Multiple Births Essay Example | Topics and Well Written Essays - 750 words

Multiple Births - Essay Example An inconsistency during the 2nd trimester between the measured fundal height and gestational age of the fetus usually present a case of twin or multiple pregnancies. Clinical presentation of these pregnancies elicit size of fetus greater than the date by exam, fetal motion not detected until 18-20 weeks, elevated AFP results (Tharpe, 2006). Confirmation of such pregnancies is made through ultrasonographic examination. Complications: Several risks and complications are associated with multiple gestations including early pregnancy loss, low birth weight along with the occurrence of intra-uterine fetal demise, preterm labor and delivery (Levene and Chervenak, 2009). There is an increased prevalence of congenital anomalies in monozygotic twins. Brain anomalies like hydrocephaly and micro-cephaly are found to be associated with multiple pregnancies. Also, risk for intra-partum asphyxia is increased in second born due to frequent fetal mal-presentation leading to traumatic delivery. Risk of maternal morbidity is also enhanced in these pregnancies. Other maternal complications include induced hypertension, gestational diabetes, anemia, urinary tract infections, pre-eclampsia, ante-partum hemorrhage, post-partum hemorrhage and endometriosis (Littleton and Engebreston, 2002). According to Avery et al., (2005) in multiple births increased risk of intra-uterine growth retardation is reported which may be due to unequal sharing of placenta among fetuses. Consequently, usual problems associated with intra-uterine growth retardation like intra-partum asphyxia, polycythemia, hypoglycemia and pulmonary hemorrhage are witnessed. In 5% of the multiple pregnancies, twin-to-twin transfusion syndrome is observed which is due to vascular anastomosis between the circulations of monozygotic twins sharing the same placenta. The transfusions taking place in single direction may render the donor fetus anemic, while the recipient fetus becomes polycythemic. Eventually, either of the twin fetuses may become hydropic due to volume overload or anemia. In some severe cases, the donor twin may expire. Management: Patients with multi-fetal pregnancies are followed closely with ultrasonographic examination to assess fetal growths and development throughout her pregnancy. Patient m ay be hospitalized if she develops signs of preterm labor or other complications. Delivery room management of multiple births requires larger number of trained personal for resuscitation/CPR in case of preterm delivery and availability of blood as multi-fetal pregnancies experience frequent blood loss and may lead to post-partum hemorrhage (Gilstrip et al., 2002). Multiple births offer a challenge to nurses and health paramedics in delivery room. Where majority of multiple pregnancies should be delivered normally a caesarean section is suggested as a preferred mode of delivery (Levene and Chervenak, 2009). For a vaginal delivery, continuous electronic monitoring of the fetal vital signs, tolerance to labor (attained by fetal electronic heart beat monitor) and uterine activity should be done (Cruickshank and Shetty, 2009). Delivery should be done till 40th week of gestation because of increased risk of peri-natal morbidity after the due date. In the labor management of twin gestation prostaglandins or oxytocin can be administered to induce vaginal delivery (Creasy et al., 2004).