PFM.29 Audit on management of twin pregnancies in a district general hospital

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NICE has introduced a multiple pregnancy national guideline in September 2011 with recommendations for care of these high-risk patients.


The management and outcome of twin pregnancies in the Countess of Chester Hospital over a 12-month period were reviewed using NICE guidelines as standards.


Retrospective electronic case notes review was undertaken to assess compliance with NICE guidelines for all twin deliveries from October 2012 to September 2013.


54 twin pregnancies were identified and the distribution of monochorionic monoamniotic (MCMA), monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) was 5%, 19%, and 76% respectively. All patients had chorionicity confirmed before 14 weeks gestation and were appropriately referred for consultant-led care. There was a 55.5% uptake of Down’s Syndrome screening in this study group. NICE recommended varied scan frequencies for the different twin subtypes and adherence were measured at 100% (MCMA), 80% (MCDA), and 92% (DCDA). There were 2 pregnancy losses and an incidence of Twin-to-Twin Transfusion Syndrome of 3.7% in this study population. Elective delivery was offered at NICE recommended gestations in 100% of monochorionic pregnancies and 71% of dichorionic pregnancies.


The audit demonstrated compliance for most standards with NICE recommendations in the management of twin pregnancies. A Regional guideline has been introduced in response to the NICE recommendations. We will present our data and intend to re-audit our practice to ensure continued compliance.

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