WIREDGOV

A new quality standard on multiple pregnancy has the potential to transform the care of women expecting twins and triplets, according to experts.

While the majority of multiple births are healthy resulting in healthy babies, they do pose greater risks for both mother and baby, with maternal mortality and preterm birth both considerably higher among multiple pregnancies.

A factor that can increase risks in multiple pregnancy is when fetuses share a placenta. This can lead to feto-fetal transfusion syndrome, which is where there is an imbalance of blood flow across the placenta from one baby to another.

This condition can occur in monochrionic pregnancies, where there is only one outer membrane that surrounds the fetus, and which accounts for 20 per cent of stillbirths among multiple pregnancies.

To ensure that women with multiple pregnancy receive the best possible care, NICE has produced a multiple pregnancy quality standard, which contains 8 measurable statements that can help improve services.

These include a statement that women with a multiple pregnancy have the chorionicity and amnionicity of their pregnancy determined using ultrasound and recorded between 11 weeks and 0 days and 13 weeks and 6 days.

NICE says carrying this out will allow healthcare professionals to determine whether fetuses share a placenta, which increases the risk of complications. It will also allow women to be assigned the correct plan of care for their pregnancy.

To ensure that fetuses are monitored consistently throughout the pregnancy, NICE says that women with a multiple pregnancy should have their fetuses labelled using ultrasound and recorded between 11 weeks 0 days and 13 weeks 6 days.

The fetuses should be labelled with respect to whether they are left, right, upper or lower.

Further statements include that women with a multiple pregnancy are cared for by a multidisciplinary team, which should consist of a specialist obstetrician, a specialist midwife and an ultrasonographer.

The multidisciplinary team should coordinate clinical care for women with twin and triplet pregnancies to minimise the number of hospital visits, provide care as close to the woman's home as possible, and provide continuity of care between hospitals and the community which includes GPs, community midwives and health visitors.

Jane Denton, Director of The Multiple Births Foundation and Chair of the Topic Expert Group which developed the quality standard, said: "The NICE multiple pregnancy quality standard, in conjunction with the NICE guideline on multiple pregnancy, has the potential to transform the care of women expecting twins and triplets.

"Women with a multiple pregnancy are now clearly recognised as a distinct group requiring specialist care. The quality standard sets out how to improve the outcomes for these women and their babies and ensure that they receive consistent and high standard care throughout the pregnancy which includes preparing them for parenting."

She added: "The NICE quality standard and guideline also sets the framework for continuity of care including the important links with staff providing neonatal services and those in the community."