MULTI

PREGNANCY
PLE
NCM 109: Care of the Mother and Child at Risk or with Problems
(Acute and Chronic) Lecture

Julius Caesar P. Collado

BSN II – F
What is Multiple Pregnancy?
 It is the gestation of twins, triplets,
quadruplets, or more infants.

 It is considered a complication of pregnancy

because a woman’s body must adjust to the
effects of more than one fetus.
 What are causes of Multiple Pregnancy?
 Heredity. A family history of multiple pregnancy raises the chances
of having twins.

 Older age. Women older than 30 have a greater chance of multiple

conception. Many women today are waiting to have children until
later in life. They may have twins as a result.

 High parity. Having 1 or more previous pregnancies, especially a

multiple pregnancy, raises the chances of having multiples.

 Race. African-American women are more likely to have twins than

any other race. Asian and Native Americans have the lowest
twinning rates. White women, especially those older than 35, have
the highest rate of higher-order multiple births (triplets or more).
What are other factors causing
Multiple Pregnancy?
 Ovulation-stimulating medicines, such as clomiphene citrate and
follicle stimulating hormone (FSH). These help produce many
eggs. If fertilized, they can result in multiple babies.

 Assisted reproductive technologies. In vitro fertilization (IVF) and

other methods may help couples get pregnant. These technologies
often use ovulation-stimulating medicines to produce multiple eggs.
These are then fertilized in the lab and returned to the uterus to
grow.
What are the symptoms of Multiple
Pregnancy?
 Uterus is larger than expected for the dates in
pregnancy
 More morning sickness
 Greater appetite
 Too much weight gain, especially in early
pregnancy
 Fetal movements felt in different parts of the
stomach at the same time
How is Multiple Pregnancy
diagnosed?
 It is suspected early in pregnancy when the uterus begins to
increase in size at a faster rate than usual.

 AFP levels will also be elevated.

 At the time of quickening, a woman may report flurries of action at

different portions of her abdomen rather than at one consistent
spot (such as where the feet are located).

 Upon auscultation of the abdomen, multiple sets of fetal heart

sounds can be heard.
How is Multiple Pregnancy
diagnosed?
The provider may make the diagnosis with a health history, physical
exam, and the following tests:
 Pregnancy blood testing. Levels of human chorionic gonadotropin
(hCG) may be quite high with multiple pregnancy.
 Alpha-fetoprotein. Levels of a protein released by the fetal liver and
found in the mother's blood may be high when more than 1 fetus is
making the protein.
 Ultrasound. This is an imaging test that uses high-frequency sound
waves to create images of blood vessels, tissues, and organs.
Ultrasounds can be done with a vaginal transducer, especially in early
pregnancy. Or they can be done with an abdominal transducer in later
pregnancy.
How is Multiple Pregnancy
diagnosed?
What are the Complications of
Multiple Pregnancy?
Preterm labor and birth
Gestational high blood pressure
Gestational diabetes
Anemia
Birth defects
Miscarriage
Twin-to-twin Transfusion Syndrome (TTTS)
Abnormal amounts of amniotic fluid
Cord entanglement
Cesarean section delivery
Postpartum hemorrhage
What are the Complications of
Multiple Pregnancy?
 How does Multiple Pregnancy
happen?
Multiple pregnancy often happens when more than 1 egg is
fertilized and implants in the uterus. This is called
FRATERNAL TWINNING. It can produce boys, girls, or a
combination of both.
Fraternal multiples are simply siblings conceived at the same
time. But just as siblings often look alike, fraternal multiples
may look very similar. Fraternal multiples each have a
separate placenta and amniotic sac.
How does Multiple Pregnancy happen?
How does Multiple Pregnancy
happen?
 Sometimes, 1 egg is fertilized and then splits into 2 or more
embryos. This is called IDENTICAL TWINNING. It makes all
boys, or all girls. Identical multiples are genetically the same.
 They often look so much alike that even parents have a hard
time telling them apart. But these children have different
personalities and are distinct people.
 Identical multiples may have individual placentas and
amniotic sacs.
 Most share a placenta with separate sacs. Rarely, identical
twins share 1 placenta and a single amniotic sac.
How does Multiple Pregnancy happen?
How are Multiple Pregnancies delivered?
 Delivery of multiples depends on many factors including the fetal
positions, gestational age, and health of mother and fetuses.
 Generally, in twins, if both fetuses are in the vertex (head-down)
position and there are no other complications, a vaginal delivery is
possible.
 If the first fetus is vertex, but the second is not, the first fetus may be
delivered vaginally, then the second is either turned to the vertex
position or delivered breech (buttocks are presented first). These
procedures can increase the risk for problems such as prolapsed cord
(when the cord slips down through the cervical opening).
 Emergency cesarean birth of the second fetus may be needed.
Usually, if the first fetus is not vertex, both babies are delivered by
cesarean. Most triplets and other higher-order multiples are born by
cesarean.
How are Multiple Pregnancies delivered?
How are Multiple Pregnancies delivered?
How are Multiple Pregnancies delivered?
How are Multiple Pregnancies delivered?

 Vaginal delivery may take place in an operating room

because of the greater risks for complications during birth

g
and the potential need for cesarean delivery.

 Cesarean delivery is usually needed for fetuses that are

in abnormal positions, for certain medical conditions of
the mother, and for fetal distress.
What are the Therapeutic Management
for Multiple Pregnancy?
 Monitor and assess for postpartum bleeding.
 Help in planning for adequate nutrition and rest during
pregnancy.
 Emphasize the need for more frequent prenatal visits.
 Maternal and fetal testing
 Administration of Tocolytic and Corticosteroid
medications
 Cervical cerclage
 Monitor vital signs

NURSING RESPONSIBILITIES