This is an automatically translated article.
The success or failure of delivery of twins or more depends on the correct diagnosis of positions, positions of the two fetuses, good preparation of means of care and resuscitation for mother and fetus, and knowledge knowledge, skills and experience of the birth attendant.
1. When are there indications, contraindications for delivery of twins or more?
1.1 Indication The pregnant woman was assigned to deliver the birth of twins or more and was assessed for a favorable progress in labor.
1.2 Contraindications In the following cases, it is not indicated for delivery of twins or more to ensure the safest during childbirth for both mother and child:
Twins conjoined twins Twins placenta pregnancy: The first pregnancy is in the breech position, the second pregnancy is in the first position, so when descending, the two fetuses may have an abnormal placenta, the shoulder has signs of fetal distress, prolapse of the umbilical cord... Uterine scar old caesarean section, placenta previa, pregnant women give birth to their first child but are older. The mother suffers from diseases that cannot give birth vaginally: Cardiovascular disease, high blood pressure, severe preeclampsia ... Where there is no operating room, there is not enough medical facilities to monitor and resuscitate. for pregnant women and infants.
Thai phụ chỉ được đẻ thường khi cuộc chuyển dạ tiến triển thuận lợi
2. The process in delivering birth from twins or more
2.1 Preparation Only monitoring from district level upwards. If the emergency case cannot be transferred in time or the possibility of multiple pregnancy has not been diagnosed before, all levels are required to handle it to ensure the health and safety of both mother and fetus. Pregnancy requires 3 people: An obstetrician, an anesthesiologist, and a nurse to support the doctor, and provide care and resuscitation. Maternity: Women have been given prenatal counseling about the advantages and disadvantages of a normal birth. Before giving birth, the mother will have an enema, urinary catheter, and vaginal hygiene. Pregnant women are placed an intravenous line to regulate uterine contractions and resuscitation as needed. 2.2 Conduct delivery from twins or more Ensure that the health of the mother and the fetus are continuously monitored, the risk of fetal distress is detected, and appropriate and timely treatment is made.
2.2.1 Delivering the first baby This is usually a baby in the lateral position, sometimes the breech position, the contractions are still weak at this time. If it is a cephalothorax, deliver the baby as usual. Broken amniotic fluid easily causes prolapse of the umbilical cord, so it should be taken into account. After delivery, clamp the umbilical cord toward the placenta before cutting to prevent blood loss of the second fetus if an anastomosis is present.
Luôn theo dõi và đảm bảo sức khỏe của mẹ và thai nhi trong suốt quá trình sinh đẻ
2.2.2 Check immediately, position, fetal heart rate of the 2nd fetus The second fetus is always at risk of hypoxia. The reason is that after the birth of the first pregnancy, the uterine cavity is too wide open, making the next pregnancy not able to adjust well, easy to give birth in an abnormal position, in reverse or shoulder position. Therefore, it is necessary to carefully check the position, position, and position of the fetus in the abdomen.
In the case of oxytocin infusion with strong uterine contraction, difficult to determine the position, it is necessary to temporarily stop the infusion to monitor the uterus, determine the fetal position and rotate the fetus in case of abnormal position.
2.2.3 Delivering the second fetus If it is the first position, continue oxytocin infusion, amniocentesis if there is uterine contraction, fix the position and deliver the baby as usual. If it is an abnormal position such as forehead or shoulder position, then press the amniotic fluid immediately and turn the fetus into the butt position. Midwifery as usual.
The pregnancy rotation at this time is quite convenient because the fetus is usually small, in addition, when a pregnancy comes out, the uterus is wide. This operation needs to be done quickly because if it is done too slowly, it will cause the cervix to contract and the placenta to fall off, making the second pregnancy more likely to fail.
It should be noted that the fetus is rotated only if the amniotic fluid is still intact, the fetus is small, and the uterus does not squeeze the fetal part. If not eligible, it is best to have a cesarean section. It is not easy to have uterine rupture, placental abruption, traumatized fetus, pregnancy failure...
Continue to do the same with the remaining pregnancy (if still available)
Vegetable book: After the pregnancy has been discharged. , conducting active management in the period of placental delivery is likely to have bleeding complications due to uterine atony, must use drugs to contract the uterus immediately and maintain intravenous drip.
Cho sản phụ dùng thuốc co bóp tử cung để đẩy hết nhau thai ra ngoài
2.3 Monitoring delivery from twins or more The risk after pregnancy is uterine atony, which should be prevented by using drugs to increase uterine contractions, rub the uterus to ensure a safe contraction of the uterus. whole. Pregnant women should be closely monitored after giving birth because bleeding may occur secondary to uterine atony. Ensuring good nutrition gives pregnant women the ability to quickly recover health. If a pregnant woman is found to have a ruptured uterus, she must be resuscitated by emergency cesarean section quickly, depending on the status of the injury to resolve. If the woman has had enough children, the fissure is small, and there is no infection, then the restoration should be performed. If the woman has had enough children, the break is wide, and the infection is infected, the uterus should be removed. All uterine interventions require systemic antibiotics to prevent infection. In the process of giving birth is extremely dangerous, painful for the mother as well as the fetus, birthing from twins or more is much more dangerous. Therefore, pregnant women often need to go to the doctor to be closely monitored, especially in the last days before "giving birth".
Currently, Vinmec International General Hospital has fertility packages to care for pregnant mothers from the early stages to the time of birth. To register for examination and treatment at Vinmec International General Hospital, you can contact Vinmec Health System nationwide, or register online HERE.
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