Multiple Pregnancy Powepoint

8/7/2019 Multiple Pregnancy Powepoint

1/39

MULTIPLE PREGNANCYMULTIPLE PREGNANCY


2/39

occurs when more than one fetusoccurs when more than one fetusiscarried to term in a singleiscarried to term in a singlepregnancypregnancy

differentdifferent names for multiple birthsnames for multiple births

are used, depending on theare used, depending on thenumberofnumberofoffspringoffspring

commoncommon multiples are two andmultiples are two andthree, known as twins and tripletsthree, known as twins and triplets


3/39

Multiple birth siblings areMultiple birth siblings areeithereithermonozygoticmonozygoticoror

dizygoticdizygotic..

MultiplescalledMultiplescalled polyzygoticpolyzygoticrepresent some combination ofrepresent some combination offraternal and identicalfraternal and identical siblings.siblings.


4/39

Identical twinsIdentical twins


5/39

Fraternal twinsFraternal twins


6/39

TheThe f ollowingfollowing areare thethe

mostmost commoncommon symptomssymptomsofof multiplemultiple pregnancypregnancy..However,However, eacheach womanwoman

maymay experienceexperiencesymptomssymptoms differentlydifferently..SymptomsSymptoms ofof multiplemultiplepregnancypregnancy maymay includeinclude::


7/39

uterus is larger than expecteduterus is larger than expected

for the dates in pregnancy.for the dates in pregnancy.increased morning sickness.increased morning sickness.increased appetite.increased appetite.

excessive weight gain,excessive weight gain,especially in early pregnancy.especially in early pregnancy.fetal movements felt infetal movements felt in

different partsof abdomen atdifferent partsof abdomen atsame time.same time.


8/39

DiagnosisDiagnosis ofof multiplemultiple fetusesfetuses

maymay bebe mademade earlyearly ininpregnancy,pregnancy, especiallyespecially ififreproductivereproductive technologiestechnologies

havehave beenbeen usedused.. InIn additionaddition totoaa completecomplete medicalmedical historyhistory andandphysicalphysical examination,examination,

diagnosisdiagnosis maymay bebe mademade byby::


9/39

pregnancypregnancy bloodblood testingtesting

-- LevelsLevels ofof humanhumanchorionicchorionic gonadotrophingonadotrophin

((hCGhCG)) maymay bebe quitequite highhighwithwith multiplemultiple pregnancypregnancy..


10/39

alphaalpha--fetoproteinfetoprotein --

LevelsLevels ofof aa proteinproteinreleasedreleased byby thethe fetalfetal liverliver

andand f oundfound inin thethemother'smother's bloodblood maymay bebehighhigh whenwhen moremore thanthan

oneone fetusfetus isis makingmaking thetheproteinprotein..


11/39

ultrasoundultrasound -- aa diagnosticdiagnostic imagingimagingtechniquetechnique whichwhich usesuses highhigh--frequencyfrequencysoundsound waveswaves andand aa computercomputer toto createcreateimagesimages ofof bloodblood vessels,vessels, tissues,tissues, andand

organsorgans.. UltrasoundsUltrasounds areare usedused toto viewviewinternalinternal organsorgans asas theythey function,function, andand totoassessassess bloodblood flowflow throughthrough variousvariousvesselsvessels -- withwith aa vaginalvaginal transducer,transducer,

especiallyespecially inin earlyearly pregnancy,pregnancy, oror withwithanan abdominalabdominal transducertransducer inin laterlater

pregnancypregnancy..


