Women giving birth to twins or triplets should be offered specialist care
Women who are expecting twins or triplets should receive specialist care from a team of healthcare professionals, according to latest NICE guidance.
The number of multiple births has risen over the last thirty years and now accounts for 3 per cent of all live births, as more women turn to assisted reproduction techniques such as in-vitro fertilisation (IVF).
While many women with twins or triplets experience a complication-free pregnancy, the rate of stillbirth in women with multiple pregnancies is 2.5 times higher than those expecting just one child.
Women with multiple pregnancies are also more likely to have complications such as miscarriage, anaemia, hypertension, vaginal bleeding, preterm delivery, and an assisted birth or caesarean.
Children born through multiple pregnancy are at increased risk of low birth weight and prematurity, which in turn can lead to congenital malformation, cerebral palsy and impaired physical and cognitive development.
NICE's first guideline on multiple pregnancy says that women with multiple pregnancy should be referred to a team of doctors, midwives and ultrasonographers once their scan is confirmed.
This team should be experienced in caring for women expecting twins or triplets and should support the woman throughout her pregnancy.
The team should offer women information and emotional support specific to such births at first contact, and that ongoing opportunities for further discussion should be given.
This includes advice on antenatal and postnatal mental health and wellbeing; antenatal nutrition; the risks, symptoms and signs of preterm labour; likely timing and methods of delivery; breastfeeding and parenting.
The care provided should be coordinated to keep the number of hospital visits to a minimum and to provide care as close to the woman's home as possible.
Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE, said “Although many women will have a normal pregnancy and birth, it is well known that there are higher risks involved for these types of pregnancy and so it is important to get it right.
“This is the first time NICE has published recommendations for healthcare professionals on managing multiple pregnancy, based on the best available evidence.
“We hope this guideline will set the standard of high-quality care which should be provided to all women pregnant with twins or triplets.”
Jane Denton, Director of the Multiple Births Foundation, added: “The NICE guideline on multiple pregnancy will transform the care for women expecting twins and triplets and is a significant milestone in the management of multiple pregnancies.
“Although much of the care at present is very good, there are many inconsistencies and often poor coordination between healthcare professionals if mothers are referred to other hospitals.
“These recommendations address all of these concerns and will give mothers confidence that they are receiving the highest standard of care, appropriate to their individual needs.”
A suite of tools has been produced alongside the guideline to help put the recommendations into practice, including a guide table for scheduling antenatal appointments. This provides an easy to use timeline for actions such as maternal blood pressure measurement, urinanalysis and ultrasound scans.
28 September 2011