P2 - Lecture Twin Pregnancy JW Multiples Intrapartum and Postpartum 11 March 202

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Page 1: Preparation for Birth

• Discussion on partum and postpartum care related to multiple births.

• Emphasizes preparation for birth discussed by Pip and parent education classes.

• Factors affecting care include type of training (e.g., Catholic-owned facilities).

Twin Deliveries

• Vaginal birth preferred unless complications arise (e.g., twin B in breech presentation).

• Locked twins can occur when one twin presents before the other, raising the risk of complications.

• Discussions with healthcare team may lead to considering a cesarean section in certain cases.

• Other presentations (e.g., oblique or transverse) may lead to cesarean discussions if labor occurs.

Page 2: Infusion and Monitoring

• Infusions may be initiated to augment labor between twins, especially in cases of significant time delays.

• Fetal surveillance should be continuous; a CTG (cardiotocography) is often utilized.

• Preparations include blood cross-matching for potential cesarean sections or emergencies.

• Use of epidural is discussed for pain management, particularly if hypertension is present.

• Options for analgesia need to be available without pressure to use them unless necessary.

• Obligation to ensure availability of medical team members, including obstetricians and midwives, based on multiple births.

Page 3: CTG Monitoring and Team Coordination

• Establish clear presence of necessary medical personnel.

• Two midwives are recommended for twin births, with additional staff for triplets.

• Paediatricians and anaesthetists also required for comprehensive care during delivery.

• The CTG trace allows differentiation between twin A and twin B based on heart rate variations.

Continuous Monitoring

• Monitoring should be vigilant, with at least a one-minute assessment to understand heart rates and potential distress.

• Distinguishing between the two fetuses is crucial to avoid confusion, particularly during interventions.

Page 4: Preparation for Resuscitation

• Ensure operational portable ultrasound is on hand to monitor positioning of twin 2 immediately after twin 1’s delivery.

• Options like forceps may be necessary for efficient delivery of the second twin.

• Oxytocin infusions may be utilized for both augmentation and uterine contractions; caution with timing is essential.

Page 5: Postnatal Considerations

• Continuous monitoring yields valuable data, especially regarding Apgar scores, which guide postnatal decisions.

• Neonatal units are necessary for early deliveries (before 36 weeks); cord blood gases are assessed accordingly.

• The postpartum period is extended based on premature births, with council guidelines recommending 4-6 weeks of care post-discharge.

Healthcare Provider Responsibilities

• The midwife's role includes supporting parents adjusting to life with multiple infants, managing breastfeeding or bottle-feeding, and monitoring overall health.

• If the baby's preterm hospitalization affects postnatal timing, it must be communicated effectively to the parents.

Page 6: Extended Postpartum Care

• Clarification on how postnatal care schedules differ based on infant discharge and hospitalization timelines.

• Potential for care requests to exceed typical postnatal periods if complications arise.

• Recommendations on providing abundant support for families, especially first-time parents of multiples.

• Final reflections on embryogenesis and the importance of understanding fetal development for practitioners.

Preparation for Birth of Twins - Intrapartum

• Understanding Intrapartum Care: Emphasis on preparation for the delivery of twins and ensuring proper protocols are in place.

• Equipment Considerations: Necessary equipment for twin delivery includes:

  • Portable ultrasound for immediate monitoring of positioning of twin 2 after twin 1's delivery.

  • Instruments such as forceps may be needed for efficient delivery of the second twin.

  • Epidural equipment for pain management is essential, especially in cases of maternal hypertension. (Hypertension is stated below)

  • CTG (cardiotocography) machine for continuous fetal surveillance to differentiate between twin A and twin B based on heart rate variations.

• Team Coordination: Ensure the presence of:

  • Two midwives for adequate support during delivery.

  • Anaesthetists and paediatricians for comprehensive care.

• Infusion and Monitoring: Set up for potential intravenous infusions to augment labor and monitor fetal status continuously. Blood cross-matching should be prepared for possible cesarean sections or emergencies.

Hypertension:Hypertension, also known as high blood pressure, is a chronic medical condition where blood pressure in the arteries is persistently elevated. Blood pressure is determined both by the amount of blood the heart pumps and the resistance of the arteries to blood flow.

• Normal Blood Pressure: Generally considered to be below 120/80 mmHg.

• Stages of Hypertension:

  • Elevated: 120-129/<80 mmHg

  • Stage 1: 130-139/80-89 mmHg

  • Stage 2: ≥140/90 mmHg

• Causes: Risk factors include obesity, lack of physical activity, smoking, excessive salt intake, excessive alcohol consumption, stress, and family history of hypertension.

• Symptoms: Often asymptomatic, but can include headaches, shortness of breath, or nosebleeds in more severe cases.

• Complications: If untreated, can lead to serious health issues such as heart disease, kidney damage, and stroke.

• Management: Lifestyle changes like diet and exercise, and may include medication to control blood pressure.

Hypotension: Hypotension, or low blood pressure, is a condition where blood pressure in the arteries is lower than normal.

• Normal Blood Pressure: Generally considered to be above 90/60 mmHg.

• Causes: Can be caused by blood loss, dehydration, nutritional deficiencies, certain medications, and underlying medical conditions such as heart problems or endocrine disorders.

• Symptoms: May include dizziness, fainting, blurred vision, nausea, and lack of concentration.

• Complications: Severe hypotension can lead to shock, which is a life-threatening condition requiring urgent medical attention.

• Management: Treatment depends on the underlying cause and may involve increasing fluid intake, adjusting medications, or addressing the contributing health issues.

Examples of Low Blood Pressure Ranges

• Normal Blood Pressure: Above 90/60 mmHg

• Elevated Blood Pressure: 120-129/<80 mmHg

• Stage 1 Hypertension: 130-139/80-89 mmHg

• Lower Limit of Hypotension: Below 90/60 mmHg

• Severe Hypotension: Often defined as below 70/40 mmHg, indicating potential shock.