SARASOTA MEMORIAL HOSPITAL
NURSING PROCEDURE
PS1094
TITLE:
DELIVERING A TWIN GESTATION BY
MEANS OF A DOUBLE SET-UP IN THE
LABOR AND DELIVERY SETTING
(obs11)
ISSUED
FOR:
DATE: 02/93
REVIEWED: 9/15
PAGES: 1 of 4
RESPONSIBILITY:
Nursing
RN – Maternal Services
PURPOSE:
To provide information to assist the nurse working in Labor
and Delivery to coordinate the care of a patient with a twin
gestation to be delivered under a double set-up if one is so
requested by the attending physician.
RATIONALE:
1. The route of delivery for twins should be determined by
the position of the fetuses, the ease of fetal heart rate
monitoring, and maternal fetal status.
2. Patients admitted to the Labor and Delivery unit and
identified as a twin gestation, will be delivered under a
double set-up in the Labor & Delivery OR suite
beginning with the birth of Twin A.
2. A support person participating in the birth experience
will be present at the discretion of the attending
obstetrician.
3. Nurses from the NICU will attend the delivery as
appropriate.
4. RT will attend the delivery as appropriate.
5. Attendance of a neonatologist will be required if
deemed necessary.
6. Anesthesiologist/CRNA will be in attendance upon
transfer of the patient to the Labor & Delivery OR suite.
EXCEPTIONS:
Patients with a twin gestation will be exempt from the
above guidelines if one or more of the following exists:
1. Scheduled/unscheduled Cesarean Section ordered by
physician for the birth of both twins.
2. Twin pregnancy deemed not viable by attending
physician.
3. Twin B identified as a fetal demise.
4. Twin A and B both identified as fetal demises.
TITLE:
DELIVERING A TWIN GESTATION BY MEANS OF A
DOUBLE SET-UP IN THE LABOR AND DELIVERY
SETTING
(obs11)
PAGE: 2 of 4
DEFINITION:
Double Set-Up: Equipment and personnel present to
provide a vaginal and/or Cesarean delivery in the same
room at the same time.
EQUIPMENT:
1. The patient with a twin gestation will be delivered in
the OB Operating Room (OB OR) utilizing a double
set-up, the nurse will have available in the OR the
following:
a. Instruments and equipment for a vaginal and
Cesarean delivery;
b. Two infant warmers and resuscitation equipment;
c. Portable ultrasound machine;
d. Fetal monitor;
e. Stirrups for the surgical bed; and
f. Two circulating nurses, a scrub nurse or CST, two
NICU/NSY nurses, RT, anesthesiologist or CRNA,
neonatologist, and OB physician.
PROCEDURE:
ADMISSION
1. When a patient with a twin gestation is admitted for
active labor, the L&D nurse will notify NICU/Nursery,
the L&D communicator, and the appropriate personnel
of the need for a double set up.
2. NICU/Nursery will set up the equipment needed for the
infants (i.e. Infant warmers and resuscitation
equipment). The L&D nurse will coordinate all the
equipment necessary for a double set up (vaginal
delivery and a cesarean section).
3. A patient with a twin pregnancy may labor in a labor
room. The L&D nurse will advise all personnel listed
above of the patient’s progress and of any
complications during labor.
4. The patient will sign a consent for cesarean section.
TITLE:
DELIVERING A TWIN GESTATION BY MEANS OF A
DOUBLE SET-UP IN THE LABOR AND DELIVERY
SETTING
(obs11)
PROCEDURE (cont’d):
PAGE: 3 of 4
DELIVERY
1.
In the Labor & Delivery OR suite under a Double SetUp, the attending L&D nurse will:
a. Notify, or designate notification, to the following:
1.
L&D Communicator
2.
NICU/RT
3.
Anesthesiologist and CRNA
4.
Neonatologist
5.
On-call personnel (if needed)
6.
Supervisor and/or APN (if needed).
7.
OB Hospitalist may be notified to see
availability to assist if provider requests
b. Prepare the patient for transport to the OB OR.
c. Instruct the support person to don appropriate
attire and wash their hands.
2.
The NICU personnel will:
a. Set up the equipment needed for the infants (i.e.,
infant warmers and resuscitation equipment).
b. Notify Respiratory Therapy at their discretion.
c. Assume care of the infants at the time of delivery
and determine if infants will be admitted to the NICU
or Newborn Nursery. See Policy 126.604 “Admission
Criteria for MBU” or Policy 126.660, “NICU:
Admission Care and Transfer”
TITLE:
DELIVERING A TWIN GESTATION BY MEANS OF A
DOUBLE SET-UP IN THE LABOR AND DELIVERY
SETTING
(obs11)
PAGE: 4 of 4
PROCEDURE (cont’d):
RECOVERY
Following delivery, the patient will be recovered:
a. In a labor room providing both twins delivered vaginally.
If there are no beds available in the Labor & Delivery unit,
then the patient will be recovered in the OB PACU.
DOCUMENTATION:
Documentation of this procedure will be done on the
Labor & Delivery EMR
REFERENCE:
American Academy of Pediatrics (7th ed.) (2012).
Guidelines for Perinatal Care. AAP: Washington, D.C.
REVIEWING AUTHOR (S):
__________________________________
Debbie Dietz, MSN, RNC-OB, C-EFM, APN, Labor and
Delivery/Antepartum/OB ECC