EP.0375 An audit of care in the multiple pregnancy journey
Brehaut, Georgina Burton, Claudia Arlidge, Maggie
Brehaut, Georgina
Burton, Claudia
Arlidge, Maggie
Glos Author
Date
2022-06-10
Subject
Type
Conference Abstract
Collections
Abstract
Objective: To provide the highest quality multiple pregnancy care with the aim of reducing complications and improving outcomes for mothers and babies.
To ascertain the current level of care being provided to women and families with multiple pregnancies.
To assess whether this is in line with current national guidance which was updated in 2019.
Design: Retrospective audit.
Method: This audit analysed multiple pregnancies and multiple births between1st May 2020 to 1st May 2021.
The audit standards were predefined based upon the NICE guidance NG137 Twin and Triplet Pregnancies. There was an expected compliance defined at 100%.
Cases were identified through the informatics team. Antenatal, intrapartum and postnatal notes were analysed. Both written notes and computer systems including Trakcare and Viewpoint were used.
Data extracted was collated within excel and included information about maternal, fetal and neonatal factors. These were then assessed against the audit standards prior to being analysed by clinicians to draw conclusions and recommendations.
Results:
Certain areas of antenatal and postnatal care showed 100% compliance with the audit standards. These included; documentation of chorionicity/amnionicity at first scan, referral to fetal medicine if <10th centile, continuous foetal heart rate monitoring in labour and active management of third stage of labour. All MCDA pregnancies were counselled on risk of twin-to-twin transfusion syndrome.
However the following areas did not meet the standard; only 23.30% had evidence of aspirin prescription from 12 weeks, 16.67% had full blood count between 20–24 weeks and 63.33% at 28 weeks. 66.67% met recommendations for fetal growth assessment by ultrasound.70% were counselled on risk of preeclampsia, 66.67% were counselled on risk of pre-term birth, 36.67% were counselled regarding corticosteroids, 90% discussed mode of delivery options, 70% were counselled on growth concerns, 16.67% were counselled on risk of post-partum haemorrhage, 86.67% had discussed epidural and 93.33% of deliveries occurred at recommended gestation, or earlier if risk of maternal/fetal compromise.
Conclusions: These results are encouraging for intrapartum and postnatal care but show areas for significant improvement. In particular, aspirin for reduction of hypertensive disease, appropriate scan surveillance, optimisation of haemoglobin levels, and the antenatal risk discussions and options with regard to mode of birth need improvement and documentation. It is important to understand the limitations when auditing clinical discussions retrospectively. Following a period of staff education and implementation of an updated care pathway we will reaudit to ensure the best possible care is provided.
Citation
Brehaut, G., Burton, C., & Arlidge, M. (2022). An audit of care in the multiple pregnancy journey. BJOG: An International Journal of Obstetrics and Gynaecology. https://doi.org/10.1111/1471-0528.8_17178