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.

  • 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.