A report from Mothers and Babies: Reducing risk through audits and confidential enquiries across the UK (MBRRACE-UK) has been published reviewing stillbirth and neonatal deaths in UK twin pregnancies. Whilst rates have reduced from approximately 9 (2013) to 7 (2017) per 1,000 for stillbirths, the risks are still much higher than for singleton pregnancies.
The report highlights a number of issues relating to ultrasound scanning, which include lack of adherence to national guidelines relating to ‘frequency of scans’ for monochorionic twin pregnancies, inconsistency in the labelling of twins which can impact on the monitoring of growth for each twin and growth charts being inaccurate, unavailable or not completed.
In many cases discordance between the estimated fetal weight was not calculated in line with RCOG guidance (2016) on the management of monochorionic twin pregnancies, NICE guidance (2019) on twin and triplet pregnancy or, when it was, management advice was not followed.
Signs of twin to twin transfusion syndrome were not recognised and appropriate referral was delayed or lacking in cases of growth restriction or abnormal liquor volume.
Recommendations were made including auditing ‘adherence to the national guidance for scan frequency and the quality of scans and training in order to improve the quality of scanning and documentation of scans provided by the multidisciplinary team at all levels’, which includes sonographers, obstetricians and fetal medicine specialists.
‘Particular attention should be paid to:
● Consistent labelling of the twins;
● Plotting measurements on a growth chart;
● Calculating weight discordance (where appropriate);
● Recognition of the complications of twin pregnancy and referral to fetal medicine specialist in line with national guidance;
● Ensuring the availability of adequately trained sonographers to monitor twin pregnancies’.
There was also a recommendation for ensuring ‘a local process for regularly reviewing the training and expertise of sonographers and the quality of scanning of twin pregnancies’ is in place.
Other relevant recent publications include: