Quality statement 7: Advice and preparation for preterm birth

Quality statement

Women with a multiple pregnancy have a discussion by 24 weeks with one or more members of the multidisciplinary core team about the risks, signs and symptoms of preterm labour and possible outcomes of preterm birth.

Rationale

The multidisciplinary core team have expert knowledge in managing multiple pregnancies. Women with a multiple pregnancy are at increased risk of maternal and fetal complications in pregnancy and preterm birth. It is important that they are given advice on the possible risks, signs and symptoms of preterm labour so that they know what to expect and who to contact quickly if such symptoms arise. Women should also be informed that a preterm birth is associated with an increased risk of admission to a neonatal unit.

Quality measures

Structure

Evidence of local arrangements to ensure that women with a multiple pregnancy have a discussion by 24 weeks with one or more members of the multidisciplinary core team about the risks, signs and symptoms of preterm labour and possible outcomes of preterm birth.

Data source: Local data collection.

Process

The proportion of women with a multiple pregnancy who have a discussion by 24 weeks with one or more members of the multidisciplinary core team about the risks, signs and symptoms of preterm labour and possible outcomes of preterm birth.

Numerator – the number of women in the denominator who have had a discussion by 24 weeks with one or more members of the multidisciplinary core team about the risks, signs and symptoms of preterm labour and possible outcomes of preterm birth.

Denominator – the number of women with a multiple pregnancy that is greater than 24 weeks' gestation.

Data source: Local data collection. NHS Maternity Statistics – 2010/2011:

  • 'Complications during non-delivery obstetric episodes, 2010/11 (Table 24).

  • Singleton, twin and higher order multiple deliveries by gestation and birth status, 2010/11 (Table 26).'

Outcome

Levels of satisfaction with support and confidence to recognise the signs and symptoms of preterm labour.

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'.

The Care Quality Commission's Maternity services survey 2018 collected data on singleton and multiple births and asked the questions 'Thinking about your antenatal care, were you spoken to in a way that you could understand?' and 'Thinking about your antenatal care, were you involved enough in decisions about your care?'. The total number of respondents is also stated, although results are not broken down by singleton or multiple pregnancies.

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 discussion by 24 weeks with one or more members of multidisciplinary core team about the risks, signs and symptoms of preterm labour and possible outcomes of preterm birth.

Healthcare practitioners ensure that women with a multiple pregnancy have a discussion by 24 weeks with one or more members of multidisciplinary core team about the risks, signs and symptoms of preterm labour and possible outcomes of preterm birth.

Commissioners ensure that they commission services in which women with a multiple pregnancy have a discussion by 24 weeks with one or more members of multidisciplinary core team about the risks, signs and symptoms of preterm labour and possible outcomes of preterm birth.

Women who are pregnant with twins or triplets (referred to as a multiple pregnancy) discuss the risks and signs of an early (preterm) labour with one or more members of their healthcare team. The discussion should take place by 24 weeks of their pregnancy and also cover the possible problems associated with an early birth.

Source guidance

Twin and triplet pregnancy (2019) NICE guideline NG137, recommendations 1.3.5 and 1.9.3

The timeframe of 'by 24 weeks' is based on the multiple pregnancy antenatal care proforma and care pathways produced by Twins Trust.

Definitions of terms used in this quality statement

Multiple pregnancy

A multiple pregnancy is defined as a twin or triplet pregnancy.

[Expert opinion]

Preterm labour

The risk of preterm birth is higher in multiple pregnancies. About 60 in 100 twin pregnancies are delivered by 37 weeks, and 75 in 100 triplet pregnancies are delivered by 35 weeks.

The benefits and risks of targeted corticosteroids for fetal lung maturation should be discussed when providing information about preterm labour.

The signs and symptoms of preterm labour include more frequent and regular contractions, ruptured membranes, unusual or severe backache or other pain.

The potential need for neonatal management and the role of neonatal networks, including the possibility of admission of babies to a neonatal unit after birth, should also be discussed. Where possible, staff from the neonatal unit should be involved in the discussion and women should be provided with appropriate information about the neonatal services.

[NICE's guideline on twin and triplet pregnancy, recommendations 1.3.5 and 1.9.1 to 1.9.3]

Equality and diversity considerations

Information on the risks, signs and symptoms of preterm labour should be understood by all women so that they can feel fully informed. Information should be provided in an accessible format (particularly for women with physical, sensory or learning disabilities and women who do not speak or read English).