Key messages for obstetricians and fetal medicine specialists from the confidential enquiry into stillbirth and neonatal death in twins
This paper highlights the key findings and recommendations from the recent MBRRACE Confidential Inquiry into twin deaths, and is essential reading for healthcare professionals working in maternity care. The report found that in around 1 in 2 deaths care was poor, and better care may have prevented a baby dying. This paper identifies areas where care may have been poor (covering areas like preterm birth, antenatal care, TTTS, care in labour and more) and offers evidence-based suggestions on how these shortcomings can be addressed through practice and research.
Read more at https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1002/uog.23594
A call to action: Long-term neurodevelopment in twins is under reported, poorly understood and a growing public health concern. It is time to combine clinical excellence and academic rigour to improve outcomes that matter to families.
We know that twins, triplets and more show differences in their neurodevelopment compared to singletons. For example, they are at higher risk of cerebral palsy. Studies also show that monochorionic twins (who shared a placenta during pregnancy) are at higher risk than dichorionic twins (each with their own separate placenta). Currently, research is mainly focused on pregnancies with complications, such as TTTS. However, this leaves a large group of monochorionic twins who did not experience complications but do seem to be at higher risk of long-term effects, for which research is not currently being carried out. Additionally, the research into long-term effects of pregnancy complications is limited. The way that babies are followed up after birth varies between hospitals and this means that there isn’t enough comparable data to provide good evidence of the long-term effects these babies experience. This paper recommends that all monochorionic twins (whether from a complicated or uncomplicated pregnancy) are monitored into childhood for long-term effects, in a carefully planned way, so that we can see exactly what the prognosis is for monochorionic twins’ development.
Read more at https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.23591
Controversies in the management of twin pregnancy
This paper examines some of the key issues facing clinicians when caring for a multiple pregnancy, and the questions which remain unanswered around how best to provide this care. In particular, uncertainties around screening and management of specific pregnancy complications do not always have an obvious answer, and more evidence may be needed to resolve those issues. This paper outlines what these questions are and suggests further areas for research.
Read more at https://pubmed.ncbi.nlm.nih.gov/32799348/
Atypical twin-to-twin transfusion syndrome
This paper considers some cases where TTTS would be considered ‘atypical’, meaning it may not follow the usual trajectory and/or may need special treatment. Atypical cases include TTTS with sFGR (growth restriction); TTTS with heart problems but little difference in amniotic fluid levels, TTTS with TAPS that occurs before laser intervention, monoamniotic pregnancies with TTTS (where two babies share one amniotic sac), and cases where a gap appears in the membrane between the babies which can reduce the difference in fluid levels between the two sacs. The paper explains how to identify these cases and the evidence to date about treatments. This is vital information to be able to adapt treatment to the needs of individual pregnancies which have any of these factors. The paper recommends that doctors who treat these cases should combine their findings to provide the best evidence for these cases.
Read more: https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.24899