Chapter: Maternal and Child Health Nursing : Obstetric Conditions that Complicate Pregnancy
Diagnosis of twins
Diagnosis of twins
The
diagnosis of twins is not always easy in primigravidae with firm abdominal
walls, or in obese women, and experienced doctors and midwives may not always
detect them. The period of gestation is also difficult to assess.
An ultrasonic
scan will demonstrate two heads at 15 weeks; two gestational sacs have been
seen at eight weeks. X-rays may be used after the 30th week.
Twins may
first be diagnosed by finding the uterus large and the fundus well above the
umbilicus after the birth of the first baby.
On inspection
Suspicious
is aroused when the uterus is unduly large for the period of gestation after
the 20th week. The uterus looks round or broad and fetal movement
may be seen over a wide area, but this is not diagnostic. At term, a woman of
average build has an abdominal girth of about 100cm. the possibility of
polydramnios must be considered, and it can be present in conjunction with or
independent of twins, but palpation should help to conclude the diagnosis.
On palpation
Finding
two heads is diagnostic. If one fetus lies in front of the other, it may not be
easy to detect two heads or two backs. Should the fetal head seem small in
comparison with the size of the uterus this rather suggests the presence of two
fetuses. Excessive fetal parts might make one suggest that twins were present.
Auscultation
Hearing
two fetal hearts is not a reliable method of diagnosis because with a large,
vigorous fetus, the fetal heart can sometimes be heard over a wide area.
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