Excerpt

NICE’s original guideline on multiple pregnancy was published in 2011 and updated in 2019.

This guideline contains recommendations specific to twin and triplet pregnancies and covers the following clinical areas: optimal methods to determine gestational age and chorionicity; maternal and fetal screening programmes to identify structural abnormalities, chromosomal abnormalities and feto-fetal transfusion syndrome (FFTS), and to detect intrauterine growth restriction (IUGR); the effectiveness of interventions to prevent spontaneous preterm birth; and routine (elective) antenatal corticosteroid prophylaxis for reducing perinatal morbidity. The guideline also advises how to give accurate, relevant and useful information to women with twin and triplet pregnancies and their families, and how best to support them.

Contents

• 1. Guideline summary
  • 1.1. Guideline development group membership, NCC-WCH staff and acknowledgements
  • 1.2. Care pathway/algorithm
  • 1.3. Key priorities for implementation
  • 1.4. Recommendations
  • 1.5. Key research recommendations
  • 1.6. Research recommendations
  • 1.7. Other versions of the guideline
  • 1.8. Schedule for updating the guideline
• 2. Introduction
  • 2.1. Multiple pregnancy
  • 2.2. For whom is this guideline intended
  • 2.3. Related NICE guidance
• 3. Guideline development methodology
  • 3.1. Introduction
  • 3.2. Developing review questions and protocols and identifying evidence
  • 3.3. Reviewing and synthesising evidence
  • 3.4. Incorporating health economics
  • 3.5. Evidence to recommendations
  • 3.6. Stakeholder involvement
  • 3.7. Specific considerations for this guideline
• 4. Determining gestational age and chorionicity
  • 4.1. Gestational age
  • 4.2. Chorionicity
• 5. General care
  • 5.1. Information and emotional support
  • 5.2. Nutritional supplements
  • 5.3. Diet and lifestyle advice
  • 5.4. Specialist care
• 6. Fetal complications
  • 6.1. Screening for chromosomal abnormalities
  • 6.2. Screening for structural abnormalities
  • 6.3. Monitoring for feto-fetal transfusion syndrome
  • 6.4. Monitoring for intrauterine growth restriction
• 7. Maternal complications
  • 7.1. Hypertension
• 8. Preterm birth
  • 8.1. Predicting the risk of preterm birth
  • 8.2. Preventing preterm birth
  • 8.3. Untargeted corticosteroids
• 9. Indications for referral to a tertiary level fetal medicine centre
  • Introduction
  • Review question
  • Existing NICE guidance
  • Description of included studies
  • Health economics profile
  • Evidence to recommendations
  • Recommendations
• 10. Timing of birth
  • Introduction
  • Review question
  • Existing NICE guidance
  • Description of included studies
  • Published health economic evidence
  • Evidence profiles
  • Evidence statement
  • Health economics profile
  • Evidence to recommendations
• 11. Cost effectiveness analyses
  • 11.1. Introduction
  • 11.2. Cost effectiveness of specialist care compared to usual care for women with twin or triplet pregnancies
  • 11.3. Cost effectiveness of elective birth compared to expectant management for multiple pregnancies
• 12. References
• 13. Abbreviations and glossary
  • Abbreviations
  • Glossary
  • Health economics terms
• Appendix A. Scope
• Appendix B. Declarations of interest
• Appendix C. Registered stakeholder organisations
• Appendix D. Review questions
• Appendix E. Review protocols
• Appendix F. Search strategies
• Appendix G. Excluded studies
• Appendix H. Evidence tables
• Appendix I. Forest plots
• Appendix J. GRADE findings

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.

This guideline has been fully funded by NICE. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient.

Implementation of this guidance is the responsibility of local commissioners and/or providers.