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Twin pregnancies with complications impact on neurodevelopment study

What is the title of the research?

Twin pregnancies With complications; Impact on Neurodevelopment Study (TWINS)

What is the aim of the research?

The primary aim of this research is to establish the incidence of adverse neurodevelopment outcomes in normal twin pregnancies and those affected by TTTS, sIUD, sIUGR, TRAP, TAPS.

The secondary objectives are to examine whether there are potential confounders in this reported association, to investigate whether these risks can be predicted antenatally and to identify maternal or fetal markers that could be used to screen for adverse neurodevelopmental outcomes.

The research will look at two groups of women – those who had uncomplicated twin pregnancies and those whose pregnancies were complicated by Twin to twin transfusion syndrome (TTTS), Single intrauterine death (sIUD), Selective Intrauterine growth restriction (sIUGR), Twin Reversed Arterial Perfusion (TRAP) and Twin anaemia polycythemia sequence (TAPS). It will measure the neurodevelopment of the babies at different ages.

How long will the study take?

Approximately one year, beginning in March 2016 and finishing in March 2017.

Who will be conducting the research?

Dr.Asma Khalil and members of the steering Committee of the TTTS Registry will be conducting the research.  It will be a multicentre study involving maternity units across the UK.

Dr. Khalil is a Consultant in Fetal Medicine and Obstetrics at the Fetal Medicine Unit of St. George’s Hospital, which is a tertiary referral unit for the management of complex multiple pregnancies run according to NICE (National Institute for Health and Care Excellence) guidance.   She is also Lead Clinician of the Multiple Pregnancy Service, St. George’s Hospital, a NICE Fellow and Lead on the International Society of Ultrasound in Obstetrics and Gynaecology Twin Pregnancy Clinical Standard.

Dr Khalil and the other collaborators are all specialists in the field of multiple pregnancies and are widely published.

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?

Findings from the research will be presented at national conferences, published in peer reviewed journals and be presented as evidence for the updating of the NICE guidance; Royal College of Obstetricians and Gynaecologist’s (RCOG) Green-top Guidelines on the ‘Management of Monochorionic Twin Pregnancy’ and for updated drafts of the International Society of Ultrasound in Obstetrics and Gynaecology’s (ISUOG) Clinical Standard “Management of Twin Pregnancy”.Babies of complicated twin pregnancies are at risk of brain abnormalities and neurodevelopment delay.  However studies so far have been small in size and lack appropriate controls, so are at high risk of bias. This study will help to establish the prevalence of neurodevelopment delay in uncomplicated pregnancies and complicated pregnancies.  It could also identify the risk factors for adverse long term neurodevelopment outcomes in complicated twin pregnancies and help to put procedures in place to ensure better outcomes developmentally for those babies.

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