Updated guidance for the management of twin and triplet pregnancies from the National Institute for Health and Care Excellence guidance (NICE), UK: what ’s new that may improve perinatal outcomes?

AbstractIn September 2019, NICE published updated guidance on the management of multiple pregnancy (NG 137). Many of the previous recommendations for care are upheld but there have been important changes: increased frequency of combined ultrasound/specialist antenatal care appointments for pregnancies containing a monochorionic placenta (twins and triplets), increased frequency of ultrasound monitoring in all triplet pregnancies, changes in the definition of selective growth restriction and for its subsequent referral pathways, the introduction of some monitoring for TAPS in monochorionic pregnancies (albeit in complex pregnancies or at an advanced stage), and a recommended timing of birth for any pregnancy with monoamniotic fetuses. New recommendations have been made for mode of delivery, fetal monitoring in labour, maternal analgesia and for the prevention of post ‐partum haemorrhage. Notable is the absence of any recommendation relating to the prevention of preterm birth. The basis and implications of the updates that may improve perinatal outcomes are discussed.

Source: Acta Obstetricia et Gynecologica Scandinavica - December 3, 2019 Category: OBGYN Authors: Janice L Gibson, James S Castleman, Shireen Meher, Mark D Kilby Tags: COMMENTARY Source Type: research