Nusing Implications Conclusion

Multiple Pregnancy Essay Help
Paper should be a minmum of 5 pages and must follow APA format. Must use a variety of professional reerences, including nursing jornals. Wikipedia is not acceptable. Paper should include at least the following: Background: Epidemiology include current statistics on disease distribution risk factors definitions & background data Prognosis Pathophysiology: Review of normal system anatomy and physiology (breif statement) Functional changes associated with diseae process: clinical presentation disease progression Diagnostic Procedures: Labs (discuss implications for relevant labs) Disease specific diagnostic tests (discuss expected findings Treatments: medications (discuss specific drugs used) medical/surgical procedures current treds in care/treatment: may include research currently being done; whats new on the horizon to improve patient outcomes.

Nusing Implications Conclusion ANSWER Multiple pregnancy Multiple pregnancies are a condition that results from intricate interaction of environmental and genetic determinants.

Currently the condition is increasingly becoming frequent after a 30 to 40 year decrease trend. The following paper aims at discussing multiple pregnancy in detail. The paper shall cover epidemiology, pathphysiology, diagnostics, treatment, and nurses implications among other aspects. Multiple pregnancy is defined a condition that occurs when more than one fetus is maintained in a single pregnancy to the full term of birth (Kilby, 2006). The more than one fetus is known as twins and naturally occur about one in 100 births. Twin pregnancy results in two types of twins or fetus, identical and fraternal. In the identical twins, they represent the splitting of a sole fertilized zygote into two separate individuals while the fraternal twins represent two eggs being fertilized by a two different sperms (Kilby, 2006). Multiple pregnancy has over the years risen steadily since the 70s.

The current rise in multiple pregnancy incidences reflects the increased use of fertility drugs and the change in age distribution of women at birth, where more women are giving birth at older ages. In the late 80s, multiple pregnancy was 22 percent a figure higher than that recorded in the 70s of 18 percent (Ward Platt, Glinianaia & Rankin, 2006). In addition, over the past 10 years there has been an increase in triplets compared to twins. The occurrence of multiple pregnancy varies from nation to nation, with the elevated rates being recorded in Nigeria and the lowest in Japan. Rates also vary from ethnic and racial groups. The twinning rate in Caucasoid is about eight per a 1000 births and for Negroes about twice of that (Ward Platt, Glinianaia & Rankin, 2006). In the U.S, the black incidences rates exceed those of whites. Multiple pregnancy rates for Chinese, American Indian, Filipino, and Japanese is 24 to 43 percent lower than black births and 13 to 31 percent lower than the rates of white births. In Sweden, the multiple pregnancy rates has been significantly lower in towns than rural environs.

In contrast, Finland has reported a 1 to 2 percent increase of twinning rates in the rural community compared to urban community (Ward Platt, Glinianaia & Rankin, 2006). The variance is likely to be encouraged by differences in mean parity and age. Maternal pregnancy is accompanied with some risk factors the major one being maternal age. Multiple pregnancy rates have exorbitantly increased between the ages of 15 and 35 years. In other reports and studies, increase in twinning rate has increased with maternal age of up to 35 to 40 years. These results are very similar to studies about the mean age of singletons and mothers of twins and case-control studies (Kilby, 2006). This current pattern has been characterized by the subsequent decline in ovarian function of older women and the increase of levels of gonadotrophins with age, given the maximum stimulus of follicles occurs between the ages of 35 to 40. There has been a decrease in the twinning rates in women aged 40, which has initiate a lot of speculation to the causes. Selective means like increased abortions in multiple pregnancy in older women and environmental and genetic aspects are among some of the suspected cause that are just mere speculation. In multiple pregnancy prognoses, a history of earlier dizygotic twins boosts the probability of multiple pregnancy (Keith & Blickstein, 2005). In the U.S, the mortality rate of multiple pregnancy is merely higher than that of singleton. Hemorrhage is five times frequent in multiple pregnancy rates as in normal single pregnancy. However, multiple pregnancy has a higher probability of operative delivery and abnormal presentation, with increased complication. Common occurrences in multiple pregnancy include premature labor and premature rapture of membranes (Keith & Blickstein, 2005). In addition, prenatal morbidity and mortality rates are increased in multiple pregnancy, due to its complications and preterm delivery.

