(2) High-risk conditions may be associated with and include premature
delivery, hemorrhage, hypertensive disorders, abnormal presentation and position,
hydramnios (an excess of amniotic fluid), and uterine dysfunction.
(3) Uncomfortable symptoms experienced by the mother during the last
trimester are the same as for the mother with a single fetus. However, the symptoms
occur earlier and are more intense. The symptoms are:
(a) Heaviness of the lower abdomen.
(b) Back pains.
Swelling of the feet and ankles.
(d) Difficulty in sleeping that is due to abdominal distention.
(e) Woman tires easily.
b. Labor and Delivery Process.
(1) The first stage of labor for the mother is essentially the same as for the
woman with a single fetus. Effacement and dilatation occur the same if there is an
adequate labor pattern.
Possible complications during labor and delivery include the following.
(a) Possible prolapsed cord. Babies of multiple births tend to be
smaller than single fetus and may not fill the pelvis completely. The cord may drop
when the membranes rupture.
(b) Possible fetal respiratory distress that is due to analgesia.
Analgesia is administered very conservatively. The infant's size normally prevents them
form metabolizing analgesia from their systems prior to birth. Withholding it avoids
respiratory difficulties following delivery.
(c) Entanglement of fetuses during delivery. Presentation of all fetuses
should be known prior to delivery. If the first fetus is not vertex, cesarean section is
normally done. This prevents the first fetus from becoming entangled with other
fetuses. More than two fetuses indicate cesarean section for control and quick access
to the infants.
c. Nursing Interventions.
(1) Monitor the patient and fetuses continuously. Internal monitoring is
applied to the presenting fetus. External monitoring is applied to the second fetus.
Additional fetuses should be monitored at least every 15 minutes during the first stage
with a Doppler and recorded. The mother's vital signs should be checked and recorded