Obstetric and Gynecological Nursing - The Carter Center

One fetus may be died and be retained in uterus until term,
when it will be expelled with the placenta as a flattened paper
like fetus called a fetus papyraceous. Twin babies are small
and often preterm.
Diagnosis of twin pregnancy
Diagnosis of twin pregnancy may be difficult, although a family
history of twins should alter the midwife to the possibility.
Ultrasound: -it will demonstrate two heads at 15 weeks when
the outline of the head will be noted
X -ray- may be used after the 12 th week of gestation.
Abdominal examination
Inspection:- the size of the uterus may be larger than
expected for the period of gestation after the 20 th week.
Palpation:- The fundal height may be greater than expected
for the period of gestation.
- The presence of two fetal poles (head or breech) multiple
fetal limbs.
- Lateral palpation may reveal two fetal backs or limbs on
both sides.
- Pelvic palpation one fetus may lie behind the other and
make palpation difficult.
Auscultation:-Hearing two fetal hearts is not diagnostic.
Comparison of the heart rates should reveals difference of at
least 10 beats per minutes.
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