of the pain we both were feeling. I could feel our baby B's kicks. Her hearts were still beating and as her mother, I was responsible for protecting her! My heart was broken that we couldn't save her! I knew in the next few days we have to say goodbye to her for her own sake! We didn't want her to suffer! I knew if she inherits even 10% of my genes she would question us if we didn't do it.
We both messaged our work and got a few weeks off! We were lucky that in this situation we didn't need to worry about work and have compassionate managers and teammates.
Of course, our Baby A and Baby B had names! Sasha Elara Sayari was Baby B and Pasha Metis Sayari was Baby A. We had picked universal and unisex names for our baby girls. We wanted them to identify their own identity. We picked Jupiter moon names for their middle name which is also referred to as ancient Greek philosophy.
Although imaginations are not my gem somehow I had some ideas about how our babies may look like. I was imagining taking them to the science museums or teaching them how to code! I had also asked Harry that he should be responsible for organising fun activities for our future family because sometimes I'm intense! I was planning on how I can come back to work after short maternity leave because I knew girls who see their mother's work are more independent in future!
Well, all of our dreams were gone! The next step was going through the termination. The termination wasn't an easy process either! It requires you to take two sets of tablets. One, 36 hours before admitting to the hospital. The next sets when you are at the hospital and keep repeating every 3 hours till the babies delivered. My doctor expecting an easy procedure and mentioned to us we will be home by dinner time! I ended up being in the hospital overnight and experiencing almost 30 hours of labour! Thankfully I used the epidural injections to relieve the physical pain.
Both Harry and I are strong people. We have experienced so many difficulties in our life and we knew we can overcome our emotional pains and move on. We both admit those 5 days from the day we heard about the death of our twin girl till the day I got released from the hospital seemed like a month to us!
The feelings of you are not in control, experiencing disappointment and anger at the same time, seeing your dream future just destroyed in front of your eyes in a matter of days gave us so many perspectives. We are fortunate to have each other, our families and our friends and colleagues. We were grateful for all the kind messages, homemade foods, taking care of our dog when we were at the hospital.
You may ask, why are you sharing this story here. It's simply to help other couples who might be going through the same pain. Miscarriage, stillborn, elective termination are all painful but you are not alone! Going through a high-risk pregnancy is hard. You will be surprised to know how the medical field didn't have many advancements as compared to IT! If you are having MoMo twins, both Harry and I wish you the best of luck. I was desperately looking for information about MoMo twins when I was pregnant. I wanted to know about what happens if one of the twines were smaller than the other and what's the survival rate! Will the smaller twin catchup? I even joined Tiktok and was following a few mums with momo twins to find out more. I hope the details I shared in this blog post helps you.
If you are a medical researcher, I'm more than happy to share all of the scans with you. We hope those help other MoMo twins. To honour the short life of our twins we sponsored two disadvantage children via https://www.thesmithfamily.com.au/