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'Referral advice' recommendation details

Multiple pregnancy

Guidance ID NICE 'referral advice' recommendation 'Referral advice' category
CG129 If it is not possible to determine chorionicity by ultrasound at the time of detecting the twin or triplet pregnancy, seek a second opinion from a senior ultrasonographer or offer the woman referral to a healthcare professional who is competent in determining chorionicity by ultrasound scan as soon as possible. Time frame Not Specified
CG129 Referrals to the enhanced team should not be made routinely for women with twin and triplet pregnancies but should be based on each woman's needs. Time frame Not Specified
CG129 Offer women with twin and triplet pregnancies who have a high risk of Down's syndrome (use a threshold of 1:150 as defined by the NHS Fetal Anomaly Screening Programme [FASP]) referral to a fetal medicine specialist in a tertiary level fetal medicine centre. Time frame Not Specified
CG129 Estimate fetal weight discordance using two or more biometric parameters at each ultrasound scan from 20 weeks. Aim to undertake scans at intervals of less than 28 days. Consider a 25% or greater difference in size between twins or triplets as a clinically important indicator of intrauterine growth restriction and offer referral to a tertiary level fetal medicine centre. Time frame Not Specified
CG129 Seek a consultant opinion from a tertiary level fetal medicine centre for: -monochorionic monoamniotic twin pregnancies -monochorionic monoamniotic triplet pregnancies -monochorionic diamniotic triplet pregnancies -dichorionic diamniotic triplet pregnancies -pregnancies complicated by any of the following: -discordant fetal growth -fetal anomaly -discordant fetal death -feto-fetal transfusion syndrome. Time frame Not Specified
CG129 For women who decline elective birth, offer weekly appointments with the specialist obstetrician. At each appointment offer an ultrasound scan, and perform weekly biophysical profile assessments and fortnightly fetal growth scans. Time frame Not Specified
CG129 Women with twin and triplet pregnancies involving a shared amnion should be offered individualised care from a consultant in a tertiary level fetal medicine centre. Time frame Not Specified

This page was last updated: 22 August 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.