MATERNAL AND EARLY CHILD HEALTH

Health Evidence Bulletins - Wales

Date of Completion: 23.6.97

The contents of this bulletin are likely to be valid for approximately one year, by which time significantly new research evidence may become available


6. Multiple pregnancy

(Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation)

With the advent of assisted conception there has been a steep increase in the incidence of multiple pregnancy from 10-15/100,000 maternities prior to 1981 to more than twice that number in 1991. Such pregnancies put added strain both on the family and on maternity and perinatal services. The increased risks associated with multiple pregnancy relate mostly to the greater chance of premature labour and to complications of the deliveryi.
 
i. Office of Population Censuses and Surveys, Botting B (ed.). The health of our children. Decennial supplement. London: HMSO, 1995. p.71
The Statements The Evidence
6a. There is no sound evidence to support routine hospitalization for bed rest for women with twin pregnancy (i).

(Health gain notation - 5 "unlikely to be beneficial")

i. Chalmers I, Enkin M, Keirse MJNC. Effective care in pregnancy and childbirth. Oxford: Oxford University Press, 1989 pp. 625-631
(Type I evidence - systematic review. Summary in Enkin M, Keirse MJNC, Renfrew M, Neilson J. A guide to effective care in pregnancy and childbirth. 2nd ed. Oxford: Oxford University Press. 1995. p. 106)
6b. Whether a policy of routine hospitalization is justified for selected women such as those with triplet or higher multiple prgnancy, or for those with early cervical dilatation, has not been adequately tested. These women are often self admitted with discomfort and anxiety so controlled trials seem unlikely (i).
(Health gain notation - 4 "unknown")
i. Chalmers I, Enkin M, Keirse MJNC. Effective care in pregnancy and childbirth. Oxford: Oxford University Press, 1989 pp. 625-631
(Type II evidence - one small trial. Summary in Enkin M, Keirse MJNC, Renfrew M, Neilson J. A guide to effective care in pregnancy and childbirth. 2nd ed. Oxford: Oxford University Press. 1995. p. 106)

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6c. Neither the routine use of cervical cerclage or oral betamimetics have been shown to reduce the incidence of premature labour (i).

(Health gain notation - 4 "unknown")

i. Chalmers I, Enkin M, Keirse MJNC. Effective care in pregnancy and childbirth. Oxford: Oxford University Press, 1989 pp. 633-646, 713-715.
(To date there have been an inadequate number of controlled trials on which to base a recommendation for practice. Summary in Enkin M, Keirse MJNC, Renfrew M, Neilson J. A guide to effective care in pregnancy and childbirth. 2nd ed. Oxford: Oxford University Press. 1995. p. 107)
6d. Home monitoring of uterine activity may reduce the incidence of babies born weighing less than1500g but the small trials available have high potential for bias and home uterine activity monitoring should only be adopted within adequately controlled trials (i).
(Health gain notation - 4 "unknown")
i. Enkin M, Keirse MJNC, Renfrew M, Neilson J. A guide to effective care in pregnancy and childbirth. 2nd ed. Oxford: Oxford University Press, 1995. p. 107.

(Type V evidence - expert opinion)

6e. There is little evidence regarding the best mode or type of delivery for women with multiple pregnancy, other than general advice on optimum management of premature labour (see Chapter 13)(i).
(Health gain notation - 4 "unknown")
i. Enkin M, Keirse MJNC, Renfrew M, Neilson J. A guide to effective care in pregnancy and childbirth. 2nd ed. Oxford: Oxford University Press, 1995 p. 108
6f. One limited trial found no advantage of Caesarean Section for a second twin presenting other than as a vertex (i).

(Health gain notation - 5 "unlikely to be beneficial")

i. Crowther CA. Effect of Caesarean delivery of the second twin. Cochrane database of systematic reviews. Cochrane Library. 1997 Issue 2.
(Type II evidence - randomised controlled trial. NB In Cochrane database but poorly supported by evidence)
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Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: weightmanal@cardiff.ac.uk