MULTIPLE PREGNANCIES

 Usually referred to as multiple gestation, is one in which more than one fetus
develops simultaneously in the mother's womb.
 Twin birth is by far the most common multiple birth.

Two types of twin pregnancy:

1. Fraternal twins / dizygotic

>develop from two separate ova released at the same time and fertilized by two
separate sperm.

2. Identical twins / monozygotic

> represent the splitting of a single fertilized zygote (union of two gametes or
male/female sex cells to produce a developing embryo) into two separate individuals.

>Identical twins will have the same DNA, genetic material (genotype), but it may
be expressed differently.

Three ways identical twins exist in the uterus:

1. dichorionic-diamniotic twins- division of the fertilized egg occurs within 72

hours past fertilization, before the inner cell mass has developed.
2. monochorionic-diamniotic twins- division occurs in the range of four to eight
days after fertilization, and the inner cell mass divides in two.
3. monochorionic-monoamniotic twins- contained in the same amniotic sac. The
division of the fertilized egg in this case occurs nine to 13 days past fertilization
or near the time of implantation in the uterus.
Possible complications of monoamniotic twins:

•Cord Entanglement- one of the main complications and have been reported to be
about 48%6. In the absence of an amniotic membrane, umbilical cords can easily
become entangled hindering fetal movement and development.

> Colour Doppler assessment of the umbilical cord was performed in order to
anticipate early signs of cord entanglement.

•Cord Compression-a life threatening condition preventing oxygenation and vital

nutrients resulting in fetal death.

•Twin-to-Twin Transfusion Syndrome (TTTS) - This causes one twin to become

undernourished with associated oligohydramnios whereas the other twin develops
severe polyhydramnios.
Symptoms of multiple pregnancy

The following are the most common symptoms of multiple pregnancy. However, each
woman may experience symptoms differently. Symptoms of multiple pregnancy may
include:

• uterus is larger than expected for the dates in pregnancy

• increased morning sickness
• increased appetite
• excessive weight gain, especially in early pregnancy
• fetal movements felt in different parts of abdomen at same time

CAUSES OF MULTIPLE PREGNANCIES:

 Maternal age- a woman who gives birth at 37 is four times more likely to have
fraternal twins than at age 18.
 use of fertility treatments such as

• In vitro fertilization (IVF)

• Gamete intrafallopian transfer (GIFT)

• Zygote intrafallopian transfer (ZIFT)

>intrauterine insemination or artificial insemination (the injection of sperm into

a woman's uterus with a syringe) is the only fertility treatment that does not
increase the chances of conceiving multiples.

RISKS:

> Premature birth and low birth weight

> Pre Eclampsia

> Cerebral palsy

> Selective reduction

> Maternal anemia

DIAGNOSTICS:

Ultrasound examinations- Transabdominal ultrasound

 determines the number of fetuses

 detects fetal anomalies
  follows the growth and development of each fetus
 serves to monitor the length of the cervix in anticipation of preterm labor

MANAGEMENT:

 Increased nutrition
 More frequent prenatal visits
 Bed rest
 Tocolytic medications such as terbutaline and magnesium sulfate
 Corticosteroids medication

PROGNOSIS:

 Many multiple pregnancies reach fruition without difficulties; however, many

do not. Despite medical advances, if the babies are born too early, they may
survive but will have sequelae that limit the quality of life. If the babies are
born prematurely, immediate medical care increases the chance of survival
without any complications.

AFTER PREGNANCY

Twins Saddle Hold

 Twin Football Hold
CORDILLERA CAREER DEVELOPMENT COLLEGE
Buyagan, Poblacion La Trinidad Benguet

COLLEGE OF NURSING

MULTIPLE PREGNANCIES

Submitted by:
Ortiz, May-Ann Bernadette O.
Gonsadan, Smith
BSN IV-SECTION A

Submitted To:
Ms. Maureen Ano, RN

Date submitted:
09-03-2010