Ɛnanom pii dwen wɔn ba no akwahosan ho bere nyinaa wɔ nyinsɛn mu, sɛ́ ebia ɔrenyin yiye no, ɛnte saa? Enti, ɛtɔ da bi a sɛ wo duruyɛfo yɛ ultrasound scan na ɔka biribi te sɛ, "Nsonsonoe kakra wɔ akokoaa no awotwaa mu, enni awotwaa no mfinimfini, na mmom ɛbata nkyɛnkyɛn ho a," ɛyɛ ade a ɛfata sɛ mpofirim ara wobɛte ehu ne dadwen kakra nka. Ɛno ne nea yɛfrɛ no tebea te sɛ eyi ``Marginal Cord Insertion''. Enti, momma yɛnka eyi ho asɛm pefee nnɛ, wɔ ɔkwan a wubetumi ate ase so? So biribi wɔ hɔ a ɛsɛ sɛ yesuro, na momma yɛnhwehwɛ nea ɛrekɔ so wɔ eyi mu ankasa.

So wunim nea Marginal Cord Insertion yɛ?

Sɛ yɛbɛka no tiawa a, `(Marginal Cord Insertion)` yɛ nsakraeɛ kakra wɔ ɔkwan a akokoaa no awotwaa hama `(Umbilical Cord)` fa so bata `(Placenta)` ho wɔ nyinsɛn mu. Wunim, `(Umbilical Cord)` no te sɛ nkwa hama a ɛka ɛna ne akokoaa no bom. Akokoaa no nam saa awotwaa mu hama yi so nya aduannuru ne mframa pa a ohia nyinaa fi ɛna no hɔ. Saa awotwaa hama yi bata akwaa soronko bi a wɔfrɛ no `(Placenta)`, a ɛba bere a nyinsɛn nkutoo mu.

Mpɛn pii no, ɛsɛ sɛ wɔde awotwaa no hama no bata awotwaa no mfinimfini, anaasɛ ɛbɛn no yiye. Nea enti a ɛte saa ne sɛ aduannuru tumi fi ɛna no mu kɔ awotwaa no mu na efi hɔ kɔ akokoaa no mu yiye a biribiara nsiw no kwan. Ɛno ne ɔkwan a ahobammɔ wom sen biara.

Nanso, wɔ `(Marginal Cord Insertion)` mu no, saa awotwaa hama yi ntumi nkɔ awotwaa no mfinimfini, na mmom ɛne awotwaa no ano anaa ano (bɛyɛ milimita 20 kɔ akyirikyiri). Sɛ yɛbɛka no pɛpɛɛpɛ a, saa nkitahodi yi ne awotwaa no ano ntam kwan yɛ sɛntimita abien anaa nea ennu saa. Sɛ wɔde saa abusuabɔ yi kɔ nkyɛnkyɛn a, ɛtɔ mmere bi a (ɛnyɛ bere nyinaa) aduannuru akwantu a efi awotwaa no mu kɔ akokoaa no mu no betumi ayɛ brɛoo kakra. Sɛ ɛba saa a, ebia akokoaa no nyin bɛyɛ brɛoo kakra. Yɛfrɛ eyi `(IUGR - Intrauterine Growth Restriction)`. Afei nso, ɛtɔ mmere bi a akokoaa no koma bɔ tumi so tew bere a ɔrewo no.

Nanso, ade a ɛho hia sen biara wɔ ha ne sɛ nyinsɛn dodow no ara a `(Marginal Cord Insertion)` wom no ba awiei wɔ awo a ahoɔden wom mu a ɔhaw biara nni ho. Enti, eye sɛ woremmɔ hu ntɛm ara, ɛnte saa?

Saa tebea yi abu so dɛn?

Saa tebea yi a wɔfrɛ no ``Marginal Cord Insertion'' no taa ba nyinsɛn a wɔawo wɔn pii, te sɛ mmanoma anaa mma abiɛsa mu sen nyinsɛn a wɔyɛ biako. Ɛba wɔ nyinsɛn 2% kosi 25% mu. Dodow no sua wɔ nyinsɛn a wɔyɛ biako mu na ɛkɔ soro wɔ nyinsɛn pii mu.

Dɛn ne sɛnkyerɛnne ahorow a ebetumi aboa wo ma woahu sɛ wowɔ Marginal Cord Insertion anaa?

