twins

The TwinsTaghreed Eyuni

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By the end of this presentation you will be able to:

* Define twins

* Identify the twins types

* Know about the incidence of twins

* Know the diagnosis of the twins

* Identify the chances to deliver prematurely

* Understand the risks of premature birth

* Know the potential complications of twins

* Understand the nursing managements

* Identify the important mother and family educational topics

What is twins

• A twin is one of two offspring produced in the same pregnancy.[1] Twins can either be monozygotic ("identical"), meaning that they develop from one zygote that splits and forms two embryos, or dizygotic ("fraternal") because they develop from two separate eggs that are fertilized by two separate sperm.

Types of twins

• Dizygotic twin 2 sperms, 2 eggsIncidence : variableFetal sex : same or different

Membranes : dichorionic, diamnionicPlacenta : one fused or two separate

• Monozygotic twin Incidence : 1:250 pregnanciesFertilization : 1 sperm, 1 eggFetal sex : same.Placenta : one fused or separate (two separate : dichorionic)Division of zygote : depend on day of twinning

Diagnosis

History : maternal family history, advanced maternal age, large maternal size

Clinical examination : size > date (2nd trimester)

Ultrasound : separate gestational sac, 2 head or abdomen in the same plane

the chances to deliver prematurely

• According to the March of Dimes, close to 60 percent of all twins and more than 90 percent of triplets are born prematurely (before 37 weeks). The average twin pregnancy lasts 35 weeks. Triplet pregnancies average 33 weeks, and quad pregnancies average 29 weeks.

the risks of premature birth

• Babies born before their time may not be completely ready for the outside world. Their lungs, brain, and other organs may not be fully developed, their immune system may not be ready to fight off infections, and they may not be able to suck or swallow.

• The earlier a baby is born, the greater the risks. Premature babies born between 34 and 37 weeks generally do very well. Babies born before 28 weeks may survive, but they'll need intensive medical care and a little luck.

potential complications of having twins

• Twins often don't have a chance to reach a healthy weight before they're born. While the average single baby weighs 7 pounds at birth, the average twin weighs 5.5 pounds. Babies with low birth weights are likely to have health problems even if they weren't born prematurely.

• Low-birthweight babies often have trouble breathing on their own. They may not be fully prepared to fight infections, control their body temperature, or put on weight. For these reasons, almost all low-birthweight babies have to spend time in a neonatal intensive care unit before going home

• Preeclampsia, a disorder characterized by high blood pressure and protein in the urine, develops in roughly 10 to 15 percent of women carrying twins, twice the rate of women carrying one baby. The condition tends to develop earlier as well. And once it starts, it can be especially severe. When preeclampsia is severe, it can affect many organs and cause serious or even life-threatening problems.

• Placental abruption, when the placenta detaches from the uterine wall before delivery, is also more likely when you're carrying more than one baby. It can happen any time in the second half of pregnancy and can lead to growth problems, preterm delivery, or stillbirth.

Nursingmanagement

General Principles

Prepare the delivery bedPrepare all the equipment needed Connect to CTG with dual monitoring capabilityAdminister IV fluids as ordered to maintain fluid balanceUse aseptic techniques when performing pelvic examination. Start oxytocin infusion as orderedStart Tocolytic agent for uterine relaxation as orderedBe ready for emergency SCAssess for postpartum hemorrhageImmediate availability of blood

Mother education

Nutrition

Teach the mother about the diet: * 3500 kcal/day

Iron (60 mg/day)Folic acid (1 mg/day)Calcium (2000 mg/day)

Teach her about the expected TWG:*16 – 20 kg at term

Growth evaluation

Advise the mother to do serial U/S in 2nd and 3rd trimester:

* Monochorionic twins every 2 – 3 wks in 2nd trimester

* Dichorionic twin every 4 – 6 wks in 2nd trimester (or after 20 wks)

Preterm prevention

Advise the mother to have bed rest: Is often recommended for prevention of preterm labor

Teach the mother how to do home uterine monitoring:

Effectively detects contractions predictive of preterm labor

General principles

• Prepare the mother for having the new twins

• Teach the mother how to deal with the twins in different situations

• Teach the mother how to breast feed the twins

References:• http://

www.babycenter.com/0_pregnant-with-multiples-potential-complications_3584.bc

• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595249/• Adegbite A. L, Castille S, Ward S, Bajoria R. Neuromorbidity in preterm

twins in relation to chorionicity and discordant birth weight [Electronic version]. American Journal of Obstetrics and Gynecology. 2004;190:156–163. [PubMed]

• Chism D. M. 1998. The high risk pregnancy sourcebook. WebMD. Retrieved March 5, 2004, fromhttp://www.WebMd.com.

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