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Prevalence, birth outcomes and clinical management of monochorionic monoamniotic (MCMA) twin and all triplet pregnancies

What is the title of the research?

Prevalence, birth outcomes and clinical management of monochorionic monoamniotic (MCMA) twin and all triplet pregnancies

What is the aim of the research?

This research project aims to determine the prevalence of MCMA twin and triplet (any chorionicity) pregnancies and to compare birth outcomes and clinical management of these pregnancies.

The study will use NorSTAMP (Northern Survey of Twin and Multiple Pregnancy) data from the North East and Southwest Thames Obstetric Research Collaboration (STORK) data from the South for 2000 -2013.

The pregnancy outcomes to be explored will include early fetal loss, stillbirth, twin to twin transfusion syndrome, fetal growth retardation, congenital amomalies, neonatal mortality and morbidity, mode of delivery, gestational age at birth and birth weight.  These will be compared between the NorSTAMP and STORK data and also before and after publication of the NICE guidelines.

The investigation of clinical management will include referrals to a specialist centre and /or management within a specialist clinic; referrals for intensive monitoring in the tertiary centre; neonatal interventions and compare these between NorSTAMP and STORK deliveries.

How long will the study take?

10 months, from April 2016 to January 2017.

Who will be conducting the research?

Dr. Therese Hannon will lead the research.  She is Consultant in Fetal Medicine and Obstetrics at the Department of Fetal Medicine, Newcastle upon Tyne NHS Foundation Trust (NUTH), a tertiary referral unit for the management of complex multiple pregnancies.  Dr. Hannon will be supported by a number of specialists at other units, including collaborator Professor Basky Thilaganathan of St. Georges University of London, and all have had their research widely published.

Dr. Svetlana Glinianaia, an experienced perinatal researcher with expertise in multiple pregnancy epidemiogogy will be collecting and analysing the data.

Which of the 7 prioritised research areas does the study fit into?

Research that identifies the incidence of monochorionic monoamniotic (MCMA) twin and triplet pregnancies and the most effective clinical management strategies for them. 

Why is this research important?

Although MCMA twin pregnancies and triplets are very rare (MCMA pregnancies occur in about 1 in 10,000 pregnancies overall and triplet pregnancies occur in about 3 per 10,000 pregnancies) they have a high risk of adverse pregnancy outcomes (for example, 15-20% of MCMA pregnancies result in perinatal death after 20 weeks).

As these types of pregnancies are rare there is little evidence to show the best way of clinically managing them.  Therefore, accurate data is needed for meaningful analysis of their clinical management and pregnancy outcomes.

This research will use data from the largest UK cohort of MCMA twin and triplet pregnancies. The findings from this research will inform future provision of NHS services and contribute to the evidence for effective clinical management of these high risk pregnancies.

The results will be shared widely with the medical community and disseminated via national conferences and journals; submitted as evidence to update NICE guidance and the RCOG for consideration in redrafts of RCOG Green-top Guideline, “Management of Monochorionic Pregnancy.”





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