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Saving lives, supporting families

Tamba's research plan 

Research to save lives, change lives and create better futures for multiple birth families   

We know that investing in the right pieces of research has the potential to save lives. It is hoped that our ambitious research plan over the next few years will do just that – save lives, change lives and create better futures for multiple birth families.

Tamba's BIG Research Appeal

Tamba's BIG Research Appeal is an extension of our passion and commitment to make all multiple pregnancies safer than they are today, for both mums and babies. We’ve committed, with your help, to undertaking the widest multiple pregnancy research programme anywhere in the world, which should save lives and reduce prematurity. We have partnered with the British Maternal and Fetal Medicine Society (BMFMS) to find the best researchers to undertake seven pieces of clinical research all designed to help reduce the risks associated with multiple pregnancies, such as prematurity, stillbirth and neonatal death, which are all much higher than singleton pregnancies. Click here to find out more

Twin to Twin Transfusion Syndrome (TTTS) Registry

TTTS is a potentially fatal disease effecting twins that share a placenta, where one twin transfuses blood to another.  Left untreated most babies die. Currently there is too little research conducted looking at the most effective treatments for TTTS in the short or longer term.  There is no comprehensive outcome data collected and published in the UK so doctors cannot compare what is working best and why.  There are also no longer term follow ups to understand the longer term consequences of individual treatments. That is why we have partnered with St George’s hospital and other fetal medicine centres throughout the UK to set up a UK-wide registry of all TTTS pregnancies, their treatments and outcomes.  This will provide a comprehensive set of data to help improve clinical skills and patient care.  It will establish a platform to allow long term follow up of TTTS survivors at a national level. The data will also be invaluable for future on going research into TTTS.  With all the fantastic support we received via our TTTS Appeal we have raised our £30,000 initial target to get the TTTS Registry up and running.  The TTTS Registry will be going live in October 2015 and any niggles worked on through the rest of the year. The TTTS registry will be a UK first and is the most practical way of driving improvements in the next few years and longer term.  There will be continuous running costs associated with the registry and we need to appoint a research midwife to liaise with the hospital units to ensure the data is collected and entered correctly etc. We will also be extending the registry to cover other TTTS complications such as TAPS and TRAPS. So your continued fundraising is very much needed and greatly appreciated! For more information visit our TTTS Appeal page.  To further this research you can make a donation

TTTS:Developing a new way to treat babies in the womb

Professor Christopher Lees at Queen Charlotte’s and Chelsea Hospital, Imperial College, London is investigating a new type of treatment for TTTS (twin to twin transfusion syndrome) babies in the womb involving a powerful form of ultrasound. TTTS occurs in about 10-15% of identical twins who share a placenta. Blood vessels are no longer shared equally, which means the donor twin has a decreased blood volume. This leads to slower than normal growth and a poor urinary output causing little to no amniotic fluid. The larger twin (the recipient) becomes overloaded with blood. This puts a strain on the baby’s hearts and causes them to have too much amniotic fluid. If left untreated, 90% of TTTS babies will die. Currently the most popular treatment is laser ablation, where the blood vessels shared in the placenta are blocked, equalising the amount each baby receives.  As laser ablation is a surgery, it is invasive and can lead to serious complications. To avoid this, Professor Lees is looking into a new form of treatment – a powerful form of ultrasound. As it does not involve surgery, the theory is that the ultrasound treatment could be safer than laser therapy.  Professor Lees hopes this means babies could be treated earlier in pregnancy and hopefully this will improve their chances of surviving and escaping a disability.Click here to read more

Worlds First Twin Pregnancy Growth Chart

In 2013, thanks to the help of our donors and supporters, we raised money via our Beanstalk Appeal to fund our first piece of clinical research, carried out by St George’s Hospital in London, to develop the world’s first twin pregnancy growth charts. Twin babies are measured during pregnancy using singleton growth  charts and clinicians must use their judgement to decide how the  pregnancy  is progressing. The twin pregnancy growth charts will make it easier to identify twins who  have genuine growth restriction and who are therefore at risk of stillbirth, and  may need intervention to keep them safe. They will also prevent the false  diagnosis (thinking that the babies are growth restricted but they are not)  therefore potentially avoiding unnecessary intervention in the form of  premature delivery. These charts have the potential to save twin babies’ lives…For more information, visit our beanstalk appeal page

