Antenatal management of multiple pregnancies within the UK: A survey of practice

Gent, Joanna; Nanda, Surabhi; Khalil, Asma; Sharp, Andrew

doi:10.1016/j.ejogrb.2020.08.024

Cited by 9 publications

(4 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…No consensus was reached on screening for preterm labour or the routine use of cervical screening in twin pregnancies. However, studies show that in clinical practice, despite the conflicting guidelines, many specialists carry out routine cervical length screening [ 81 , 85 , 86 ], highlighting the importance of stakeholder involvement during guideline development to ensure it reflects best current practice. It also raises concern that guidelines regarding the management of twins has had limited impact [ 85 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical practice guidelines for the antenatal management of dichorionic diamniotic twin pregnancies: a systematic review

O’Connor

Leitão

et al. 2023

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Objective This review aimed to identify guidelines with recommendations applicable to the antenatal management of dichorionic diamniotic twin pregnancies within high-income countries, appraise their methodological quality, and discuss the similarities and variability across guidelines. Method A systematic literature review of electronic databases was performed. Manual searches of guideline repositories and websites of professional organisations were performed to identify additional guidelines. The protocol for this systematic review was registered on PROSPERO (CRD42021248586, 25 June 2021). AGREE II and AGREE-REX tools were applied to assess the quality of eligible guidelines. A narrative and thematic synthesis described and compared the guidelines and their recommendations. Results Twenty-four guidelines were included, from which 483 recommendations were identified across 4 international organisations and 12 countries. Guidelines addressed eight themes and recommendations were classified accordingly: chorionicity and dating (103 recommendations), fetal growth (105 recommendations), termination of pregnancy (12 recommendations), fetal death (13 recommendations), fetal anomalies (65 recommendations), antenatal care (65 recommendations), preterm labour (56 recommendations) and birth (54 recommendations). Guidelines showed significant variability in recommendations, with conflicting recommendations regarding non-invasive preterm testing, definitions surrounding selective fetal growth restriction, screening for preterm labour and the timing of birth. Guidelines lacked a focus on standard antenatal management of DCDA twins, management of discordant fetal anomaly and single fetal demise. Conclusions Specific guidance for dichorionic diamniotic twins is overall indistinct and access to guidance regarding the antenatal management of these pregnancies is currently difficult. Management of discordant fetal anomaly or single fetal demise needs greater consideration.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical practice guidelines for the antenatal management of dichorionic diamniotic twin pregnancies: a systematic review

O’Connor

Leitão

et al. 2023

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…Many recommendations have suggested aspirin prophylaxis as a general measure during multiple gestations owing to an increased risk of PE in twin pregnancies. Even in nations with national standards, doctors do not advocate universal prophylaxis, and up to 15% of doctors decide to administer aspirin to all twins’ mothers [ 53 ]. However, a sufficiently powered randomized controlled study is urgently required to consider the paucity of information on the effectiveness of aspirin in avoiding preeclampsia in twins.…”

Section: Aspirin Prophylaxis In Multiple Pregnanciesmentioning

confidence: 99%

Preeclampsia and aspirin

Ahn¹,

Hwang²

2023

Obstet Gynecol Sci

View full text Add to dashboard Cite

Preeclampsia (PE) is a multisystem disorder that is an important cause of maternal and perinatal deaths. Currently, delivery is the only final treatment for PE. This practice is usually accompanied by premature birth, which inevitably increases neonatal morbidities. Aspirin is a non-selective NSAID that irreversibly inhibits cyclooxygenase enzymes involved in converting arachidonic acid to prostaglandins and thromboxane. Aspirin inhibits thromboxane A2 production via platelet aggregation, thereby increasing the prostacyclin/thromboxane A2 ratio and reducing platelet aggregation. Since the first case report of aspirin's potential use during pregnancy was reported in 1978, many studies have attempted to confirm the effect of aspirin on preeclampsia, and the results have been controversial. However, this preventive strategy is generally accepted in clinical practice.As evidence for aspirin's prevention of pre-eclampsia has been accumulating, a recent study investigated the effectiveness of aspirin at high doses of 150 mg, which is higher than before.However, there is an ongoing debate about how much aspirin should be used during pregnancy and when to start aspirin therapy. Guidelines for the use of prophylactic aspirin during pregnancy vary slightly among countries and groups. In this article, we review and summarize the evidence regarding the use of aspirin for PE prevention.

show abstract

“…Moreover, surveys among MFM specialists reveal that in clinical practice, despite the conflicting guidelines, most of the MFMs caring for twins perform routine CL screening in twin pregnancies. 65,110 Because cervical insufficiency is a dynamic process, it is likely that some cases of cervical shortening that occur after the routine CL measurement (usually done at midgestation) may be missed. Therefore, it is reasonable that serial measurements of CL may improve the detection of women with a short cervix who are at a high risk of PTB.…”

Section: Screening For Congenital Anomaliesmentioning

confidence: 99%

Special considerations regarding antenatal care and pregnancy complications in dichorionic twin pregnancies

Hiersch

Attali

Melamed

2022

American Journal of Obstetrics & Gynecology MFM

View full text Add to dashboard Cite

Antenatal management of multiple pregnancies within the UK: A survey of practice

Cited by 9 publications

References 6 publications

Clinical practice guidelines for the antenatal management of dichorionic diamniotic twin pregnancies: a systematic review

Clinical practice guidelines for the antenatal management of dichorionic diamniotic twin pregnancies: a systematic review

Preeclampsia and aspirin

Special considerations regarding antenatal care and pregnancy complications in dichorionic twin pregnancies

Contact Info

Product

Resources

About