Recommendation ID
Indications for referral to a tertiary level fetal medicine centre:- What is the incidence of monochorionic monoamniotic twin and triplet pregnancies, and what clinical management strategies are most effective in such pregnancies?
Any explanatory notes
(if applicable)
Why this is important:- Monochorionic monoamniotic twin pregnancies occur rarely, as do all triplet pregnancies (fewer than 200 women give birth to triplets each year in England and Wales). Across the guideline, the evidence relating to such pregnancies was very limited in quantity and quality, with monochorionic monoamniotic pregnancy often listed as an exclusion criterion in studies reviewed for the guideline. Monochorionic monoamniotic pregnancies and triplet pregnancies are associated with greater complexity and risks to the woman and babies than other pregnancies considered in the guideline. The lack of evidence for effective clinical management of these pregnancies influenced the Guideline Development Group to recommend referral to a tertiary level fetal medicine centre for monochorionic monoamniotic twin pregnancies and complicated triplet pregnancies (including monochorionic and dichorionic triplet pregnancies).
Further research to determine the incidence of monochorionic monoamniotic pregnancies and triplet pregnancies of different chorionicities would inform future provision of NHS services, as would research into the most effective models for clinical management of such pregnancies. Studies could include national audits of clinical care and outcomes in such pregnancies before and after publication of the guideline. They should also include consideration of the impact of referral (or non-referral) to a tertiary level fetal medicine centre on perinatal psychological and emotional wellbeing of women and their partners.

Source guidance details

Comes from guidance
Multiple pregnancy: antenatal care for twin and triplet pregnancies
Date issued
September 2011

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No