Better care of pregnant women expecting multiple births ‘would cut stillbirths’

More than 600 emergency Caesarean sections and up to 100 stillbirths could be prevented each year if NHS hospitals followed official guidelines on multiple births, a study has found.

The project, sponsored by the Department of Health and Social Care, found that more babies would survive, fewer would be admitted to hospital and £8 million could be saved if UK hospitals took better care of pregnant mothers expecting twins, triplets or quadruplets.

It said guidelines laid down by the National Institute for Health and Care Excellence (Nice) in 2011 and 2013 are not being adhered to uniformly across the NHS.

  • 634 fewer emergency Caesarean sections
  • 100 fewer stillbirths
  • £8m savings

The guidelines and quality standards set out how women with a multiple pregnancy should be cared for, including access to specialist doctors and midwives, and ultrasound operators.

Women should also have a defined care plan, extra ultrasound checks as needed and have an expert in foetal medicine involved in their care if their pregnancy is higher risk or if there are complications.

Signs of premature labour must be discussed with women by 24 weeks of pregnancy and discussions around delivery should occur by 32 weeks.

Run by the Twins And Multiple Births Association (Tamba), the three-year project in 30 maternity units found that adhering to Nice guidelines could lead to 634 fewer emergency Caesarean sections each year, up to 100 fewer stillbirths and savings of £8 million a year.

The project saw 65% of units experience a reduction in their neonatal admissions rate for multiples in 12 months.

The report said that if all units in England adhered to the Nice guidelines, neonatal admissions could be reduced by 1,308 within a year.

In one unit there was a decrease in the neonatal death rate for multiples from 3.2% to 0%.

Evidence from St George’s University Hospital in London, which is an exemplar unit and an early adopter of the Nice guidance, saw a 70% reduction over five years in the stillbirth rate, from 14 per 1,000 in 2012 to four per 1,000 in 2016.

In England, multiple pregnancies are 1.5 times more likely to result in stillbirth than singleton pregnancies, three times more likely to result in neonatal death and seven times more likely to see the baby need neonatal care.

As part of the Tamba project, specialist multiple midwives and staff supported NHS employees to implement the Nice guidance.

Units were audited and then revisited 12 months later to assess the impact of the changes.

Keith Reed, chief executive of Tamba, said: “We know, and now have the evidence to prove, that following Nice guidance on multiple pregnancies works.

“We urge the NHS to ensure local maternity teams are aware that this project can make a considerable contribution to meeting the Government’s ambition to reduce stillbirths, neonatal deaths and preterm births.

“Evidence shows that whilst units know they should follow this guidance, they often find it difficult and can face barriers without a third party assisting.

“As an independent third party with specialist multiple midwives, staff at the units we worked with were keen to become involved, and the results speak for themselves.”

Mr Reed said more funding is urgently needed to reach other maternity units in England.

A Department of Health and Social Care spokesman said: “We want the NHS to be the safest place in the world to have a baby and as part of the NHS long term plan, backed by an extra £33.9 billion a year by 2023/24, the number of stillbirth and neonatal deaths over the next five years is planned to halve.

“Tamba’s excellent research, funded by the department, demonstrates how many lives can be saved when the NHS follows latest clinical guidelines.

“It is important this research is acted upon so it can make a real impact in reducing these tragedies.”

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