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NICE issues multiple pregnancy guidance

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Women who are expecting twins or triplets need much closer monitoring - including extra scans - to cut down the risk of problems, according to new NHS guidance.

At present, there is no clear guideline on how many scans women should receive, and the number varies across England.

Today’s document from the National Institute for Health and Clinical Excellence (NICE) says women should receive a minimum of six scans, and in some cases 11.

Nice is also calling for specialist teams with expertise in multiple pregnancies to care for women expecting twins or triplets and help lower the risk of complications.

Specialist teams could also be key in driving down the number of women needing an assisted birth (such as with forceps) or a Caesarean section.

The guidance, which applies to England and Wales, also says there is no evidence that taking bed rest prevents women going into premature labour.

Drugs to prevent labour, or offering a stitch to keep the cervix closed, should also not be routinely offered in these cases as there is no evidence to support their use, it said.

Dr Fergus Macbeth, director of the centre for clinical practice at NICE, said: “We know there is a real clinical need for this guideline because NHS antenatal care for women expecting twins or triplets appears to vary considerably across England and Wales.

“For example, not all women with multiple pregnancies are cared for in dedicated settings such as ‘twin clinics’ or by multidisciplinary teams of healthcare professionals.

“This can lead to higher than necessary rates of assisted birth and Caesarean sections and also means that women are not appropriately assessed for possible risks during pregnancy.”

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