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Multiple pregnancy: antenatal care for twin and triplet pregnancies [CG129]

Measuring the use of this guidance

Recommendation: 1.1.1.1

Offer women with twin and triplet pregnancies a first trimester ultrasound scan when crown–rump length measures from 45 mm to 84 mm (at approximately 11 weeks 0 days to 13 weeks 6 days) to estimate gestational age, determine chorionicity and screen for Down's syndrome (ideally, these should all be performed at the same scan; see 1.1.2.1 and 1.1.2.2

What was measured: Proportion of women seen at one of the 30 participating units who reported they had the chorionicity and amnionicity of their pregnancy determined by 14 weeks.
Data collection end: August 2017
90%
Data collection end: August 2018
94%
Area covered: England
Source: Twins and Multiple Birth Association (TAMBA). NICE works the final report.


Recommendation: 1.1.2.2

Assign nomenclature to babies (for example, upper and lower, or left and right) in twin and triplet pregnancies and document this clearly in the woman's notes to ensure consistency throughout pregnancy.

What was measured: Proportion of women seen at one of the 30 participating units with a multiple pregnancy who have their fetuses labelled using an ultrasound scan and recorded between 11 weeks 0 days and 13 weeks 6 days.
Data collection end: August 2017
21%
Data collection end: August 2018
32%
Area covered: England
Source: Twins and Multiple Birth Association (TAMBA). NICE works the final report.


Recommendation: 1.1.2.11

Networks should agree care pathways for managing all twin and triplet pregnancies to ensure that each woman has a care plan in place that is appropriate for the chorionicity of her pregnancy.

What was measured: Proportion of women seen at one of the 30 participating units with a multiple pregnancy who have a care plan that specifies the timing of antenatal care appointments with the multidisciplinary core team appropriate for the chorionicity and amnionicity of their pregnancy.
Data collection end: August 2017
38%
Data collection end: August 2018
56%
Area covered: England
Source: Twins and Multiple Birth Association (TAMBA). NICE works the final report.


Recommendation: 1.2.3.1

Clinical care for women with twin and triplet pregnancies should be provided by a nominated multidisciplinary team consisting of: a core team of named specialist obstetricians, specialist midwives and ultrasonographers, all of whom have experience and knowledge of managing twin and triplet pregnancies an enhanced team for referrals, which should include: a perinatal mental health professional a women's health physiotherapist an infant feeding specialist a dietitian. Members of the enhanced team should have experience and knowledge relevant to twin and triplet pregnancies.

What was measured: Proportion of women seen at one of the 30 participating units with a multiple pregnancy who were seen by an MDT.
Data collection end: August 2017
32%
Data collection end: August 2018
55%
Area covered: England
Source: Twins and Multiple Birth Association (TAMBA). NICE works the final report.

What was measured: Proportion of women seen at one of the 30 participating units with a multiple pregnancy who were seen by a specialist obstetrician.
Data collection end: August 2017
61%
Data collection end: August 2018
67%
Area covered: England
Source: Twins and Multiple Birth Association (TAMBA). NICE works the final report.

What was measured: Proportion of women seen at one of the 30 participating units with a multiple pregnancy who were seen by a specialist midwife.
Data collection end: August 2017
11%
Data collection end: August 2018
38%
Area covered: England
Source: Twins and Multiple Birth Association (TAMBA). NICE works the final report.

What was measured: Proportion of women seen at one of the 30 participating units with a multiple pregnancy whose scans were undertaken by a sonographer with specialist training in multiples.
Data collection end: August 2017
24%
Data collection end: August 2018
60%
Area covered: England
Source: Twins and Multiple Birth Association (TAMBA). NICE works the final report.


Recommendation: 1.3.4.2

Start diagnostic monitoring with ultrasound for feto-fetal transfusion syndrome (including to identify membrane folding) from 16 weeks. Repeat monitoring fortnightly until 24 weeks.

What was measured: Proportion of women seen at one of the 30 participating units with a multiple pregnancy who were monitored for fetal complications according to the chorionicity and amnionicity of their pregnancy.
Data collection end: August 2017
49%
Data collection end: August 2018
83%
Area covered: England
Source: Twins and Multiple Birth Association (TAMBA). NICE works the final report.


Recommendation: 1.7.1.1

Discuss with women with twin and triplet pregnancies the timing of birth and possible modes of delivery early in the third trimester.

What was measured: Proportion of women seen at one of the 30 participating units with a multiple pregnancy who had a discussion by 32 weeks about the timing of birth and possible modes of delivery.
Data collection end: August 2017
68%
Data collection end: August 2018
86%
Area covered: England
Source: Twins and Multiple Birth Association (TAMBA). NICE works the final report.



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