Childbirth in a multiple pregnancy is considered to be the boundary between the physiological and pathological, taking into account the more frequent complications with them.
Management of births should be carried out under the monitor control with the prevention and treatment of intrauterine fetal hypoxia, with timely correction of abnormalities of labor.
Keeping childbirth requires great attention and patience. It is necessary to carefully monitor the condition of the parturient woman and the fetus, the development of labor, the promotion of the fetus through the birth canal.
With the onset of labor with timely delivery and the progressive opening of the cervix until the full disclosure and absence of outpouring of amniotic fluid, amniopuncture with a thick needle or amniotomy is performed, which eliminates excessive overstretching of the uterus and contributes to the intensification of labor. The water is released slowly, to prevent possible complications - prolapse of the umbilical cord, small parts of the fetus, premature detachment of the normally located placenta. In the first stage of labor, anesthesia and prophylaxis of fetal hypoxia occur every 2-4 hours. If necessary, prescribe medicamental stimulation of labor.
The period of expulsion of the fruit is carried out "with a needle in the vein." To take action when complications arise. After the birth of the first fetus, the dressing of the fetal and maternal ends of the umbilical cord is performed to prevent the blood loss of the second fetus when it is an identical twins. Immediately determine the position, position, appearance, presentation of the fetus, remaining in the uterus, listen to his heartbeat. After 10-15 minutes, a vaginal examination and amniotomy are performed. In the longitudinal position of the fetus, the birth is conservative. In the transverse position of the second fetus, the fetus rotates onto the stem and pulls it beyond the pelvic end. To avoid complications, a cesarean section is performed.
Indications for cesarean section during multiple pregnancy are:
- The unpreparedness of the birth canal after 38 weeks of pregnancy and intrauterine suffering
- Pelvic presentation of the first and second fetus, especially in women giving birth for the first time;
- Infertility, miscarriage, stillbirth in the anamnesis;
- Women who give birth for the first time in the older 28 years;
- Pelvic presentation of the first fetus;
- Transverse position of the first fetus;
- Lack of birth-stimulation effect or strengthening of labor for three hours;
- Premature pregnancy.
The third period of labor in multiple pregnancies is carried out "with a needle in the vein", through which 5% glucose with oxytocin infusion is drip. It is necessary to carefully monitor the condition of the parturient woman and blood loss. If bleeding occurs, it is necessary to remove the separated afterburn or a manual examination of the uterine cavity, the uterus massage on the fist.
Litter that was born should be carefully inspected to ensure its integrity, as well as to clarify the mono-or bizigotne of the origin of multiple pregnancies.
In the postpartum period, especially in the first hours after childbirth, it is necessary to carry out preventive measures increased blood loss - a bubble with ice on the abdomen, follow the regular urination, perform exercises of therapeutic gymnastics to increase the tone of the muscles of the anterior abdominal wall, prescribe medications that help to reduce the muscles of the uterus - oxytocin in injections, hinalgin in tablets.
The discharge of mothers with twins from the hospital can be delayed due to possible complications of the postpartum period and the period of newborns. After the discharge of the mother with the twins require increased attention of doctors of women's and children's consultations.