Participants wanted for a study on parenting multiples

First-time parents of multiples are being sought for a new study on parenting.
Laura Maguire, a full-time research student at Birmingham City University, would like to hear from couples living in the West Midlands.
She is exploring how parents meet the challenges of parenting twins, triplets or higher multiples from birth through the first five years of life.
Laura is interested in speaking to parents who have multiples aged between three months and five years old who would be willing to share their experiences and the daily realities facing mothers, fathers and the couple together. She would like to arrange a meeting where she would speak to both parents together, and then possibly separate interviews at a later stage. All interviews would be recorded, completely confidential and all participants would remain anonymous. 
Anyone interested in taking part can email laura.maguire@bcu.ac.uk or call 07954 421347 or 0121 3317117.

Study on early vs late intervention for twin reversed arterial perfusion sequence

The Twin Reversed Arterial Perfusion Intervention STudy (TRAPIST) will look into whether early intervention (at 12-14 weeks gestation) improves the survival and two-year development of children compared to later intervention (at 16-18 weeks gestation) in twin pregnancies complicated by TRAP.
TRAP (twin reversed arterial perfusion) is a complication of shared circulation in monochorionic twins who share a single placenta. In TRAP cases, reversed blood flows from the healthy twin (pump twin) towards the abnormal twin. This strains the heart of the pump twin and can increase urine output, which can trigger premature birth.
The condition is now being routinely diagnosed at the 12-week routine ultrasound scan, but treatment is traditionally offered at the 16-week point.
Dr Asma Khalil at St George’s Hospital, the clinician behind the UK-TRAPIST study, says intervention before 16 weeks carries a higher risk of miscarriage. In some TRAP cases, the reversed blood flow stops by itself and the intervention planned at 16 weeks is not required.
However, it has also been shown that diagnosis at 12 weeks with treatment delayed until the 16th week is associated with a high pregnancy loss (up to 33%) of the pump twin.  Previous studies have also shown that earlier treatment usually results in delivery closer to the expected date of delivery with improved survival rates.
In order to ascertain which method is better, Dr Khalil and her team will be putting people into groups and giving each group a different treatment. The results can then be compared to see if one is better than the other.
To make sure the groups are the same to start with, each patient is randomly selected by a computer to either go in the early treatment group or the later treatment group. 
The UK-based study is part of a wider international multicentre trial led by Professor Liesbeth Lewi (Leuven, Belgium). Five centres in the UK are planning to participate. Click here to find out more

Research into the effectiveness of bed rest during multiple pregnancy

Clinicians have been assessing the effectiveness of bed rest in hospital or at home to improve pregnancy outcomes for women with a multiple pregnancy
Bed rest at home or in hospital is a very common intervention to prevent preterm birth in women with multiples. Strict bed rest refers to the confinement to rest in bed the entire day and to minimise all physical activity, except for toileting and healthcare-related visits. Women who are recommended to partial rest are allowed some physical activity, but are encouraged to continuously rest in bed for several hours during the day.
Bed rest, with or without hospitalisation, may have the potential to reduce the risk of preterm birth, fetal and neonatal mortality, and long-term morbidity.
The effectiveness of bed rest for multiple pregnancies is constantly being reviewed in order to better guide doctors in their decisions.
A review in 2001, which was updated in 2010, found that routine hospitalisation and bed rest for women with a multiple pregnancy may improve fetal growth, but did not find sufficient evidence to reduce the risk of preterm birth and perinatal mortality.Clinicians systemically evaluate the latest evidence of bed rest. You can read more about their research here at the Cochrane Library.


