[go: up one dir, main page]
Scribd
Upload
252 views10 pages

Management During Labor of Multiple Pregnancy: Manish Gupta Roll No-47

This document provides guidelines for the management of labor and delivery of multiple pregnancies. It recommends that delivery take place in an equipped hospital with an intensive care unit. Vaginal delivery is allowed when both twins are vertex presentation. Close monitoring by an obstetrician, anesthetist, and neonatologists is advised. Analgesics should be limited due to small baby size. Urgent delivery of the second baby may be needed in cases of bleeding, cord prolapse, or fetal distress. Cesarean section is indicated for non-cephalic presentations, IUGR, or monoamniotic/monochorionic twins with twin-twin transfusion syndrome. Difficult cases involving interlocking heads may require manipulation or

Uploaded by

manish
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
252 views10 pages

Management During Labor of Multiple Pregnancy: Manish Gupta Roll No-47

This document provides guidelines for the management of labor and delivery of multiple pregnancies. It recommends that delivery take place in an equipped hospital with an intensive care unit. Vaginal delivery is allowed when both twins are vertex presentation. Close monitoring by an obstetrician, anesthetist, and neonatologists is advised. Analgesics should be limited due to small baby size. Urgent delivery of the second baby may be needed in cases of bleeding, cord prolapse, or fetal distress. Cesarean section is indicated for non-cephalic presentations, IUGR, or monoamniotic/monochorionic twins with twin-twin transfusion syndrome. Difficult cases involving interlocking heads may require manipulation or

Uploaded by

manish
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 10

MANAGEMENT DURING LABOR

OF MULTIPLE PREGNANCY

 MANISH GUPTA
 ROLL NO-47
Management During LABOR
Place of delivery: equipped hospital
preferably having an INCU.
VAGINAL DELIVERY is allowed when both
twins or/are atleast the first twin is with vertex
presentation.
FIRST STAGE: normal conduction with
adiitional precaution:
-skilled obstetrician and experienced
anesthetist should be dere.
-neonatologists(2) should be present.
 Prsence of ultrasound in labour ward is
helpful.
 Patient should be in bed to prevent early
rupture of membranes.
 Use of analgesics drugs is to be limited as
babies are small and rapid delivery may
occur.
 Careful fetal monitoring is done.
 Internal examination should be done soon
after the rupture of membranes.
 IV line with ringer solution and 1 unit cross
matchd blood.
INDICATION OF URGENT DELIVERY OF
SECOND BABY:
1)SEVERE INTRAPARTUM VAGINAL BLEEDING
2)CORD PROLAPSE OF SECOND BABY
3)INADVERTENT USE OF IV
ERGOMETRINE(OXYTOCICS) WITH THE
DELIVERY OF FIRST BABY.
4)APPEARANCE OF FETAL DISTRESS
MANAGEMENT: SEE SCHEME
If however pts. Bleed heavily following birth of first
baby,immediate low rupture of membranes usually
succeeds in controlling blood loss.
s
 MANAGEMENT OF 3rd stage:
 Risk of PPH can be minimised by routine IV
0.2%METHERGIN OR OXYTOCIN 10 IU IM
following delivery of 2nd baby.
 Placenta deliverd by controlled cord traction.
 If blood loss more than avg. should be
immediately replaced by blood transfusion.
 Pt. is to be carefully watched for about 2 hrs
after delivery.
 INDICATION OF CESAREAN SECTION:
 OBS INDICATION:1)PLACENTA PREVIA
 2)SEVERE PREECLAMPSIA& PREVIOUSCS
 3)CORD PROLAPSE OF FIRST BABY
 4)ABNORMAL UTERINE CONTRACTION
 5)CONTRACTED PELVIS
 FOR TWINS:1)FIRST NONCEPHALIC
PRESENTATION
 2)IUGR, CONJOINED TWINS
 3)MONOAMNIOTIC TWINS
 4)MONOCHORIONIC WITH TTTS
 MANAGEMENT OF DIFFICULT CASES OF TWINS:
 INTERLOCKING:MC the after-coming head of first
baby getting locked with the fore-coming head of 2nd
baby.
 Vaginal manipulation to separate chins of fetuses is
done, failing which CS is done.
 Decapitation of first baby if already dead,pushing up
the decapitated head,followed by delivery of 2nd
baby&lastly delivery of decapitated head,atleast
saves one baby.
 Ocassionally ,2heads Of BOTH VERTEX twins get
locked at pelvic brim preventing engagement of
either of head& diagnosis by intranatal sonography.
T/T:DISENGAGEMENT OF HIGHER HEAD CAN
BE POSSIBLE UNDER GA.IF FAILS CS.S
 CONJOINED TWINS: RARE CONDITION
 DIAGNOSIS:during delivery when there is
obstruction in 2nd stage.Failure of traction to
deliver 1st twin in 2nd stage or inability to move
1twin without moving the other suggests this.
 Presence of bridge of tissue b/w the fetuses on
p/v exam. confirms the diagnosis.
 Management : depends on
 1)extent & site of union
 2)possibility of surgical seperation
 3)sizes of fetuses &possibility of survival.
Thankyou

You might also like