Regularly monitoring women who are pregnant with twins or triplets to spot any possible complications could prevent around 1,000 neonatal admissions per year and improve outcomes for mothers and babies, it has been claimed.
In an impact report* published today by the National Institute for Health and Care Excellence (NICE) on maternity and neonatal care, the authors focus on how NICE’s evidence-based guidance can contribute to improvements in this area of care.
From 2016 to 2019, the Twins and Multiple Births Association (TAMBA) ran a project to increase the use of NICE guidance on twin and triplet pregnancies in maternity units across England.
In the maternity units that made improvements, 65% reduced neonatal admissions and 60% reduced the emergency caesarean section rate.
NICE said that if all maternity units applied its recommendations on twin and triplet pregnancies – such as labelling the fetuses during scans so they can be told apart and monitored closely for complications – it could lead to 634 fewer emergency caesarean sections and 1,308 fewer neonatal admissions in England, per year.
This could mean preventing around a tenth of neonatal admissions of babies from multiple births in the UK each year.
Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said: “Most women having twins or triplets have a healthy pregnancy. However, there is a higher chance of complications for both the mother and babies that means women need to be monitored more closely during pregnancy, labour and birth.”
NICE guidance recommends that neonatal transfer services are available to provide babies with safe and efficient transfers to and from specialist neonatal care services because unwell new-borns may have difficulty with breathing or keeping warm and require support as they are transferred.
Over the past three years more babies have had a normal core body temperature after transfer to or from specialist care – 91.7% in 2015, 93% in 2016 and 94.4% in 2017.
In 2014, NICE recommended that women should be asked about their emotional wellbeing at antenatal appointments. Since then the proportion of midwives asking has steadily increased from 87% in 2015, 90% in 2017, to 92% in 2018.
Professor Leng added: “It’s extremely encouraging to see the improvements maternity units have made by following NICE guidance, however there is still more work to be done in areas such as helping women, who are pregnant, to stop smoking.
“These improvements will have multiple benefits for mothers and babies and will help meet the NHS Long Term Plan to halve the number of still births and neonatal and maternal deaths by 2025.”
The report also highlights that there is more work to be done in reducing valproate prescriptions, the medication for treating epilepsy and bipolar disorder which can have harmful effects on unborn babies.
*NICE impact: maternity and neonatal care. A report prepared by NICE, September 2019.