multiple pregnancy ppt..pptx

NURSING

1. MITTAL COLLEGE OF NURSING AJMER PRESENTATION ON :- MULTIPLE PREGNANCY SUBMITTED TO: SUBMITTED BY : MRS. SNEHLATA PARASHAR GAVRIKA DADHICH (NURSING LECTURER) B.SC NURSING 4 th year

2. Multiple pregnancy

3. Multiple pregnancy Definition- 'Multiple Pregnancy' is the development of more than one fetus in the utero at the same time. The simultaneous development of two fetuses is termed twins, three-triplets, four-quadruplets, five-quintuplets, six as sextuplets and seven-septuplets. Or All gestasions where more then one conceptus is formed is called multiple pregnancy. Twin pregnancy is the most commonly seen type of multiple pregnancy with two fetuses in utero.

4. Classification of twin pregnancy

5. .. 1. Dizygotic or biovular twins - develop from two separate oocytes, fertilized by two sperms during the same ovarian cycle. They are referred as "non-identical twins". They may be of same or of different sex.  2. Monozygotic or uniovular twins - are known as "identical twins" They develop from the fusion of one oocyte and one spermatozoon, which after fertilization splits into two. These twins will be of the same sex and have same genes, blood g ro ups and physical features such as eyes and hair colour, ear shapes etc.

6. On extreme rare occasions:- division occurs after 2 weeks of the development of embryonic disc resulting in the formation of conjoined twins called-Siamese twins .           Types:- - Thoracopagus (commonest) - Pyopagus (Posterior fusion) - Craniopagus (cephalic) - Ischiopagus (caudal) 

7. - Thoracopagus (commonest)

8. - pyopagus (posterior fusion)

9. -craniopagus (cephalic)

10. - ischiopagus (caudal)

11. Terms used for twin:- - Superfecundation - Superfetation - Fetus papyraceous or compressus - Fetus acardius - Vanishing twin

12. Superfecundation: Fertilization of two different ova released in the same cycle ,by separate act of coitus with in a short period of time.

13. Superfetation: Fertilization of two different ova released in two different menstrual cycle the development of one fetus over another fetus theoretically possible until 12 weeks.

14. Fetus compressus : It is a state of pregnancy when one of the fetuses dies early, gets compressed and flattened in between the membranes of the living fetus and the uterine wall. The condition is common in uniovular twins and rarely occurring in biovular twin pregnancy. The thinned out fetus is easily detectable on ultrasound examination conducted during pregnancy

15. Fetus acardius : Fetus developed with no heart, connected as a parasite to another fetus.

16. Vanishing twin syndrome: Death of one of the twins during second trimester and becoming fetus compressus , getting embedded into the placenta and expelling out during delivery with the other one may complete the term in healthy form is called vanishing twin syndrome.

17. Diagnosis:- History and clinical examination- - Family history drug history symptoms- - Increased nausea and vomiting. Uterine enlargement. Swelling in the legs. Excessive fetal movements. Cardiorespiratory changes.

18. Abdominal examination- inspection: abdomen is enlarged and barrel shaped. Palpation: palpation of too many fetal parts. Ascultation : difference in heart rates is atleast 10 beats/min. Sonography- - Separater gestational sac identified early. -amniotic fluid volume.

19. sonography

20. Biochemical tests: Levels of hCG in plasma and in urine : higher Maternal serum alpha-fetoprotein level : Elevated

21. Complication: Maternal Fetal -nausea ,vomiting - vanishing twin - anemia - preterm birth -pre eclampsia - LBW baby -preterm labor - cord compression -prolonged labor - locke twins

22. locked twin:-

23. Management:- antenatal management : Early diagnosis of twin pregnancy is extreamly important in order to prepare parents ,by giving specialist support and the advice needed by them. This will help them to care the fetus properly during antenatal period as well as prevent occurance of complication during intranatal and postnatal period .

24. Diet : The diet of a mother with multiple pregnancy should include extra calories ( aprox 300 g/day) in the form of protein 80gm/day ,fat and protein . Rest: Extra bed rest and light work is adviced .a good night sleep and away from worries is needed during antenatal period .

25. . Fetal growth assessment is carried out to find the development of fetus as serial ultrasound examination. Supplement therapy includes iron , folic acid , vitamins , and calcium

26. Hospitalization: If beds are available , the optimum time when maximum benifits is expected is hospitalization b/w 30-36 weeks. On hospitalization the risk of prematurity is much reduced , timely admission decrease frequency of preeclampsis and lower the prenatal mortility .

27. Management during labour: Induction of labour usually done around 37 weeks of gestation because of having risk of complications like intranatal bleeding , intra uterine growth retardation . progress of labour is detected by carring ut vaginal examination. Labour room should be prepared before receive pt.

28. Cont ……. An obstetrician , pediatritian , and anesthetist should be present in case of any complication. There is possibility of emergency caesarean section may be carried out, the midwife should make necessary arrangement and be prepared to meet such situations.

29. Cont ……… Explain the relatives the progress of labour ,obtain written concent . Make sure availability of one unit of compatible and cross matched blood . Careful monitoring . An intravenous line with RL solution .

30. Delivery of first baby: Same guideline as in normal labour. Clamp the cord at two place and cut it b/w. The baby should be labled . Vaginal examination should be carried out. If the uterine contraction is poor ,5 unit of oxytocin is added. Delivery of second baby must be complete within 30-35 mins.

31. Cont …… The delivery of second baby carried out in same manner. Oxytocin administration help in easy delivery of the baby . Indication of urgent delivery of 2 nd baby: - severe veginal bleeding -cord prolapse -first delivery under GA -appearance of fetal distress

32. -Delay in birth of second baby ; risk of –intrauterine hypoxia and sepsis. Methargin 0.2 mg IV is administred with the delivery of second baby. The time ,sex of the baby is noted and labelled as second twin . The risk of asphyxia is greater for second twin and active resuscitation is required immidiately after the birth .

33. Management of the third stage of labour: Deliver the placenta without delay. Empty the uterus. Oxytocin drip is continued for atleast 45 mins. Following delivery of second baby Vital sign of mother are closely observed for atleast 2 hr. Excessive blood loss is replaced by blood transfusion.

34. management of postnatal period: *c are of baby- Immidiate care *maintain airway *documentation (APGAR) *care of eye *care of skin * vit.k Maintenance of body temperature Initiation of breast feeding Monitor for weight

35. Care of mother: Gradually Pain increase, so analgesics should be offered. High calorie diet. Extra support to handle twin baby. Reassure that lactation respond to the demand made by babies sucking. At feeding time, mother must provided support and adviced for positioning. Provide knowledge to mother regarding different positions , along with advantages, attachment, from positioning.

36. Bibliography :- Dc. Dutta textbook of obstetrics. 6 th edition. Gk sandhu textbook of obstetric and midwifery. Reena wani textbook of midwifery for nurses. www.slidshare.net

37. ok Thank you