Quality statement 2: Labelling the fetuses

Quality statement

Women with a multiple pregnancy have their fetuses labelled using ultrasound and recorded between 11 weeks 0 days and 13 weeks 6 days.

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 weeks 0 days and 13 weeks 6 days.

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 weeks 0 days and 13 weeks 6 days.

Numerator – the number of women in the denominator who have had their fetuses labelled using an ultrasound scan and recorded between 11 weeks 0 days and 13 weeks 6 days.

Denominator – the number of women with a multiple pregnancy of greater than 14 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 service providers, healthcare practitioners and commissioners

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 weeks 0 days and 13 weeks 6 days.

Healthcare practitioners ensure that women with a multiple pregnancy have their fetuses labelled using an ultrasound scan and recorded between 11 weeks 0 days and 13 weeks 6 days.

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 weeks 0 days and 13 weeks 6 days.

What the quality statement means for patients, service users and carers

Women who are pregnant with twins or triplets (referred to as a multiple pregnancy) have an ultrasound scan between 11 weeks and 13 weeks 6 days of their pregnancy to record the positions of their babies.

Source guidance

  • Multiple pregnancy (NICE clinical guideline 129) recommendation 1.1.2.2 (key priority for implementation).

Definitions of terms used in this quality statement

Ultrasound scan

An ultrasound scan is used to determine chorionicity based on the number of placental masses, the Lambda or T‑sign and membrane thickness.

Note: Antenatal care (NICE clinical guideline 62) recommends determination of gestational age from 10 weeks 0 days. However, the aim in Multiple pregnancy (NICE clinical guideline 129) 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.

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. Pregnancy and complex social factors (NICE clinical guideline 110) 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.