- Often causes a flurry of excitement in the delivery room due to the health team’s curiosity. IT MUST be remembered that the focus is the delivering mother and her baby not the curiosity of the DR staff.
- Usually, it is delivered via a cesarean section due to the higher risk posed to the second fetus when delivered via spontaneous vaginal delivery (SVD). If it is to be delivered via SVD, instruct mother to go to the hospital earlier.
Classification:
- Monozygotic or identical twins
– Begins with a single fertilization (one ova and one sperm). During fusion or cell division, the zygote divides into two individuals.
– It is characterized by: 2 amnions, 1 chorion, 2 umbilical cord, and 2 placentas fused as one.
– Babies are always of the same sex.
- Dizygotic or fraternal twins
– Characterized by having 2 amnions, 2 chorions, c umbilical cord, and 2 placentas.
Possible Complications of Multiple Gestations:
1. Cord prolapse post PROM may occur.
2. Uterine dysfunction as a result of long labor and over-stretched uterus.
3. Abruptio placenta after delivery of first child.
4. Toxemia.
5. Polyhydramnios.
6. Anemia.
7. Postpartum hemorrhage.
8. Prematurity.
Management:
- Conservative analgesia use to lessen the risk for respiratory distress, which the fetus may experience secondary to immaturity.
- Support breathing exercises to lessen need for analgesia.
- Due to the risk of developing anemia and toxemia, monitor closely woman’s BP and hematocrit levels.
- After delivery of first infant, clamp (permanently rather than temporarily by an umbilical clip) both ends of the babies’ umbilical cord to prevent hemorrhage as a result of an open cord.
- Methergine for uterine involution is contraindicated to avoid compromising the status of the fetus not yet born.
- Provide emotional support. Remember, the woman unlike the health team, is more afraid than excited.
- Close monitoring postpartum. Woman is prone to:
1. Post-partal hemorrhage - due to difficulty of the uterus to contract again.
2. Uterine infection if birth is prolonged.