12/39

TERMINOLOGYTERMINOLOGY

MonozygoticMonozygotic multiple (typicallymultiple (typicallytwo) fetuses produced by thetwo) fetuses produced by thesplitting of a singlesplitting of a single zygotezygoteDizygoticDizygotic multiple (typicallymultiple (typically

two) fetusestwo) fetuses produced by twoproduced by twozygoteszygotesPolyzygoticPolyzygotic multiple fetusesmultiple fetuses

produced by twoor more zygotesproduced by twoor more zygotesLitterLitter the offspring produced bythe offspring produced bya multiple birth in nona multiple birth in non--humanhumanplacentalsplacentals


13/39

HighHigh ordersof multiple birthsordersof multiple births

(three or more offspring in one(three or more offspring in onebirth) mayresult in abirth) mayresult in acombination of fraternalcombination of fraternal

(genetically different) and(genetically different) andidentical (genetically identical)identical (genetically identical)siblings.siblings.


14/39

Causes and frequencyCauses and frequencyAccording to Hellin's Law, multiplebirths occur naturally at

approximately the rate of:Twins: 1/89 (about 1.1%) ofsingleton births,Triplets: 1/892 = 1/7921 (about

0.013%) of singleton births, andN-tuplets: 1/89N-1 (


15/39

RISKRISK


16/39

PrematurePremature birthbirthrefers to the birth of a baby of lessthan 37 weeks gestational age. The

cause for preterm birth is in manysituations elusive and unknown;many factors appear to beassociated with the development of

preterm birth, making the reductionof preterm birth a challengingproposition.


17/39

low birth weightlow birth weightLow birth weight refers to infants who weighless than 5.5 pounds at birth. Most normal

babies weigh 5.5 pounds by 37 weeks ofgestation. Intrauterine growth restrictionrefers to delayed growth within the uterus,which then leads to low birth weight. Some

babies are just small and happen to weighless than 5.5 pounds at birth. Though this isconsidered low birth weight, in these cases,it is not abnormal or a cause for concern.


18/39

pregnancypregnancy--inducedinduced

hypertensionhypertensionWomen with multiple fetuses aremore than three times as likely to

develop high blood pressure ofpregnancy. This condition oftendevelops earlier and is more severe

than pregnancy with one baby. Itcan also increase the chance ofplacental abruption (earlydetachment of the placenta).


19/39

anemiaanemia

Anemia is more thantwice as common in

multiple pregnanciesas in a single birth.


20/39

birth defectsbirth defectsMultiple birth babies haveabout twice the risk ofcongenital (present at birth)abnormalities including neural

tube defects (such as spinabifida), gastrointestinal, andheart abnormalities.


21/39

miscarriagemiscarriageA phenomenon called the

vanishing twin syndrome in whichmore than one fetus isdiagnosed, but vanishes (or ismiscarried), usually in the firsttrimester, is more likely inmultiple pregnancies. This may ormay not be accompanied by


22/39

twintwin--toto--twintwin

transfusion syndrometransfusion syndrome

Twin-to-twin syndrome is a

condition of the placenta thatdevelops only with identicaltwins that share a placenta.

Blood vessels connect withinthe placenta and divert bloodfrom one fetus to the other.


23/39

abnormal amountsabnormal amountsofof

amnioticamniotic fluidfluid

Amniotic fluid abnormalities

are more common in multiplepregnancies, especially fortwins that share a placenta.


24/39

cesarean deliverycesarean delivery

Abnormal fetal positions

increase the chances ofcesarean birth.


25/39

postpartumpostpartum

hemorrhagehemorrhageThe large placental area and

over-distended uterus place amother at risk for bleedingafter delivery in many

multiple pregnancies.


26/39

Management of multipleManagement of multiplepregnancy:pregnancy:


27/39

Specific management for multipleSpecific management for multiple

pregnancy will be determined bypregnancy will be determined byyour physician based on:your physician based on:


28/39

youryour pregnancy,pregnancy, overalloverall healthhealth andandmedicalmedical historyhistory..thethe numbernumber ofof fetusesfetuses..youryour tolerancetolerance forfor specificspecificmedications,medications, proceduresprocedures oror

therapiestherapies..expectationsexpectations forfor thethe coursecourse ofof thethe

pregnancypregnancy..

youryour opinionopinion oror preferencepreference..


