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Antepartum stillbirth in twins: a regional multi-centre audit of antenatal care
  1. P Karkhanis1,
  2. S Sturgiss2,
  3. H Brandon3,
  4. S Glinianaia4,
  5. R Bell4
  1. 1Birmingham Heartlands Hospital, Birmingham, UK
  2. 2Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
  3. 3Queen Elizabeth Hospital, Gateshead, UK
  4. 4University of Newcastle, Newcastle-upon-Tyne, UK

Abstract

Background Twins have a much higher stillbirth rate than singletons with causes of intrauterine death frequently unexplained. In the North of England the stillbirth rate in twins is higher than the national rate.

Aim To audit antenatal surveillance of twin pregnancy resulting in antepartum stillbirth against regional consensus standards of care.

Methods A retrospective, case-note analysis of all antepartum stillbirths in twins delivered 2005–2009, identified from the population-based Northern Survey of twin and multiple pregnancy. Antenatal care was reviewed independently by two consultants.

Results There were 43 antepartum stillbirths in 38 pregnancies. 21 were DCDA, 14 MCDA, one MCMA and in two cases the chorionicity was unknown. Autopsy was performed in 18 (47%) pregnancies. Major causes of stillbirth were acute or chronic antepartum hypoxia (n=25) and twin-to-twin transfusion (TTTS n=14, 9 pregnancies). Case-note review clarified causes of death in 22 cases confirming TTTS in 8 pregnancies affecting 13 twins. 66% pregnancies were delivered within 24 h of diagnosis of death, 53% by Caesarean section. The review of case notes highlighted a number of cases where elements of antenatal care might have been improved with antenatal surveillance in the majority being in line with regional standards.

Conclusion Sometimes in spite of exemplary antenatal care, stillbirths in twins may not be avoidable. The issues arising from the review will be fed back for discussion at a regional workshop. Regional datasets facilitate discussion of practice between maternity units and enable areas for improvement to be identified.

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