Complications associated with multiple pregnancy include placental abruption, placenta pervia, cord enlargement, postpartum In general, about 50 percent of twins weigh an estimated 2500 grams, although most of them have a gestational age of about 36 weeks or more (Keith & Blickstein, 2005). Multiple pregnancy accounts for 9 percent of prenatal deaths and 15 percent of premature births both directly or indirectly, which is 7 times the rate in normal single births (Keith & Blickstein, 2005). Occurrences of intrauterine development restriction are increased in multiple pregnancy. Abnormal presentation and congenital malformations are more severe in monozygous twins. Additionally, diabetes mellitus, Preeclampsia-eclampsia, and other disorders are likely to endanger the fetus. Multiple pregnancy is accompanied by several physiologic changes. During pregnancy, numerous adaptive changes occur in the maternal organism to ensure an optimal environment for the fetus growth. The physiologic adjustments take place in the woman or mother in reaction or response of the requirements of the pregnancy. These requirements include protection of the fetus, support of the fetus, preparation of the uterus for delivery and protection of the woman against probable cardiovascular harm during birth (Keith & Blickstein, 2005). All maternal systems or organism are supposed to adopt even though the degree, timing, and quality of the adaptation differ from one organ system to another and from one individual to another. Multiple pregnancy significantly influence the proper adaptation of the pregnancy demands. With the knowledge and understanding of physiologic adaptive transformations health care providers are able to predict pathology, foresee effects of twin pregnancy, and handle future and current pregnancy associated complications and disorders. Multiple pregnancy is deemed as a high risk pregnancy by health care providers, as the changes associated with it differ from those of a singleton pregnancy.

The changes generally differ due to the presence of more than one fetus in the uterine opening. Functional changes associated with multiple pregnancy include anatomical changes. The number of fetuses in the uterine cavity and the size of the uterus in determine these changes. In multiple pregnancy, the uterus grows bigger compared to the singleton pregnancy, during the 18th week the uterus is twice the size of the singleton pregnancy and during the 25th week the size is like that of a fully matured singleton pregnancy (Keith & Blickstein, 2005). Another significant anatomical change is related to the cervical length, which is vital in terms of the development duration. During multiple pregnancy, the cervical length condenses about 0.8 mm a week, a condition is a risk factor for the pregnancy but also definitely inclines the pregnancy to a premature birth. Furthermore, the amniotic fluid levels are higher compared to the singleton pregnancy. The fluid volume increases constantly until the second trimester and then alleviates during the commence of the third trimester (Kilby, 2006). Finally, in the anatomical changes weight gain differs from the singleton pregnancy. In multiple pregnancy, weight gain ought to be an estimated 16 to 20 kg, which is just about 0.6 kg per week (Kilby, 2006). In some cases a higher weight gain can be concluded to be an outcome of triplets or twins. This is because multiple pregnancy require more nutrition to support the fetuses compared to singleton. Apart from the anatomical changes, multiple pregnancy also has physiological changes. The first physiological change is in the circulatory system with the increased demand for oxygen. The demand for oxygen occurs early and is more intense compared to the singleton pregnancy (Kilby, 2006). The cardiac output enhances 30 to 40 percent by the end of the first trimester until it enhances to 50 percent greater than the output of a non-pregnant woman (Armour & Callister 2005).

