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It's been quite a week for twins

Posted Nov 05 2008 3:14pm

We have had numerous twin gestation moms on L&D in the past week. Thankfully, all but one set have stayed gestating!

We did a c/section for one set a few days ago because she broke through her cerclage, and then continued to labor and dilate, despite aggressive tocolytic therapy. Unfortunately, the babies were not in optimal position to continue on and be born vaginally, so she had a c/section. These twins were still premature, so they went right over to the NICU, and will stay there for several more weeks. Hang in there little ones! You're off to a great start!

I feel like the tocolytic queen lately. Almost every time I go in to work, I have someone one magnesium sulfate, terbutaline, procardia or indocin. Or a combination of two or more of those medications. Magnesium sulfate requires hourly rounding, where I check her vital signs (blood pressure mainly), deep tendon reflexes (no rest for the weary pregnant woman on Magnesium - sorry!), pulse ox saturation, urine output, fluid intake, checking pump settings, etc. Every four hours I'm doing a full body physical, including the all important lung sounds. Magnesium can lead to fluid imbalances where you retain the extra fluid in your lungs, called pulmonary edema, and can happen quickly in a pregnant woman. Not so nice for the woman when it happens to her.

Indocin hosts another set of difficulties. It should only be given for a short period of time, due to the side effects of: reducing the amount of amniotic fluid (oligohydramnios), and premature closure of the ductus arteriosis in the fetus. Neither of which are good for the baby!

Terbutaline can raise your heartrate, sometimes uncomfortably so that we have to stop giving you terbutaline all together.

Procardia is the least offensive of the tocolytic agents. At most, it may cause some facial flushing, or feeling a little tight in the chest, but it goes away. Procardia can be taken for not only preterm labor, but also for hypertension (it's indended use among the non-pregnant population!).
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