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

2. Etiology What is multiple pregnancy? Causes Frequency
Associated risk factors

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

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

5. Fraternal Twins
Dizygotic
2 eggs, 2 sperm, 2 embryos

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

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

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

9. Nursing Care
Nursing Diagnosis
Nursing Interventions

10. 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

11. 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

12. 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

13. 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,...)

14. 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.

15. 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

16. Outcomes
Duration
Resolution of Issue

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

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

19. Potential Outcomes: Baby
Premature birth
Twin-twin transfusion
TRAP

20. Caring for Multiple Babies
Help from family and friends
NICU
Breastfeeding

21. References
Al-Khan, A. (2008). 11 things you didn’t know about twin pregnancies. WebMD. Retrieved from
pregnancies?page=3
Fletcher, G. (2012). Multiple births. Medscape. Retrieved from
Formation of twins. (2014). University of Pennsylvania Health System. Retrieved from
How a multiples pregnancy occurs. (2014). American Pregnancy Association. Retrieved from

22. 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
complications/multiple-pregnancy/
Multiple pregnancy and birth: Twins, triplets, and high-order multiples (2014). In Society for Assisted
Technology. Retrieved from
What twin pregnancy means for mom. (2011). Mayo Clinic. Retrieved from
pregnancy/art ?pg=2
References