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Unborn twins and triplets: Guidelines by NICE

London, Sept 29 (): The NHS has been told to improve its care of pregnant women carrying twins or triplets in order to reduce the significant medical risks involved for both mothers-to-be and their babies.

NHS guidelines state that closer monitoring should be given to women expecting twins or triplets and such women should be given extra scans. The UK health watchdog NICE (the National Institute for Health and Clinical Excellence) says that expecting mothers should be referred to team of specialists and should receive no less than six scans.

Multiple births are on the rise, due mainly to an increase in the number of couples having IVF. They now account for 3% of births. The rise has been linked to the fact that older women are becoming pregnant after having IVF treatment. This makes having twins or triplets more likely, which can mean complications in birth. Until now, there have been no clear guidelines for women expecting twins or triplets in England and Wales.

Women at risk of early labor should not be routinely offered bed rest or drugs to prevent labor because there was no proof that they work. Women expecting multiple babies are at higher risk of miscarrying and having high blood pressure, as well as suffering stillbirths or having babies with congenital abnormalities.

The guidance says women expecting twins or triplets should receive at least six scans, and sometimes as many as 11. A scan should be carried out at between 11 and 14 weeks to assess whether twins share a placenta, which can increase the risk of complications.

Risk in Multiple pregnancies
The risk of stillbirth or having a premature birth is higher in multiple pregnancies
Some risks are associated particularly with babies sharing a placenta
Slow growth in the womb and congenital abnormalities are also more common

In its guidance released on Wednesday, Nice recommends that all women having an uncomplicated twin or triplet pregnancy should be cared for by a multidisciplinary team of medical experts who are experienced in such pregnancies, including obstetricians, midwives and ultrasonographers as well as a mental health professional, infant feeding specialist, dietitian and women’s health physiotherapist.

They should also undergo a risk assessment before the birth to establish whether the babies are identical siblings, where they come from the same egg and share one placenta, or have a placenta each, and undergo careful management from then on.

Identical siblings in utero involve a much higher risk of stillbirth, foetal complications and a condition called twin to twin transfusion syndrome.

Woman carrying multiple foetuses should also be given ultrasound scans in the first three months, more antenatal visits and monitoring of their babies for signs of intrauterine growth restriction after they are 20 weeks’ pregnant.

Macbeth added: “Although many women will have a normal pregnancy and birth, it is well known that there are higher risks involved for these types of pregnancy and so it is important to get it right. We hope this guideline will set the standard of high-quality care, which should be provided to all women pregnant with twins or triplets.”

“For example, not all women with multiple pregnancies are cared for in dedicated settings such as ‘twin clinics’ or by multidisciplinary teams of healthcare professionals. This can lead to higher than necessary rates of assisted birth and caesarean sections and also means that women are not appropriately assessed for possible risks during pregnancy.”

It comes as increasing numbers of women choose to abort one of their twins or triplets, usually because of the risk that they will be born disabled. NICE’s guidance suggests that the procedure of aborting one of two or three fetuses is itself dangerous, and may later lead to emotional problems in both the mother and the remaining twin.