Quality statement 4: Care planning

Quality statement

Women with a multiple pregnancy have a care plan that specifies the timing of appointments with the multidisciplinary core team appropriate for the chorionicity and amnionicity of their pregnancy.

Rationale

Women with a multiple pregnancy should have most of their antenatal appointments with a member of the multidisciplinary core team. The number of appointments and ultrasound scans a woman should have depends on the chorionicity and amnionicity of her pregnancy and any associated risk factors or complications.

Women should have a record of the expected number of antenatal appointments they should attend, who they should have them with and where they will take place.

Quality measures

Structure

a) Evidence of local arrangements to ensure that women with a multiple pregnancy 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 source: Local data collection.

b) Evidence of local audit to monitor the completeness and accuracy of the antenatal care plan for women with a multiple pregnancy.

Data source: Local data collection.

Process

The proportion of women 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.

Numerator – the number of women in the denominator 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.

Denominator – the number of women with a multiple pregnancy.

Data source: Local data collection.

Outcome

Women feel informed about their care and know which healthcare professionals they should see and when.

Data source: Local data collection. Data will also be collected against NHS outcomes framework 2013/14 indicator 4.5 'Women's experience of maternity services'.

What the quality statement means for different audiences

Service providers ensure that systems are in place for women with a multiple pregnancy to 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.

Healthcare practitioners provide women who have a multiple pregnancy with 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.

Commissioners ensure that they commission services that provide women who have a multiple pregnancy with 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.

Women who are pregnant with twins or triplets (referred to as a multiple pregnancy) have a care plan that has the dates and times of all their antenatal care appointments and details of who the appointments are with.

Source guidance

Twin and triplet pregnancy (2019) NICE guideline NG137, recommendations 1.1.13 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]

Multidisciplinary core team

A multidisciplinary core team of named specialists consists of specialist obstetricians, specialist midwives and ultrasonographers, all of whom have experience and knowledge of managing twin and triplet pregnancies.

A specialist obstetrician is an obstetrician with a special interest, experience and knowledge of managing multiple pregnancy, and who works regularly with women with a multiple pregnancy.

A specialist midwife is a midwife with a special interest, experience and knowledge of managing multiple pregnancy, and who works regularly with women with a multiple pregnancy.

An ultrasonographer is a healthcare professional with a postgraduate certificate in the performance and interpretation of obstetric ultrasound examinations.

[Adapted from NICE's guideline on twin and triplet pregnancy, recommendations 1.3.1, 1.3.4, 1.3.5 and terms used in this guideline]

Care plan

A care plan should be provided at determination of chorionicity, which specifies the frequency and timing of antenatal care appointments. The care plan should contain the recommended schedule of specialist antenatal appointments according to the chorionicity and amnionicity of a pregnancy, as detailed in the NICE guideline on twin and triplet pregnancy. The schedule of specialist appointments is also shown as part of the multiple pregnancy antenatal care proforma and care pathways produced by the Twins and Multiple Births Association.

Women may be seen for additional antenatal appointments in the community with healthcare professionals outside the multidisciplinary core team, such as neonatal unit staff, community midwives and GPs. The scheduling of these appointments will be coordinated by the multidisciplinary core team.

[Expert opinion]