Asɛm bi a ɛho hia ni. Mpɛn pii no, ɛna a ɔwɔ ``Marginal Cord Insertion'' no nnya sɛnkyerɛnne pɔtee biara.Ebia worenhu nsonsonoe biara. Wo duruyɛfo bɛtaa ahu saa awotwaa mu nhama a ɛnyɛ ne kwan so yi bere a wɔreyɛ ultrasound scan daa bere a wonyinsɛn no.

Dɛn nti na eyi (Marginal Cord Insertion) ba? Dɛn na ɛde ba?

Nhwehwɛmufo da so ara nnim nea ɛde Marginal Cord Insertion ba ankasa. Nanso, wosusuw sɛ nneɛma bi ma asiane a ɛwɔ hama a ɛte sɛɛ a wɔde bɛhyɛ mu no yɛ kɛse. Sɛnea yɛadi kan aka no, ɛtaa ba nyinsɛn a wɔwo nkokoaa pii (te sɛ mmanoma) mu. Nea ɛka ho no, nneɛma afoforo pii wɔ hɔ a ebetumi aboa:

• Nnubɔne anaa nsa a wɔnom bere a wɔyem.
• Ayaresa tebea a enni sabea te sɛ asikreyare a wowɔ.
• Ɛna mfeɛ yɛ mfeɛ aduasa nnum anaa nea ɛboro saa ( advanced maternal age ).
• Eyi ne w'awo a edi kan (`Nulliparity`).
• Bere a ɔde IUD (Intrauterine Device) adi dwuma ansa na wanyinsɛn.
• Nyinsɛn a ɛnam awoɔ mfiridwuma a wɔde ayɛ (ART - Artificial Reproductive Technology) so (e.g. test tube nkokoaa).

Nanso kae sɛ, esiane sɛ wowɔ saa nneɛma yi mu biako anaa nea ɛboro saa nti, ɛnkyerɛ sɛ wubenya Marginal Cord Insertion. Sɛ nhwɛso no, nnipa pii a wɔnam ART so nyinsɛn no betumi anya awotwaa mu hama a ɛfata. Nea ɛho hia ne sɛ sɛ biribi a ɛnteɛ wɔ awotwaa mu hama a wɔde hyɛ mu no mu mpo a, nnipa dodow no ara kɔ so nya nyinsɛn a ahoɔden wom.

Bere bɛn na wɔtaa hu sɛ ɛwɔ Marginal Cord Insertion?

Wɔtaa hu saa awotwaa mu nhama a ɛnyɛ ne kwan so yi bere a wɔreyɛ ultrasound scan wɔ ɔsram abiɛsa a ɛto so abien no mu (adapɛn 14 kosi 27) . Nanso, ɛtɔ mmere bi a, ebetumi ayɛ den ama oduruyɛfo no sɛ obehu baabi pɔtee a awotwaa hama no abata awotwaa no ho.

Wɔ tebea horow a ɛtete saa mu no, oduruyɛfo no betumi de ɔkwan titiriw bi a wɔfrɛ no Doppler adi dwuma bere a wɔreyɛ ultrasound nhwehwɛmu no. Eyi ma wuhu mogya a ɛkɔ awotwaa no ne akokoaa no ntam no pefee, na ɛno kyerɛ ɔkwan a wɔfa so ma akokoaa no aduan. Saa Doppler nhwehwɛmu yi boa ma wohu beae pɔtee a awotwaa no hama a ɛbata ho no wɔ.

Dɛn ne ayaresa ahorow a wɔde sa eyi?

Mprempren ayaresa pɔtee biara nni hɔ a ebetumi "asiesie" tebea bi a wɔfrɛ no ``Marginal Cord Insertion''. Eyi kyerɛ sɛ wontumi nsakra awotwaa no. Mmom no, wo duruyɛfo bɛhwɛ wo ne wo ba no yiye paa wɔ wo nyinsɛn no nyinaa mu. Eyi yɛ nea wɔde besiw nsɛnnennen biara a ebetumi aba ano. Wɔbɛhwɛ nso sɛ akokoaa no renyin yiye ne sɛ ebia asiane foforo bi wɔ hɔ anaa. Wɔ tebea horow bi mu no, wobetumi akamfo akyerɛ sɛ wɔnyɛ oprehyɛn a wɔde oprehyɛn (C-section) sɛ asiane bi wɔ hɔ a.

Sɛ wɔhwɛ so yiye saa a, wobetumi atew asiane ahorow no so kɛse. Enti nya wo nnuruyɛfo mu ahotoso na yɛ sɛnea wɔka.