29/39

Management of multipleManagement of multiplepregnancy may include thepregnancy may include the

following:following:


30/39

increased nutritionincreased nutrition -- MothersMothers

carrying twoor more fetuses needcarrying twoor more fetuses needmore calories, protein, and othermore calories, protein, and othernutrients, including iron.Highernutrients, including iron.Higherweight gain is alsorecommendedweight gain is alsorecommended

for multiple pregnancy. Thefor multiple pregnancy. TheAmerican College of ObstetriciansAmerican College of Obstetriciansand Gynecologistsrecommendsand Gynecologistsrecommends

women carrying twins gain atwomen carrying twins gain atleast 35 to 45 pounds.least 35 to 45 pounds.


31/39

more frequent prenatal visits (tomore frequent prenatal visits (tocheck forcomplications and tocheck forcomplications and tomonitor nutrition and weight gain)monitor nutrition and weight gain)


32/39

referralsreferrals -- Referral to a maternalReferral to a maternal--

fetal medicine specialist, called afetal medicine specialist, called aperinatologistperinatologist, forspecial testing, forspecial testingorultrasound evaluations, and toorultrasound evaluations, and to

coordinate care ofcomplications,coordinate care ofcomplications,may be necessary.may be necessary.


33/39

increased restincreased rest -- Some women maySome women may

also needalso need bedrestbedrest -- either at homeeither at homeor in the hospital depending onor in the hospital depending onpregnancycomplicationsor thepregnancycomplicationsor thenumberof fetuses.Highernumberof fetuses.Higher--orderorder

multiple pregnanciesoften requiremultiple pregnanciesoften requirebedrestbedrest beginning in the middle ofbeginning in the middle ofthe second trimester.the second trimester.


34/39

maternal and fetal testingmaternal and fetal testing --

Testing may be needed to monitorTesting may be needed to monitorthe health of the fetuses,the health of the fetuses,especially if there are pregnancyespecially if there are pregnancycomplications.complications.


35/39

tocolytictocolytic medicationsmedications -- TocolyticTocolyticmedications may be given, ifmedications may be given, ifpreterm laboroccurs, to help slowpreterm laboroccurs, to help sloworstop contractions. These may beorstop contractions. These may be

given orally, in an injection, orgiven orally, in an injection, orintravenously.intravenously. TocolyticTocolyticmedicationsoften used includemedicationsoften used include

terbutalineterbutaline and magnesiumand magnesiumsulfate.sulfate.


36/39

corticosteroid medicationscorticosteroid medications --

Corticosteroid medications may beCorticosteroid medications may begiven to help mature the lungsofgiven to help mature the lungsofthe fetus. Lung immaturity is athe fetus. Lung immaturity is a

major problem of prematuremajor problem of prematurebabies.babies.


37/39

cervicalcervical cerclagecerclage -- CerclageCerclage (a(aprocedure used tosuture theprocedure used tosuture the

cervical opening) isused forcervical opening) isused forwomen with an incompetentwomen with an incompetentcervix. This is a condition in whichcervix. This is a condition in which

the cervix is physically weak andthe cervix is physically weak andunable tostayclosed duringunable tostayclosed duringpregnancy.Some women withpregnancy.Some women withhigherhigher--order multiples mayorder multiples may

requirerequire cerclagecerclage in earlyin earlypregnancy.pregnancy.


38/39

Deliveryof multiples dependsonDeliveryof multiples dependson

many factors including the fetalmany factors including the fetalpositions, gestational age, andpositions, gestational age, andhealth of mother and fetuses.health of mother and fetuses.

Generally, in twins, if both fetusesGenerally, in twins, if both fetusesare in the vertex (headare in the vertex (head--down)down)position and there are nootherposition and there are noothercomplications, a vaginal delivery iscomplications, a vaginal delivery is

possible.possible.


39/39

"Our job as nurses is tocushion the sorrow andcelebrate the joy, everyday, while we are 'just doing

our jobs.'"

Multiple Pregnancy Powepoint

Documents

Transcript of Multiple Pregnancy Powepoint