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 Identical
o 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_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

References
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