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Single intrauterine fetal death in monochorionic multiple pregnancies 

What is the title of the research?

Single intrauterine fetal death in monochorionic (MC) twins study: incidence: maternal, fetal and neonatal consequences (single twin demise in MC twins)

What is the aim of the research?

It is an observational study using the UK Obstetric Surveillance System (UKOSS) to identify all cases of single twin demise in MC twin pregnancies over the course of 12 months. It will describe adverse maternal, fetal and perinatal consequences and explore prognostic factors.

It will analyse:

  • The incidence of SIUFD in MC pregnancy in the UK

  • Characteristics of MC twin pregnancies

  • The nature and incidence of antenatal  intervention following SIUFD

  • Description of maternal, fetal and neonatal outcomes, including mortality before and after 24 weeks, antenatal complications, maternal morbidity, gestation at delivery, mode of delivery, admission to NICU, evidence of neurological disability before and after birth.

  • Prognostic indicators for mother and baby

How long will the study take?

Approximately two years in total.

Case identification and data collection will take place over one year from September 2016 to September 2017.  Analysis of data, write up and results dissemination should be completed by August 2018.

Who will be conducting the research?

Professor Kilby is Professor of Fetal medicine at the University of Birmingham and practices at West Midlands Fetal Medicine Centre, Birmingham Women’s Hospital.  The centre is academically and clinically at the forefront of providing high quality, evidence based care for women with multiple pregnancies. It is the regional referral unit for the West Midlands for fetoscopic laser ablation. Professor Kilby is widely published on multiple pregnancies and their complications and is author of the NICE Guidelines for Management of Multiple Pregnancies, the RCOG Green top Guidelines for the management of monochorionic twins and the ISUOG guidelines on the management of multiple pregnancies.

Also conducting the research will be Dr Morris, Senior Lecturer Maternal Fetal Medicine, University of Birmingham and Professor Knight, Professor of Maternal and Child Population Health, University of Oxford,who are also widely published in maternal and fetal medicine research.

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

Research that identifies the most effective long term treatments for Twin to twin transfusion syndrome (TTTS), sIUGR and the surviving twin following the death of the co-twin.

Why is this research important?

This research is important because sIUFD in MC twins is associated with increased risk of premature delivery, death and neurological trauma (brain damage) for the co-twin. Robust information gathered from the research will allow informed counselling and management options for the Fetal medicine specialists and families. It will also allow exploration of prognostic factors, including maternal and pregnancy characteristics as well as management options.

The results will be shared widely within the medical community and with the Department of Health, ensuring the findings will be used to influence national and international guidelines in this area.

Previous cohort studies involved only small number of twin pregnancies whereas this research will involve data from approximately 220 twin pregnancies.  With the previous studies no data could be found on the maternal risks of single twin demise and there was little evidence on the most reliable way of assessing fetal wellbeing; the best use of imaging to detect central nervous system problems; timing of delivery and delivery method (whether induction of labour and vaginal delivery should be attempted).  These matters are important in terms of limiting maternal complications and long term neurodevelopmental handicap of the surviving baby.

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