Comparison of International Guidelines on the Management of Twin Pregnancy

oliver, evie, Navaratnam, kate, Gent, joanna ORCID: 0000-0001-9969-4871, Khalil, asma and Sharp, Andrew ORCID: 0000-0003-3396-7464 (2023) Comparison of International Guidelines on the Management of Twin Pregnancy. European Journal of Obstetrics Gynecology and Reproductive Biology, 285. pp. 97-104.

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Abstract

Objectives: To review current international clinical guidelines on the antenatal and intrapartum management of twin pregnancies, examining areas of consensus and conflict. Methods: We conducted a database search using Medline, Pubmed, Scopus, Academic Search Complete, CINAHL and ERCI Guidelines website. Guidelines were screened for eligibility using our inclusion and exclusion criteria. Those deemed eligible were quality assessed using the AGREE II tool and relevant data was extracted. Results: We identified 21 relevant guidelines from 16 countries including two international society guidelines. There was consensus in determination of chorionicity and amnionicity within the first trimester, fetal anomaly scan between 18 and 22 weeks and the recommended screening for twin-to-twin transfusion syndrome (TTTS). For those that provided intrapartum guidance, there was agreement in recommending caesarean section to deliver monochorionic monoamniotic (MCMA) twins, epidural anaesthesia for intrapartum analgesia and the use of cardiotocography (CTG) for intrapartum fetal monitoring. The main areas of conflict included cervical length screening, frequency of ultrasound surveillance, timing of delivery of dichorionic twin pregnancies and circumstances for recommending vaginal delivery. There was a lack of advice on intrapartum management. Conclusions: This review has highlighted the need for unified international guidance on the management of twin pregnancy. Comparisons of current guidance demonstrates a lack of confidence in the management of labour in twin pregnancies. Further evidence on intrapartum care of twin pregnancies is needed to inform practice guidelines and improve both short and long term maternal and fetal outcomes.

Item Type:	Article
Uncontrolled Keywords:	Twin, Multiple pregnancy, Guideline, Screening, Guidance, Outcomes, Twin -to -twin transfusion syndrome, Twin anaemia polycythaemia sequence, Preterm birth
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	13 Apr 2023 07:19
Last Modified:	12 Oct 2023 10:41
DOI:	10.1016/j.ejogrb.2023.04.002
Open Access URL:	https://doi.org/10.1016/j.ejogrb.2023.04.002
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3169545