So ɔkwan bi wɔ hɔ a wɔbɛfa so asiw Marginal Cord Insertion ano?

Dabi Worentumi nsiw Marginal Cord Insertion kwan sɛ ɛbɛba. Ɛnyɛ biribi a wubetumi adi so. Nanso wubetumi ne wo duruyɛfo ayɛ adwuma abɛn, ahwɛ wo nyinsɛn no so yiye, na woayɛ nea wubetumi biara de aboa ma woanya akokoaa a ɔwɔ apɔwmuden na woawo no yiye.

So tebea no (Marginal Cord Insertion) no ankasa sa?

Ebetumi aba. Mpɛn pii no, `(Marginal Cord Insertion)` nyɛ asiane kɛse mma nyinsɛn no, na saa ara nso na ensi akokoaa no kwan sɛ obenya aduannuru a ohia. Sɛ ɛba saa a, enhia sɛ wohaw wo ho dodo wɔ ɔkwan a wɔfa so de awotwaa no hama no bata ho no ho. Mmom no, nya ahotoso sɛ wo duruyɛfo bɛhwɛ sɛnea akokoaa no nyin yiye, na fa w’adwene si w’akwahosan a wobɛkɔ so akura mu bere a wonyinsɛn no so.

So Marginal Cord Insertion yɛ tebea a asiane wom?

Sɛ biribi a ɛnteɛ wɔ ɔkwan a wɔfa so de awotwaa no bata ho no mu a, ebetumi de asiane ahorow bi aba bere a wɔyem no. Nanso, nsusuw sɛ nea enye koraa bere a wɔahu sɛ wowɔ `(Marginal Cord Insertion)` no. Efisɛ wɔ nsɛm dodow no ara a wohu sɛ wɔwɔ `(Marginal Cord Insertion)` mu no, wɔwo nyinsɛn a wɔwɔ apɔwmuden ne nkokoaa a wɔwɔ apɔwmuden.

Wo duruyɛfo betumi de w’aduruyɛ ho abakɔsɛm ne nea efii ultrasound mu bae no asusuw nneɛma biara a ɛhaw wo ho. Ade biako a ɛhaw adwene kɛse ne sɛ ebia wo ba no renyin brɛoo dodo, tebea a wɔfrɛ no Intrauterine Growth Restriction (IUGR). Sɛ akokoaa no nnya aduannuru a ɛdɔɔso mfi awotwaa no mu a, ebetumi akɔ asiane mu sɛ obenya IUGR. Nea edidi so yi betumi ato wo ba a wɔawo no foforo no:

• Awo mu duru a ɛba fam: Sɛ wɔkyekyem pɛpɛɛpɛ a, akokoaa a wɔwo no a ne mu duru nnu nkaribo 5 ne ɔuns 8 (bɛyɛ kilogram 2.5).
• Apgar nkontabuo a ɛba fam: Apgar sɔhwɛ yɛ ɔkwan a wɔfa so hwɛ akokoaa akwahosan wɔ awo akyi pɛɛ. Apgar nkontabuo a ɛba fam betumi akyerɛ sɛ ebia akokoaa no wɔ ɔhaw bi wɔ wɔn koma anaa wɔn ahurututu mu. Ebia nkokoaa a wɔte saa no behia ɔhwɛ foforo.
• Ɛbɛyɛ sɛ ɛho behia sɛ wɔtra Neonatal Intensive Care Unit (NICU) a ɛkɔ soro: Wobetumi de akokoaa no akɔ NICU akɔhwɛ no foforo kosi sɛ akokoaa no ho bɛtɔ no na wobetumi de no akɔ ayaresabea a wɔhwɛ no daa.

Sɛ wo duruyɛfo susuw sɛ asiane bi wɔ wo anaa wo ba no so a, ebia ɔbɛkamfo akyerɛ sɛ wɔnyɛ oprehyɛn a wɔde twa oprehyɛn (C-section).

So (Marginal Cord Insertion) betumi abɛyɛ (Velamentous Cord Insertion)?