This occurrence is significantly related to the increased blood circulation. This phenomenon is controversial. Nevertheless, is contemplation is the enlarged levels of placental hormones and commencement of rennin-angiotensin-aldosterone system. Blood flow in the uterus and fetus increases 20 to 40 times compared to singleton pregnancy (Armour & Callister 2005). High concentrations of progestagens in twin pregnancy lead to a decline of diastolic blood pressure. This can cause the greater mass of the fetus, placentas, and amniotic fluid to compress neighboring vessels and organs causing supine hypotensive syndrome (Keith & Dera, 2007). Another physiological change occurs in the gastrointestinal system, where the frequency of emptying gastric acid is increased in multiple pregnancy. The appearance of gastric is so distinguishing that by itself it can propose a multiple pregnancy. Progesterone in the blood increases causing the intensification of the changes related to the performance of the gastrointestinal system (Keith & Dera, 2007). Progesterone directly damages peristalsis of the intestines and stomach decreasing food absorption. Most women suspect multiple pregnancy especially if they have never given birth before. For the sake of the unborn child or children, early pregnancy diagnosis is recommended especially in cases where the woman has applied reproductive technologies. The most common method of diagnosing multiple pregnancy is through ultrasound. However, there are other lab tests that are used in diagnosing multiple pregnancy (Keith & Dera, 2007). For instance, patients undergo a blood test, which the level of human constant gonadotrophin is higher in multiple pregnancy. Another method is the alpha-fetoprotein, which is involves the comparing of protein levels released by the fetal liver and levels found in the mothers blood because if it is high it means there is more than fetus making the protein. The most common and widely used is the ultrasound, which involves a imaging machine that uses a computer and high frequency sound waves to create images of organs, tissues, and blood vessels. In diagnosing multiple pregnancy, a stomach transducer is used to view the fetus and various body organs. This method is the most effective and easy to use. In treatment, various medications and surgical procedures are used. Due to the high risk of premature birth associated with multiple pregnancy, tocolytic medications can be administered to patients (Taylor, 2006). These are medications used to restrain premature delivery or labor.

Also they are used if the premature labor occurs by slowing or stopping constraints. The drugs may be administered intravenously, orally, or in an injection. tocolytic medications mostly used include magnesium sulfate and terbutaline (Taylor, 2006). Additionally corticosteroid medications can be administered to assist in developing the respiratory system of the fetus (Taylor, 2006). With the high risk of complications and abnormality in multiple pregnancy, fetuses are likely to develop immature lungs which is a common complication in immature babies. Health care providers also use surgical procedure for treating multiple pregnancy (Taylor, 2006). For instance, when dealing with women with an incompetent cervix health care providers use cerclage, a medical procedure for stitching the cervical opening (Taylor, 2006). In conclusion, multiple pregnancy is a high profile complication and nursing care should be administered appropriately. The patient should be monitored at all times and ensure the best experience in the resting or operation room. Nurses ought to maintain ethics and values in dealing with multiple pregnancy. In addition, they should consider legal issues associated with multiple pregnancy. References Armour K. & Callister L. (2005). Prevention of triplets and high order multiples: Trends in reproductive medicine. Journal of Prenatal and Neonatal Nursing, 19, 103-11. Keith, L. & Dera, A. (2007). Twin pregnancy physiology, complications and the mode of delivery. Archives of Prenatal Medicine. 13 (3): 7-16. Kilby, M. (2006). Multiple pregnancy. London, UK: RCOG Press. Keith, L. & Blickstein, I. (2005). Multiple pregnancy: epidemiology, gestation & prenatal outcome. London, UK: Taylor & Francis. Taylor, M. (2006). The management of multiple pregnancy. Early Hum Dev, 82 (6):365-70. Ward Platt, M., Glinianaia S. & Rankin, J. (2006) The North of England Multiple Pregnancy Register: five-year results of data collection. Twin Res Hum Genet, 9 (6):913-8. Submitting high quality Essays,Research Papers, Term Papers, is the only way students can score high grades( As). Students ought to hire professional Writing Service providers who can deliver high quality work within the allocated time. Click to ORDER NOW nIt’s only fair to share

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