STOPPIT 2 is the Study for the Prevention of Preterm labour In Twins 2, which is being carried out by Professor Jane Norman at Edinburgh University.
The study aims to determine whether the Arabin cervical pessary prevents preterm birth in women with a twin pregnancy and a short cervix. (A pessary is a small ring-shaped device which is inserted around the cervix).
Women with a twin pregnancy are at high risk of preterm labour. The extra risk of preterm labour in twin pregnancy is the main reason why twin babies are five times more likely to die, both within the first month or the first year of life. Preterm babies who survive are at increased risk of long term disability, and often require extensive and costly health care, so if preterm birth could be prevented in twins this would be extremely beneficial.
A large randomised trial has suggested the Arabin cervical pessary can reduce preterm birth in women with a singleton pregnancy and many clinicians use it for this purpose. A Dutch study has suggested it could also prevent preterm birth in twins. Although the pessary did not work in all twin pregnancies, it appeared to reduce preterm birth in those women with a twin pregnancy who had a short cervix.
However, before all UK women with a twin pregnancy and a short cervix can be offered the treatment via the NHS, researchers need to be certain about the benefits and risks involved.
Doctors have proposed a study to resolve the uncertainty they still have about the success rates of the pessary, define any adverse effects for mother and baby, ascertain whether women find the treatment acceptable and calculate the costs for the NHS. Click here to find out more

A study into the role of genetic. environmental and intrauterine factors in child development

Dr Eva Antoniou, joint University of Birmingham/University of Maastricht PhD studentships, looked into the correlation between genetic, environmental and intrauterine factors in child development.
She looked at data from two large twin studies: the Twins and Multiple Births Association Heritability Study (TAMBAHS) and the East Flanders Prospective Twin Survey (EFPTS).
An association between birth weight and child development has already been established, so what this study set out to find was whether there were associations between other factors of the intrauterine environment and child development.
Heritabilities of the umbilical cord, IQ, temperament and behaviour problems were estimated. Fetal characteristics, such as birth weight, placental weight and morphology, umbilical cord knots, length and insertions were all investigated in relation to the child’s development in the EFPTS study. In the TAMBAHS study, the impact of maternal pre-pregnancy weight on temperament and behaviour problems was examined.
The full report and findings can be found here 

The Bristol Twin Study (BRIT Study)

This study is being conducted at the University of Bristol by Dr Sarah Newell in the School of Clinical Sciences.
The two-year research project involves recruiting women who are pregnant with monochorionic twins (twins sharing a placenta) in the Bristol and Bath area. The study will follow them through their pregnancies and monitor the babies’ hearts, placenta and brains.
The three main aims of the study are: 
1. To look in detail at the babies’ hearts throughout the pregnancy, using a special type of ultrasound scan.
2. To look at how the babies’ brains are developing by doing an MRI scan during the pregnancy.
3. To look in more detail at how the shared placenta develops using a special type of ultrasound scan.

Improving Healthcare During Pregnancy

Research is being conducted in association with the London School of Hygiene and Tropical Medicine which involves hearing from women that have given birth during the last six month. The project looks at the communication relationships that form between mothers and their health care professionals during pregnancy and how this effects vaccine uptake during this time. Specifically it will look at the role of information in these relationships and how it interacts with the decision making process. The study is looking to hear from 350 women that have given birth during the last six months. All participation requires is the filling out of an online survey that takes around 15-20 minutes to complete and as a reward for participation each respondent will have the opportunity to enter into a prize draw to win one of three Mothercare vouchers (2x £50, 1x£100 available). Further details about Richard, the researcher, can be found at www.richardclarkeresearch.com and if you do have any questions please feel free to contact get in touch on Richard.clarke@lshtm.ac.uk.

TTTS Research

In the videos below Mark Kilby talks about the research carried out by Birmingham Women's Hospital and the National Perinatal Epidemiology Unit into the outcome of monochorionic twin pregnancies where there is single twin demise. The research is funded by Tamba and BMFMS and aims to make more information available and a better understanding of risk factors to be able support parents through a difficult time.



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