Twins
At risk for hyperemesis, GDM, HTN, hemorrhage, cesaeran, postpartum depression, preeclampsia, preterm delivery, IUGR, birth/genetic defects
- Pre-term labor education
- Fetal kick count starting at 28 weeks (10 kicks/movement within 2hrs or less)
- NST weekly starting at 36 weeks for uncomplicated dichorionic
- NST weekly starting at 32 weeks for uncomplicated monochorionic diamniotic.
Management
- Dichorionic twins
- Early US for chorionicity, detailed US at 18-22 wks, growth every 4-6 weeks, delivery at 38 weeks
- Monochorionic diamniotic twin
- Early US for chorionicity, US for TTTS (twin to twin transfusion syndrome) f/u every 2 weeks at 16 weeks, growth every 4 weeks, delivery at 34-37 weeks
- Consults with perinatologist for discordant growth, monoamniotic twins (cord accidents) or monochorionic twins (twin to twin transfusions)
Pocket Obstetrics and gynecology by K Joeph Hurt 2nd edition
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