Breaking News
February 22, 2019 - Oncotype DX Not Cost-Effective for Low-Risk Breast Cancer
February 22, 2019 - Scientists discover new type of immune cells that are essential for forming heart valves
February 22, 2019 - Talk About Déjà Vu: Senators Set To Re-Enact Drug Price Hearing Of 60 Years Ago
February 22, 2019 - Genetic defect linked to pediatric liver disease identified
February 22, 2019 - New cellular atlas could provide a deeper insight into blinding diseases
February 22, 2019 - Growing number of cancer survivors, fewer providers point to challenge in meeting care needs
February 22, 2019 - Innovative compound offers a new therapeutic approach to treat multiple sclerosis
February 22, 2019 - $1.5 million grant to develop opioid treatment program for jail detainees
February 22, 2019 - FDA’s new proposed rule would update regulatory requirements for sunscreen products in the U.S
February 22, 2019 - Most Hip, Knee Replacements Last Decades, Study Finds
February 22, 2019 - Wellness problems prevalent among ob-gyn residents
February 22, 2019 - In the Spotlight: “The world is your oyster in geriatrics”
February 22, 2019 - Successful testing of multi-organ “human-on-a-chip” could replace animals as test subjects
February 22, 2019 - Analysis of cervical precancer shows decline in two strains of HPV
February 22, 2019 - Sugary stent eases suturing of blood vessels
February 22, 2019 - From surgery to psychiatry: A medical student reevaluates his motivations
February 22, 2019 - Is New App From Feds Your Answer To Navigating Medicare Coverage? Yes And No
February 22, 2019 - New pacemakers powered by heartbeats could reduce need for surgery
February 22, 2019 - The United States records highest drug overdose death rates
February 22, 2019 - Phase 1 data reinforce safety profile of new drug for treating Duchenne muscular dystrophy
February 22, 2019 - Vitamin D supplementation less effective in the presence of obesity, shows study
February 22, 2019 - Sarepta Announces FDA Acceptance of Golodirsen (SRP-4053) New Drug Application for Patients with Duchenne Muscular Dystrophy Amenable to Skipping Exon 53
February 22, 2019 - An institutional effort to reduce the amount of opioids prescribed following lumbar surgery
February 22, 2019 - Family-history-based models perform better than non-family-history based models
February 22, 2019 - Failure to take statins leads to higher mortality rates | News Center
February 22, 2019 - New study explains why some patients report phantom sensations after limb amputation
February 22, 2019 - First motor-controlled heart valves implanted by Mainz University Medical Center
February 22, 2019 - Novel preclinical model mimics persistent interneuron loss seen in preterm infants
February 22, 2019 - Global health burden of glaucoma has increased, study reveals
February 22, 2019 - A holistic approach key to minimize treatment complexity in patients with interstitial lung disease
February 22, 2019 - 1 in 10 middle-aged Chinese adults are at high risk for heart disease, finds study
February 22, 2019 - More than half a million breast cancer patient’s lives saved by improvements in treatment
February 22, 2019 - Study finds no evidence that tougher policies prevent teenage cannabis use
February 22, 2019 - New blood test detects genetic disorders in fetuses
February 22, 2019 - Lower Self-Perception Observed in Children With Amblyopia
February 22, 2019 - Up to 15 percent of children have sleep apnea, yet 90 percent go undiagnosed
February 22, 2019 - Rare pulmonary defect prompts parents’ nationwide search for answers | News Center
February 22, 2019 - Lesbian and bisexual women at greater risk of being overweight, study finds
February 22, 2019 - UQ research may explain why vitamin D is essential for brain health
February 22, 2019 - Heart Attacks Rising Among Younger Women
February 22, 2019 - How your smartphone is affecting your relationship
February 22, 2019 - Orthopaedic surgeon receives prestigious award, $10 million grant | News Center
February 22, 2019 - New sepsis test could save thousands of lives
February 22, 2019 - Cervical cancer could be eradicated by 2100
February 21, 2019 - Sustained smoking cessation can lower risk of seropositive RA
February 21, 2019 - Thousands with chronic UTIs are not receiving the treatment they need
February 21, 2019 - Are teens getting high on social media? The surprising study seeking the pot-Instagram link
February 21, 2019 - Stanford expands biobank services | News Center
February 21, 2019 - Scientists identify link between drinking contexts and early onset intoxication among adolescents
February 21, 2019 - Strong social support may reduce cardiovascular disease risk in postmenopausal women
February 21, 2019 - Rapid expansion of interventions could prevent up to 13 million cases of cervical cancer within 50 years
February 21, 2019 - Motif Bio Receives Complete Response Letter From The FDA
February 21, 2019 - Researchers map previously unknown disease in children
February 21, 2019 - A skeptical look at popular diets: Going gluten-free
February 21, 2019 - Podcast: KHN’s ‘What The Health?’ How Safe Are Your Supplements?
February 21, 2019 - Factors associated with increased risk of developing surgical site infections
February 21, 2019 - Anticipatory signals in eye movements can help measure attentive capacity, learning with greater precision
February 21, 2019 - Study explores daily exposure to indoor air pollutants
February 21, 2019 - Evening exercise does not negatively affect sleep, may also reduce hunger
February 21, 2019 - Artificial intelligence technique can be used to identify alcohol misuse in trauma setting
February 21, 2019 - Overweight, obesity in adolescence associated with increased risk of renal cancer later in life
February 21, 2019 - BGU develops new AI platform for monitoring and predicting ALS progression
February 21, 2019 - Researchers discover a new promising target to improve HIV vaccines
February 21, 2019 - Brief Anesthesia in Infancy Does Not Mar Neurodevelopment
February 21, 2019 - Gaming system helps with autism diagnosis
February 21, 2019 - Heart Disease: Six Things Women Should Know
February 21, 2019 - More States Say Doctors Must Offer Overdose Reversal Drug Along With Opioids
February 21, 2019 - Researchers explore case studies focused on industries that kill more people than employed
February 21, 2019 - Only half of GP practice buildings are fit for purpose
February 21, 2019 - Intense exercise, fasting and hormones can enhance waste-protein removal, study shows
February 21, 2019 - Scientists can monitor brain activity to predict epileptic seizures few minutes in advance
February 21, 2019 - Study quantifies hepatic and intestinal mRNA expression of Ugt isoforms in rats
February 21, 2019 - ‘Apple-Shaped’ Body? ‘Pear-Shaped’? Your Genes May Tell
February 21, 2019 - Can we repair the brain? The promise of stem cell technologies for treating Parkinson’s disease
February 21, 2019 - Trump Plan To Beat HIV Hits Rough Road In Rural America
February 21, 2019 - PENTAX Medical introduces new electrosurgical and argon plasma coagulation platforms
February 21, 2019 - Trump plan to beat HIV hits rough road in rural America
February 21, 2019 - Eating blueberries every day could help decrease blood pressure
February 21, 2019 - ‘No Second Chances’ report calls for new measures to combat cardiovascular disease in Australia
February 21, 2019 - Mayo clinic researchers discuss local case studies of leprosy
Despite reduction in twin stillbirth rates, there is no change in still birth rates involving single fetus

