Fetal monitoring of twins

Continuous electronic fetal monitoring during prolonged labor may be a risk factor for having a child diagnosed with autism spectrum disorder

In just 50 years the prevalence of autism spectrum disorder has vaulted from extremely rare to common in every community. During this time, a large body of scientific literature has been amassed regarding what environmental, genetic, maternal, or obstetric factors may be at work. The hypothesis presented here identifies two developments in today's childbirth experience that, in combination, may provide the key: 1) a significant increase in the mean duration of labor and 2) the adoption of continuous electronic fetal monitoring utilizing Doppler ultrasound as the standard of care even in low-risk pregnancies. Together, these two factors have created an unprecedented fetal environment that has the potential to affect neuronal migration and cause non-inherited genetic disruptions. This paper will briefly describe the nature and history of contributing factors, why there may be a link between evolving maternal characteristics, obstetric trends and the increase in autism, as well as the means by which the hypothesis can be tested.

Management of Multiple Pregnancy: Labor and Delivery

Over the past 20 years, the number and rate of multiple births have dramatically increased in the United States. The rise in multiple births is mainly attributable to the increased use of ovulation-inducing drugs and the newly developed assisted reproductive technologies such as in vitro fertilization. Multifetal gestation is associated with an increased risk of perinatal morbidity and mortality. Multiple births account for an increasing percentage of low-birth-weight infants, preterm births, and infant mortality. In this article, the management of the labor and delivery of multiple gestation are reviewed. Particular emphasis is placed on the mode of delivery of twin and triplet pregnancies.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians

LEARNING OBJECTIVES

After completion of this article, the reader should be able to describe the effects of the rising rate of multiple pregnancies on perinatal morbidity and mortality, to recall the complications of diagnosing and treating abnormalities of multiple pregnancies and to list the different safe options in managing labor in a multiple gestation.

Intrapartum care for women with multiple pregnancy

Intrapartum management of multiple pregnancy presents many challenges for obstetric nurses. Optimal care often is complicated by prematurity, low and very low birth weights, and the unique circumstances of the delivery of multiple neonates. Higher perinatal mortality for multiple pregnancies continues to complicate delivery outcome. Nurses need special knowledge and skills to provide care for women with a variety of high-risk conditions in rapidly changing situations.

Fetal surveillance in multifetal pregnancy

Multiple methods of tocolysis and fetal surveillance provide unprecedented ways to improve multifetal outcomes through meticulous antepartum care. Although few practitioners have much experience with these complicated pregnancies, knowledge is growing with the increasing incidence of multifetal pregnancy. A review of the current literature regarding antepartum surveillance provides the basis for a discussion of the techniques essential to quality nursing care during multifetal pregnancy. Guidelines are provided for nursing standards in documentation, terminology, and care during surveillance of multiple fetuses.

Acute fatty liver of pregnancy

Acute fatty liver of pregnancy is a serious complication of the 3rd trimester associated with high rates of maternal-fetal morbidity and mortality. Prompt diagnosis and treatment are essential to achieve optimal maternal-fetal outcomes. Collaboration between critical-care and perinatal nursing staffs is a crucial component of managing patient care. A recent case of acute fatty liver of pregnancy is reported. A team approach resulted in the survival of the patient and the delivery of healthy twins.