Reduction in Twin Stillbirth Following Implementation of NICE Guidance

Abstract

Implementation of NICE twin guideline was associated with >70% reduction in stillbirth without a concomitant increase in neonatal mortality, admission to the neonatal unit or emergency Caesarean section. The reduction observed in monochorionionic twins was higher than that in dichorionic twins. What are the clinical implications of this work? Reduction in stillbirth in twins can be achieved through implementation of guidelines The reduction in stillbirth in twins represents a promising step towards achieving the UK national target of reducing stillbirths by 50% by 2025 National mortality reports should report the twin data separately in dichorionic and monochorionic pregnancies.

Perinatal mortality rate in multiple pregnancies: a 20-year retrospective study from a tertiary obstetric unit in Hong Kong

“…9,10 These changes can presumably be attributed to the 2011 implementation of national guidelines in the UK 11 concerning structured and more intensive antenatal monitoring; the guidelines emphasise the use of ultrasonography to determine chorioamnionicity and clarify the gestational age prior to delivery in uncomplicated multiple pregnancies. 12 To our knowledge, no Hong Kong-specific data are available regarding the trends and causes of perinatal mortality in multiple pregnancies. We recently reported the improvement of perinatal mortality in singleton pregnancies at a tertiary centre in Hong Kong between 2000 and 2019.…”

Key messages for obstetricians and fetal medicine specialists from the confidential enquiry into stillbirth and neonatal death in twins

“…A recommended schedule for antenatal ultrasound monitoring of twin pregnancy was proposed in the ISUOG twin pregnancy guideline (Figures S2 and S3) 9 and has been broadly adopted in other guidelines 14,15 . Implementation of National Institute for Health and Care Excellence (NICE) guidelines was associated with a more than 70% reduction in stillbirth rate in twin pregnancies, without a concomitant increase in the rate of neonatal death, admission to the neonatal unit or emergency Cesarean section 16 . Furthermore, a quality‐improvement program, working with 30 maternity units in the UK (The Twins Trust Maternity Engagement QI Project (T‐MEP)) demonstrated significant reductions in the rates of stillbirth, neonatal death, emergency Cesarean section and admission to the neonatal unit of twins over a 2‐year period 17 .…”