Tebea bi a wɔfrɛ no ``Marginal Cord Insertion'', titiriw wɔ nyinsɛn no fã a ɛto so abiɛsa (adapɛn 29 kosi 40) mu no betumi adan tebea a wɔfrɛ no ``Velamentous Cord Insertion''. Nanso, eyi ho yɛ na koraa.Velamentous Cord Insertion yɛ bere a awotwaa no ntumi nkɔ awotwaa no mu tẽẽ, na mmom ɛbata ntini ahorow a ɛwɔ awotwaa no akyi ho. Saa tebea yi ho yɛ na kakra sen Marginal Cord Insertion (ɛba wɔ nyinsɛn bɛyɛ 1% mu) na ɛhwehwɛ sɛ wɔde adwene si so kakra.

Wo duruyɛfoɔ bɛhwɛ ɔkwan a wɔfa so de awotwaa no mu hama no bata ho na waboa wo ama woanya nsunsuansoɔ pa wɔ saa tebea mmienu yi nyinaa mu, ``Marginal Cord Insertion`` ne ``Velamentous Cord Insertion``.

Enti, so ɛsɛ sɛ mehaw me ho wɔ Marginal Cord Insertion ho?

Dabi, ɛho nhia sɛ wohaw wo ho. Nnipa dodow no ara a wɔwɔ Marginal Cord Insertion no wɔ nkokoaa a wɔwɔ apɔwmuden. Sɛ akokoaa no renya aduannuru a ɛfata a ohia na ama wanyin a, ebia Marginal Cord Insertion a wode bɛhyɛ mu no renka wo nyinsɛn no.

Wo ne wo duruyɛfo nkasa mfa nneɛma biara a ɛhaw wo ho. Nneɛma pii wɔ hɔ a ebetumi ama asiane a ɛwɔ hɔ sɛ ɔhaw ahorow bɛba wɔ nyinsɛn biara mu no ayɛ kɛse. Ebia awotwaa no mu ade a ɛnteɛ betumi ayɛ asiane anaasɛ ɛrenyɛ saa. Wo duruyɛfo betumi akyerɛ wo kwan wɔ wo nyinsɛn no mu na wayɛ wo nhwehwɛmu wɔ nokwaredi mu.

Nsɛmmisa a ɛho hia bɛn na ɛsɛ sɛ wubisa wo duruyɛfo?

Ɛyɛ ade a ɛfata sɛ wubenya nsɛmmisa pii wɔ w’adwene mu wɔ bere a ɛte sɛɛ mu. Nsɛmmisa bi a wubetumi abisa wo duruyɛfo ni:

• Mpɛn ahe na ebehia sɛ meyɛ ultrasound scans de hwɛ me nyinsɛn no?
• So ɛsɛ sɛ meyɛ sɔhwɛ foforo bi?
• Ɛda adi dɛn sɛ Marginal Cord Insertion bɛka me nyinsɛn no?
• So ɛho behia sɛ wɔyɛ nhwehwɛmu foforo de hwɛ sɛnea akokoaa no nyin?
• Ɔkwan bɛn so na ɛsɛ sɛ meyɛ nsakrae wɔ m’aduan, m’apɔw-mu-teɛteɛ, ne nna mu dwumadi mu na ama manya nyinsɛn a ahoɔden wom sen biara?
• Da dodow ahe na ɛsɛ sɛ minya da biara? Ahomegye dodow ahe na ɛsɛ sɛ minya da biara?

Nea etwa to no, nneɛma a ɛsɛ sɛ wokae (Take-Home Message) .

Ɛyɛ ade a ɛfata sɛ wobɛte ehu nka kakra bere a wote sɛ wowɔ `(Marginal Cord Insertion)`. Nanso, mma saa yare a wɔahu yi mfa adwennwen a ɛho nhia nka wo nyinsɛn no ho. `(Marginal Cord Insertion)` betumi ahwehwɛ sɛ wɔhwɛ anaa wɔhwɛ so bio. Ebetumi aba nso sɛ tebea no renka wo nyinsɛn no koraa.

Nea ɛho hia sen biara ne sɛ wo duruyɛfo nim sɛ wowɔ saa tebea yi. Saa nsɛm yi bɛboa wɔn ma wo ne wo ba no anya apɔwmuden sɛnea wobetumi. Kae sɛ ɛnanom pii a wɔwɔ saa yare yi kɔ so wo nkokoaa a wɔwɔ apɔwmuden. Enti susuw nneɛma pa ho, di wo duruyɛfo afotu akyi, na biribiara bɛyɛ yiye!

` Awotwaa mu hama, awotwaa, nyinsɛn, akokoaa nkɔso, ultrasound, Marginal Cord Insertion, IUGR