PREDISPOSING FACTORS
PRECIPITATING FACTORS
 Increasing Maternal Age (Age
above 35)
 High Parity
 Family history (Heredity)
 Race
AGGRAVATING FACTORS
 ART - Assisted reproductive
 Anger or depression techniques
 Stress  Ovulation –stimulating
 Exposure to drugs (contraceptive medicine
pills)  Preexisting medical
 Exposure to cigarette and alcohol conditions
 Nutritional Factors
 Multiple Gestation

Ovulation

Natural
Conception ART
Conception

2 ovum 1 ovum

Cell Division

Heterotopic
Embryo Implantation
Implantation
Nursing Management

 Adequate rest
 Excessive Morning Sickness
 Fast Weight Gain  Advise to have a
 Severe Fatigue proper Diet and stay
 Elevated Beta-hCG Levels hydrated
 Abnormal AFP Test Results  Exercise
 Frequent antenatal
Visits

TYPES OF TWINS

Dichorionic (FRATERNAL) Monochorionic (IDENTICAL)

Diamniotic Diamniotic Diamniotic Monoamniotic

(Separate Placenta) (Fused Placenta)

Dizygous
Placenta

Monozygous

Dichorionic-diamniotic Monochorionic-diamniotic Monochorionic-monoamniotic

Intrauterine Growth Restriction Twin-to-twin Twin Reversed Cord Umbilical Congenital

Preterm Birth transfusion Arterial Perfusion Entanglement Cord Anomalies
(IUGR)
Thrombosis
Syndrome (TTTS) (TRAP)
Excessive fetal Structural Malformations
Fertility Treatment Metabolic and hormonal movement Elongated and
Donor Recipient Donor Recipient hypercoiled
Imbalance of cell types & vascular changes Decrease in cell number umbilical cord
Excessive amniotic Chromosomal Anomalies
fluid
Altered gene Alteration of Pump Twin Acardiac Twin
Multiple Gestation Hypovolemia Hypervolemia
expression/molecular pathways cell/tissue/organ growth  Fetal growth restriction
Abnormally long  Fetal distress  Premature
Perfusion of the lower umbilical cord  Perinatal encephalopathy &  Fetal Death
Increased Intravascular No heart- no forward flow,  Heart problems
Reduced Intravascular half of the recipient twin neurologic impairment
Fluid Volume low systemic pressure, 
Uterine Distention Fluid Volume via its iliac arteries  Neonatal liver disease Scoliosis
abnormal circulatory pattern Weak cord  Cerebral Palsy
 Stillbirth
PERINATAL EFFECT CHILDHOOD EFFECTS ADULT EFFECTS
Increased Urine
Structure  Learning Disability
 Poor Growth  Hypertension High cardiac output
 Perinatal And Neonatal Decreased urine production to increases perfusion of 
Mortality  Neurological Sequelae  Type 2 diabetes production to compensate for the fetal kidneys
Acardius Acephalus
Fetal Hypoxia,

 Perinatal depression  SIDS (slight)  Coronary Artery compensate for reduced increased blood volume
Acardius Anceps
Heart rate
 Hypoglycemia Disease blood volume  Acardius Acormus abnormalities
 Hypothermia Congestive Cardiac  Acardius Amorphus
 Prematurity Large bladder on Failure and
 RDS Small bladder on ultrasound examination, Polyhydramnios
 NEC ultrasound examination, polyhydramnios
oligohydramnios
 IVH
Preterm premature rupture
 Hypothyroxinemia
Biventicular cardiac of membranes, Preterm
infection Fetal anemia and poor hypertrophy Labor & Preterm Delivery
growth

Diastolic Dysfunction Hypoxia and Intrauterine

growth restriction

Tricuspid Regurgitation

Congestive heart failure

and fetal death
/
 CLINICAL
DIAGNOSIS

Ultrasonography Doppler Vital Signs Blood Test &

Urinalysis
Chorionicity Blood flow in the Hypertension
Umbilical Cord Trisomy

Amniotic Fluid Respiration

HCG

Detailed scan
AFP Test

Biometry
GDM
CLINICAL
MANAGEMENT
NURSING MANAGEMENT

DELIVERY ROLES AND

MANAGEMENT RESPONSIBILITIES
OF A NURSE

Vertex Presentation Non-Vertex Presentation Vertex/Non-Vertex

Presentation
INDIPENDENT NURSING INTERVENTION
Trial of Labor Cesarean Section
 Establish rapport with the client
<1500 grams >1500 grams  Assess for signs and symptoms
 Assess the vital signs
 Establish abdominal girth and fundal height
Concordance
Trial of Labor
of weight of
Discordance of  Educate the client about the symptoms and
weight of twins
(Vaginal Delivery / twins management to give knowledge what challenges
Cesarean Delivery)
they might face during the pregnancy
Vaginal Vaginal  Advice to have an increased nutrition and rests
Delivery of 1st Delivery/
Twin and Cesarean  Advice to have more frequent prenatal visits
Breech
Extraction of
2nd Twin
DEPENDENT NURSING INTERVENTION

 Administer medication as ordered by the physician

 Collect urine and blood sample as ordered by the
physician

COLLABORATIVE INTERVENTION

 Refer to a maternal fetal medicine specialist

(perinatologist)