Despite reduction in twin stillbirth rates, there is no change in still birth rates involving single fetus

image_pdfDownload PDFimage_print

A leading expert in fetal medicine at the University of Birmingham has warned that there is ‘little room for complacency’ over a fall in twin stillbirth rates as the reason for this phenomenon are complex.

In a paper published in BJOG: An International Journal of Obstetrics & Gynaecology, Mark Kilby, Professor of Fetal Medicine at the University of Birmingham’s Institute of Metabolism and Systems Research and Honorary Consultant in Fetal Medicine at Birmingham Women’s and Children’s NHS Foundation Trust, with collaborators explore the reasons as to why there has been a nearly 50 per cent fall in twin stillbirth rates from 11 to six per thousand total births between 2013 and 2016.

These figures were the findings of Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK)’s perinatal surveillance report published in June 2018. The MBRACCE-UK report noted that, although there had been a significant reduction in stillbirth rate in twins, there had been no change in still birth rates in pregnancies involving a single fetus.

Approximately one in 60 pregnancies are twins; an incidence increasing in the UK because of the use of artificial reproductive techniques and a rising maternal age.

Professor Kilby believes the fall in stillbirths in twins is, in part, due to an increasing recognition by healthcare professionals of the increased fetal risks in “identical twins”.

Identical twins either share a single placenta with a single outer membrane and two inner membranes (monochorionic diamniotic twins), or share both the inner and outer membranes (monochorionic monoamniotic twins). These twins are at higher risk due to complications such as twin-twin transfusion syndrome (TTTS), twin anaemia polycythaemia sequence (TAPS) and selective fetal growth restriction (sGR).

This recognition of the higher risks has led to the introduction of several clinical guidelines including The Royal College of Obstetricians and Gynaecologists’ Green Top Guideline on the Management of Monochorionic Twins and the generic NICE Guidelines on the Management of Twin and Triplet Pregnancy (currently under revision and to be republished in 2019).

A survey by the charity Twins and Multiple Births Association (Tamba) of 29 obstetric units has shown that hospitals following NICE guidance for management of twins have associated lower twin stillbirth, neonatal death rates and admissions to special care baby units. However, the data from Tamba through its Maternity Engagement Programme, indicates that “there is still considerable variation in implementation by NHS healthcare providers across the UK”.

Professor Kilby said: “The UK has been innovative in recommending the establishment of twin multidisciplinary teams and clinics along with several national clinical guidelines to aid the management of twin and triplet pregnancies and high risk identical twin pregnancies.

“However, adequate resourcing and professional engagement is required to prevent the current considerable variation in implementation of guidelines by NHS healthcare providers across the UK.”

Professor Kilby also states that refinements in in-utero treatments, along with new guidelines over the last 15 years on the monitoring of both identical and non-identical twins using ultrasound has also undoubtedly led to increased and earlier detection of complications .

Professor Kilby concluded: “The fall in twin stillbirth rates from 11 to six per thousand total births between 2013 and 2016 is welcome news, however, there is little room for complacency and more comprehensive uptake of clinical guidelines and close working with stakeholders such as Tamba and the Multiple Births Foundation will hopefully continue this trend into the future.”

He estimated that it would take a minimum of two years for hospital trusts in the NHS to engage with the recommendations by establishing multidisciplinary teams, a multiple pregnancy service and an infrastructure to deliver care and urged that much more work still needed to be done.

Keith Reed, CEO of Tamba, said: “Hundreds of babies lives could be saved and potentially thousands prevented going into neonatal care, but progress is at risk because funding for TAMBA’s successful Maternity Engagement Programme is due to end on March 2019 and there are another 124 obstetric units in England to engage with.”

Source:

https://www.birmingham.ac.uk/news/latest/2018/11/Expert-warns-over-‘little-room-for-complacency’-over-fall-in-twin-stillbirth-rates.aspx

Tagged with:

About author

Related Articles