Updated Twin Guidelines

Guidelines have been updated to support healthcare professionals caring for monochorionic twins pregnancies, aimed at improving early diagnosis and identification of complications.  Monochorionic pregnancies are multiple pregnancies – most commonly twin pregnancies – whereby the babies share the same placenta. Occurring in nearly a third of all twin pregnancies, this situation can results in additional complications requiring treatment and care.

It is thought that the advance in fertility treatment and increased maternal age has doubled the occurrence of twin pregnancies over the past forty years, and as a result, monochorionic twin pregnancies have also increased.

The guidelines cover a range of different complications that can occur as a result. 15% of monochorionic twin pregnancies are affected by Twin-to-Twin-Syndrome where part of the blood flow is directed to one twin, and not the other. Also, another complication, Selective Growth Restriction (SGR) is also covered, whereby there is a significant difference in size between the two babies, affecting approximately 20% of the pregnancies. For the first time, guidelines also cover Twin Anaemia-Polycythaemia Sequence (TAPS) which occurs when one baby has a high haemoglobin and the other has a low haemoglobin.

Because of these additional risks in monochorionic pregnancies, early detection, extra monitoring and support is required. Max Kilby, the lead author of the RCOG guidelines explains further:

“‘Monochorionic twin pregnancies are more complex and require close surveillance. Very sadly the risk of one or both of the twins dying is increased. Early diagnosis between 11-14 weeks gestation, alongside regular ultrasound screening every fortnight within a multidisciplinary twin pregnancy clinic is therefore essential to identify and treat complications as quickly as possible. Using the latest scientific evidence this guideline provides healthcare professionals with best practice advice for caring for women and their babies.”

Keith Reed, Chief Executive of the Twins Trust, (formerly Tamba), said:

“Although multiple births account for just 3% of all births in the UK, they account 7% of all stillbirths in England, Wales and Scotland in 2014. The risk of preterm birth is also higher for multiples, occurring in just over half of twin pregnancies and they are six times more likely to have cerebral palsy than a singleton baby. These stark statistics highlight the urgent need to improve care for women expecting more than one baby.”

For more information and to read the guidelines visit RCOG here