Pregnancy outcomes before and after institution of a specialised twins clinic: a retrospective cohort study

Abstract

BackgroundAlthough specialised clinics for multiple pregnancies are recommended by several Obstetrics and Gynaecology governing bodies, studies examining outcome before and after introduction of such clinics remain few, were performed predominantly in North America in the 1990s, and either amongst dichorionic twin pregnancies only or where chorionicity was not specified. Our objective, in the modern setting with twins of known chorionicity, was to compare maternal and neonatal outcomes of twin pregnancies before and after commencement of a consultant-led, multidisciplinary twins clinic (TC).MethodsRetrospective cohort study of 513 women, with birth of twins at ≥20 weeks’ gestation, January 2007 to November 2011, at a metropolitan tertiary maternity hospital, Sydney, Australia. Demographic, pregnancy, and outcome data were obtained from hospital databases. Women receiving TC care (2009–2011) were compared to those receiving general antenatal clinic (ANC) care (2007–2010) and private care (2009–2011). Other models of care were excluded. Main outcome measures were total maternal inpatient stay, mode of birth, gestational age at birth, and neonatal nursery admission.Results286 women were included in the main analyses: 84 attended ANC, 101 TC, and 101 a private obstetrician. TC women had similar demographics to ANC women and were slightly younger than private patients. TC women had lower Caesarean section rates (55 % vs. 70 % ANC and 76 % private, p = 0.008) and fewer late preterm (34 + 0–36 + 6 weeks) births, (26 %TC vs. 44 % ANC and 41 % private, p < 0.001). Median maternal inpatient stay was shorter in TC than ANC (7 vs. 8 days, p = 0.009) and similar to private (7 days). Nursery admission rates were higher in private patients (67 % vs. 49 % ANC and 47 % TC, p = 0.001) and average birthweight lower (2283 g vs. 2501 g ANC and 2496 g TC, p < 0.001).ConclusionsWithin a single centre, maternal and neonatal twin pregnancy outcomes varied significantly by model of care. Introducing a specialised twins clinic in our setting decreased Caesarean section rates, late preterm birth, and inpatient stay compared to ANC.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0654-5) contains supplementary material, which is available to authorized users.

Reduction in twin stillbirth following implementation of NICE guidance

“…The NICE guidance provided many recommendations (Appendix S1), including the establishment of specialist clinics for twins. Our findings add to the scarce evidence supporting the role of such clinics 10,11 . Women receiving care in a consultant-led multidisciplinary twins clinic at a metropolitan tertiary center in Sydney, Australia, had lower rates of Cesarean section (55% vs 70%) and PTB at 34-36 weeks (26% vs 44%) than did those managed in a general antenatal care clinic 11 .…”

Expertise in physiological breech birth: A mixed‐methods study

“…A recent systematic review suggested that experienced mentorship in clinical practice is an important corollary to breech training, associated with higher rates of attendance at actual vaginal breech births . Models of specialist care provision have been explored with good results in areas such as twin pregnancy and birth and birth after cesarean delivery . While much work has been done on the benefits of models of continuity of caregiver provided by midwives, less research has addressed the impact of continuity of obstetric caregiver, and trusting, stable relationships within the professional team.…”

Maternal and perinatal outcomes and factors associated with twin pregnancies among preterm births: Evidence from the Brazilian Multicenter Study on Preterm Birth (EMIP)

“…Antenatal care requires special guidelines including more frequent prenatal visits, ultrasounds, and neonatal intensive care support for assisting potential perinatal complications. Reduced perinatal morbidity and mortality and PTB rates are some of the benefits from antenatal and intrapartum care specialized programs for twin pregnancies . Brazil, like many low‐ and middle‐income countries, seeks better coverage and regulation of neonatal intensive care services .…”