Multiple Gestation Brooke Bracy JB Kagabo Danielle Loomis

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 o o Identical Fraternal ● Higher order multiples o 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_Display. Animation. aspx? gcid=000058&ptid=17

References Al-Khan, A. (2008). 11 things you didn’t know about twin pregnancies. Web. MD. Retrieved from http: //www. webmd. com/baby/features/11 -things-you-didnt-know-about-twinpregnancies? page=3 Fletcher, G. (2012). Multiple births. Medscape. Retrieved from http: //emedicine. medscape. com/article/977234 -overview#a 0199 Formation of twins. (2014). University of Pennsylvania Health System. Retrieved from http: //www. pennmedicine. org/encyclopedia/em_Display. Animation. 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 (3 rd 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- References 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/twinpregnancy/art-20048161? pg=2