Chapter 11: Multiple Gestation

Question 1

What is Multiple Gestation

Answer 1

refers to a pregnancy in which two or more fetuses are present in the uterus, and the majority of multiples are twins

Question 2

Associated Complications

Answer 2

• maternal morbidity is higher
• high-risk pregnancy
• preterm labor often results from uterine overdistension and frequently necessitates an early operative delivery
• PTL, gestational diabetes, increased UTIs, preeclampsia/eclampsia, acute fatty liver, pulmonary embolism, placenta previa, fetal intrauterine growth restriction (IUGR), abnormal presentation, and umbilical cord prolapse
• increased risk of pulmonary edema caused by expanded plasma volume and increased cardiac output
• nutritional requirements are increased
• early in pregnancy, may suffer hyperemesis gravidarum as a result of higher levels of pregnancy hormones

Question 3

Diagnosis

Answer 3

confirmed by ultrasound examination

• reveals multiple gestational sacs with yolk sacs by 5 weeks of gestation and multiple embryos with cardiac activity by 6 weeks
• rapid uterine growth, excessive maternal weight gain, or palpitation of three or more fetal large parts (cranium and breech) on Leopold maneuvers
• lab tests show elevated levels of human chorionic gonadotropin (hCG), human placental lactogen (hPL), and maternal serum (alpha) a-fetoprotein

Question 4

Management

Answer 4

• appropriate trained specialist should manage obstetric care
• delivery should take place at a level III facility

Question 5

Nursing Implications

Answer 5

• hospitalization may be needed because of increased risk of complications
• have families voice their concerns
• serial ultrasounds, nonstress tests, and biophysical profiles will be part of the assessment for fetal-well being and growth
• fetal heart rate monitoring on each fetus