nursing discussion for the case..

1. Taghreed Eyuni
9193004

2. Define twins
Identify the twins types
Know about the incidence of twins
Know the diagnosis of the twins
Identify the chances to deliver prematurely
Understand the risks of premature birth
Know the potential complications of twins
Understand the nursing managements
Identify the important mother and family educational topics

3. • A twin is one of two offspring produced in
the same pregnancy.[1] Twins can either be
monozygotic ("identical"), meaning that they
develop from one zygote that splits and
forms two embryos, or dizygotic ("fraternal")
because they develop from two separate
eggs that are fertilized by two separate
sperm.

4. 2 sperms, 2 eggs
Incidence : variable
Fetal sex : same or different
Membranes : dichorionic, diamnionic
Placenta : one fused or two separate

5. Incidence : 1:250 pregnancies
Fertilization : 1 sperm, 1 egg
Fetal sex : same.
Placenta : one fused or separate
(two separate : dichorionic)
Division of zygote : depend on day of twinning

6. History :
maternal family history, advanced maternal age,
large maternal size
Clinical examination : size > date (2nd trimester)
Ultrasound : separate gestational sac, 2 head
or abdomen in the same plane

7. • According to the March of Dimes, close to 60
percent of all twins and more than 90 percent of
triplets are born prematurely (before 37 weeks).
The average twin pregnancy lasts 35 weeks.
Triplet pregnancies average 33 weeks, and
quad pregnancies average 29 weeks.

8. • Babies born before their time may not be completely ready for the
outside world. Their lungs, brain, and other organs may not be fully
developed, their immune system may not be ready to fight off
infections, and they may not be able to suck or swallow.
• The earlier a baby is born, the greater the risks. Premature babies
born between 34 and 37 weeks generally do very well. Babies born
before 28 weeks may survive, but they'll need intensive medical
care and a little luck.

9. • Twins often don't have a chance to reach a healthy weight before
they're born. While the average single baby weighs 7 pounds at
birth, the average twin weighs 5.5 pounds. Babies with low birth
weights are likely to have health problems even if they weren't born
prematurely.
• Low-birthweight babies often have trouble breathing on their own.
They may not be fully prepared to fight infections, control their body
temperature, or put on weight. For these reasons, almost all low-
birthweight babies have to spend time in a neonatal intensive care
unit before going home

10. • Preeclampsia, a disorder characterized by high blood
pressure and protein in the urine, develops in roughly 10
to 15 percent of women carrying twins, twice the rate of
women carrying one baby. The condition tends to
develop earlier as well. And once it starts, it can be
especially severe. When preeclampsia is severe, it can
affect many organs and cause serious or even life-
threatening problems.

11. • Placental abruption, when the placenta
detaches from the uterine wall before
delivery, is also more likely when you're
carrying more than one baby. It can
happen any time in the second half of
pregnancy and can lead to growth
problems, preterm delivery, or stillbirth.

13. Prepare the delivery bed
Prepare all the equipment needed
Connect to CTG with dual monitoring capability
Administer IV fluids as ordered to maintain fluid balance
Use aseptic techniques when performing pelvic examination.
Start oxytocin infusion as ordered
Start Tocolytic agent for uterine relaxation as ordered
Be ready for emergency SC
Assess for postpartum hemorrhage
Immediate availability of blood

15. Teach the mother about the diet:
* 3500 kcal/day
Iron (60 mg/day)
Folic acid (1 mg/day)
Calcium (2000 mg/day)
Teach her about the expected TWG:
*16 – 20 kg at term

16. :
* Monochorionic twins
every 2 – 3 wks in 2nd trimester
* Dichorionic twin
every 4 – 6 wks in 2nd trimester (or after 20 wks)

17. Advise the mother to have bed rest:
Is often recommended for prevention of preterm labor
Teach the mother how to do home uterine
monitoring:
Effectively detects contractions predictive of preterm
labor

18. • Prepare the mother for having the new
twins
• Teach the mother how to deal with the
twins in different situations
• Teach the mother how to breast feed the
twins

19. • http://www.babycenter.com/0_pregnant-with-multiples-potential-
complications_3584.bc
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595249/
• Adegbite A. L, Castille S, Ward S, Bajoria R. Neuromorbidity in preterm
twins in relation to chorionicity and discordant birth weight [Electronic
version]. American Journal of Obstetrics and Gynecology. 2004;190:156–
163. [PubMed]
• Chism D. M. 1998. The high risk pregnancy sourcebook. WebMD. Retrieved
March 5, 2004, fromhttp://www.WebMd.com.