Audit of Antenatal and Intrapartum care in Multiple Pregnancies

 OBJECTIVE: This audit is to look into the antenatal and intrapartum care of women with multiple pregnancies in Mid Yorkshire Hospitals Teaching Trust (MYHTT). To audit the compliance with the MYHTT guidelines that are based on the National Institute of Clinical Excellence (NICE) guideline 137, Green-top Guideline 51 and the recommendations from the Mothers and Babies Reducing Risks through Audits and confidential enquiries across United Kingdom  (MBRRACE-UK) Perinatal Confidential Enquiry on Stillbirths and Neonatal deaths in Twin pregnancies January 2021 report.

 DESIGN: A retrospective audit of antenatal and intrapartum care of women with multiple pregnancies who delivered at MYHTT .

 METHODOLOGY: All women with multiple pregnancies who delivered at MYHTT between 01January2023 to 31December2023. Data was collected from the electronic patients records on Badgernet. 85 women were identified, 10 women were excluded from the audit due to care being primarily given at other hospitals. 75 women were included in the audit where most of the antenatal and postnatal care was delivered at MYHTT.

 RESULTS:

 Dichorionic Diamniotic (DCDA) twin pregnancy was identified in 53(70.7%) of pregnancies, monochorionic diamniotic (MCDA) twins in 20 (26.7%). Monochorionic monoamniotic (MCMA) in 1(1.3%) and dichorionic triamnioitic (DCTA) in 1(1.3%) pregnancies.

Twin pregnancy was diagnosed, amniocity and chorionicity defined before 13+6/40weeks in 100% cases. 97% cases were seen by consultant in clinic, chorionicity based risks discussed in 85% cases, timing and mode of delivery discussion before 32/ 40 weeks was done in 99% women. Ultrasound scans were performed fortnightly in MCDA twins in 100% cases and every four weeks in DCDA twins in 98% cases. Aspirin was commenced in 78 cases, hypertensive diseases diagnosed in 14%, diabetes, thyroid disorders detected in 20% cases. Twin to twin transfusion identified in 10% of MCDA twins. Antenatal spontaneous single fetus demise diagnosed in 2(3%) cases. Labour was spontaneous in 34% cases, and 37% women delivered after 37 weeks. 66% women had a caesarean birth.  Postpartum haemorrhage with blood loss over 500 ml was in 50% women, blood transfusion required in 9%.  Maternal sepsis diagnosed in 6% and no case of maternal death. Neonatal sepsis was diagnosed in 4% and death of any baby in 2 cases.

 CONCLUSION:

There was good adherence to local and national guidelines. Multiple gestations were diagnosed before 14/40 weeks with appropriate clinic and scan appointments. There was higher caesarean section rate where twin2 was presenting as breech.