Multiple Gestation Brooke Bracy, JB Kagabo, Danielle Loomis, Kristen Osip, & Jillian Queen

Etiology What is multiple pregnancy? Causes Frequency Associated risk factors

Types of Multiple Gestation Twins Identical Fraternal Higher order multiples triplets, quadruplets, etc.

Identical Twins Monozygotic One egg, one sperm, divides into 2 embryos

Fraternal Twins Dizygotic 2 eggs, 2 sperm, 2 embryos

Higher Order Multiples Triplets, quadruplets, quintuplets, etc. Variations of identical or fraternal multiples.

Treatments Common Complications with Multiple Gestation and Treatments for them: Preterm Birth/Labor Preeclampsia Gestational Diabetes Placental Problems

Treatments Continued... Other Considerations Activity Precautions Metabolic & Nutritional Monitoring Delivery of Baby

Nursing Care Nursing Diagnosis Nursing Interventions

Nursing Diagnosis: Mom Anxiety r/t uncertain outcome of pregnancy Fatigue r/t increased physiological demand of a multifetal pregnancy and/or care of more than one infant Deficient knowledge r/t multiple pregnancy or caring for more than one infant Stress overload r/t multiple coexisting stressor, family demands

Nursing Diagnosis: Mom cont’d Imbalanced nutrition: less than body requirement r/t increased physiological demands. Insomnia r/t impairment of normal sleep pattern; parental responsibility Increased risk for postpartum hemorrhage r/t uterine atony Risk for ineffective breastfeeding r/t lack of support, physical demands of feeding more than one infant

Nursing Diagnosis: Infants Risk for delayed development: fetuses r/t multiple gestation Neonatal jaundice r/t feeding pattern not well established Risk for impaired attachment r/t inadequate time with each newborn and lack of the ability to provide care for multiple infants Imbalanced nutrition: less than body needs r/t ineffective breastfeeding or lack of infant formula

Nursing Interventions Assess level of anxiety and physical reactions to anxiety. Teach different ways to cope with stress and anxiety. Encourage the pt. to take rest as needed, and help her identify family members or others who can help at home to do different chores. Educate pt. and family about multiple pregnancy (increasing nutrition, preventing hypertension, gestational diabetes, substance abuses,...)

Nursing Interventions Cont’d Assess sleep history such as bedtime routine, sleep pattern, use of stimulant. From history asses the degree and chronic nature of insomnia. Encourage pt. to focus on positive aspect of life, and to avoid use of stimulant before bedtime Encourage the mother to breastfeed to facilitate bonding and attachment. Tell the mother that formulas also can be used.

Nursing Interventions cont’d Frequently assess the mother for bleeding Assess uterine fundus, and do fundal massage if found boggy Administer medication as prescribed Promote bonding and attachment with each child Encouraged participation in infant’s care Suggest parents to keep feeding and care schedule so that they do not become confused

Outcomes Duration Resolution of Issue

Expected Outcomes: Mom Frequent check-ups Increased nutrients Weight gain Precautions

Potential Outcomes: Mom High blood pressure Gestational diabetes Early labor Delivery Medications

Potential Outcomes: Baby Premature birth Twin-twin transfusion TRAP

Caring for Multiple Babies Help from family and friends NICU Breastfeeding http://www.pennmedicine.org/encyclopedia/em_DisplayAnimation.aspx?gcid=000058&ptid=17

References Al-Khan, A. (2008). 11 things you didn’t know about twin pregnancies. WebMD. Retrieved from http://www.webmd.com/baby/features/11-things-you-didnt-know-about-twin- pregnancies?page=3 Fletcher, G. (2012). Multiple births. Medscape. Retrieved from http://emedicine.medscape.com/article/977234-overview#a0199 Formation of twins. (2014). University of Pennsylvania Health System. Retrieved from http://www.pennmedicine.org/encyclopedia/em_DisplayAnimation.aspx?gcid=000058&ptid=17 How a multiples pregnancy occurs. (2014). American Pregnancy Association. Retrieved from http://americanpregnancy.org/multiples/how-multiples-occur/

Ladwig, G. B, & Ackley, B. J (2010). Mosby's guide to nursing diagnosis (3rd ed., pp. 98-99). Maryland Heights: Elsevier Health Sciences. Multiple pregnancy. (2014). Children’s Hospital of Wisconsin. Retrieved from http://www.chw.org/medical-care/fetal-concerns-center/programs/conditions/pregnancy- complications/multiple-pregnancy/ Multiple pregnancy and birth: Twins, triplets, and high-order multiples (2014). In Society for Assisted Technology. Retrieved from http://www.sart.org/BOOKLET_Multiple_Pregnancy_and_Birth/ What twin pregnancy means for mom. (2011). Mayo Clinic. Retrieved from http://www.mayoclinic.org/healthy-living/pregnancy-week-by-week/in-depth/twin- pregnancy/art-20048161?pg=2 References