Quality statement 2: Labelling the fetuses

Quality standard

Quality statement
Rationale
Quality measures
What the quality statement means for different audiences
Source guidance
Definitions of terms used in this quality statement
Equality and diversity considerations

Quality statement 2: Labelling the fetuses

Quality statement

Women with a multiple pregnancy have their fetuses labelled using ultrasound and recorded between 11⁺² weeks and 14⁺¹ weeks.

Rationale

Labelling the fetuses and recording this in the notes at the dating scan, using left and right, or upper and lower, allows the fetuses to be consistently identified throughout the pregnancy. It also takes into account that the 'leading' fetus may change as pregnancy progresses and labelling by number can cause confusion, particularly with left and right fetuses.

Quality measures

Structure

Evidence of local arrangements to ensure that women with a multiple pregnancy have their fetuses labelled using an ultrasound scan and recorded between 11⁺² weeks and 14⁺¹ weeks.

Data source: Local data collection.

Process

The proportion of women with a multiple pregnancy who have their fetuses labelled using an ultrasound scan and recorded between 11⁺² weeks and 14⁺¹ weeks.

Numerator – the number of women in the denominator who have had their fetuses labelled using an ultrasound scan and recorded between 11⁺² weeks and 14⁺¹ weeks.

Denominator – the number of women with a multiple pregnancy of greater than 14⁺¹ weeks' gestation.

Data source: Local data collection.

Outcome

Consistent identification of fetuses in multiple pregnancies.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that systems are in place for women with a multiple pregnancy to have their fetuses labelled using an ultrasound scan and recorded between 11⁺² weeks and 14⁺¹ weeks.

Healthcare practitioners ensure that women with a multiple pregnancy have their fetuses labelled using an ultrasound scan and recorded between 11⁺² weeks and 14⁺¹ weeks.

Commissioners ensure that that they commission specialist services for women with a multiple pregnancy to have their fetuses labelled using an ultrasound scan and recorded between 11⁺² weeks and 14⁺¹ weeks.

Women who are pregnant with twins or triplets (referred to as a multiple pregnancy) have an ultrasound scan between 11 weeks 2 days and 14 weeks 1 day of their pregnancy to record the positions of their babies.

Source guidance

Twin and triplet pregnancy. NICE guideline NG137 (2019), recommendations 1.1.4 and 1.3.7 to 1.3.10

Definitions of terms used in this quality statement

Multiple pregnancy

A multiple pregnancy is defined as a twin or triplet pregnancy. [Expert opinion]

Ultrasound scan

An ultrasound scan is used to determine chorionicity based on the number of placental masses, the Lambda or T‑sign and the presence of amniotic membrane(s) and membrane thickness. [NICE's guideline on twin and triplet pregnancy, recommendation 1.1.3]

Note: NICE's guideline on antenatal care for uncomplicated pregnancies recommends determination of gestational age from 10 weeks 0 days. However, the aim in NICE's guideline on twin and triplet pregnancy is to minimise the number of scan appointments that women need to attend within a short time, especially if it is already known that a woman has a twin or triplet pregnancy (for example, as a result of IVF treatment).

Labelling the fetuses

Labelling of the fetuses should be documented in the ultrasound report. An electronic copy of the ultrasound report and an ultrasound image should also be stored on the radiology reporting and picture archiving system. Hard copies of the report should be printed out and placed in the women's hand-held maternity notes and their hospital notes.

The fetuses should be labelled using either the lateral orientation (left and right) or the vertical orientation (upper and lower). Labelling of fetuses should be carried out at all ultrasound scans to ensure consistent identification throughout the pregnancy. [Expert opinion]

Equality and diversity considerations

Some pregnant women have complex social needs and may be less likely to access or maintain contact with antenatal care services. Examples of women with complex social needs include, but are not limited to, women who:

have a history of substance misuse (alcohol or drugs)
have recently arrived in the UK as a migrant, asylum seeker or refugee
have difficulty speaking or understanding English
are aged under 20 years
have experienced domestic abuse
are living in poverty
are homeless.

It is therefore appropriate that professionals give special consideration to women with complex social needs. NICE's guideline on pregnancy and complex social factors includes recommendations on how to make antenatal care accessible to pregnant women with complex social needs and how to encourage women to maintain ongoing contact with maternity services.