{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T19:15:59Z","timestamp":1785006959904,"version":"3.55.0"},"reference-count":28,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,9,12]],"date-time":"2020-09-12T00:00:00Z","timestamp":1599868800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>There has been an unprecedented fall in the rate of stillbirth in twin pregnancy in the UK. It is contested whether implementation of the National Institute for Health and Care Excellence (NICE) guidance on the antenatal management of uncomplicated twin pregnancies has contributed to this change. The aim of this study was to investigate whether the implementation of NICE guidance was associated with a reduction in the rate of stillbirth in twin pregnancies delivered in a large UK hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective cohort study including all twin pregnancies delivered at St George's Hospital, London, UK, between 2000 and 2018. Data were analyzed according to two time periods: before implementation of the NICE guidance on twins (before June 2013; pre\u2010NICE) and after its implementation (after June 2013; post\u2010NICE). The exclusion criteria were higher\u2010order multiple gestations, pregnancies of unknown chorionicity, pregnancies complicated by miscarriage, those that underwent termination and those diagnosed with vanishing twin. The main outcome was stillbirth. Other outcomes included neonatal death (NND), admission to the neonatal intensive care unit (NICU) and emergency Cesarean section. We planned <jats:italic>a priori<\/jats:italic> a sensitivity analysis according to chorionicity. The chi\u2010square test and Mann\u2013Whitney <jats:italic>U<\/jats:italic>\u2010test were used to compare outcomes between the study groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included in the analysis 1666 twin pregnancies (3332 fetuses), of which 1114 pregnancies (2228 fetuses) were delivered before and 552 pregnancies (1104 fetuses) after June 2013. Of those, 1299 were dichorionic and 354 were monochorionic diamniotic. The incidence of stillbirth was significantly lower in the post\u2010NICE than in the pre\u2010NICE group (3.6 per 1000 births <jats:italic>vs<\/jats:italic> 13.5 per 1000 births; <jats:italic>P<\/jats:italic>\u2009=\u20090.008). The reduction in stillbirth rate was from 8.5 to 3.6 per 1000 births (<jats:italic>P<\/jats:italic>\u2009=\u20090.161) in dichorionic and from 33.6 to 3.8 per 1000 births (<jats:italic>P<\/jats:italic>\u2009=\u20090.011) in monochorionic diamniotic twin pregnancies. There was no significant difference in the rates of NND (<jats:italic>P<\/jats:italic>\u2009=\u20090.625), NICU admission (<jats:italic>P<\/jats:italic>\u2009=\u20090.506) or emergency Cesarean section (<jats:italic>P<\/jats:italic>\u2009=\u20090.820) between the two groups. The median gestational age at delivery was significantly lower in the post\u2010NICE than in the pre\u2010NICE group (median 36.3 <jats:italic>vs<\/jats:italic> 36.9\u2009weeks; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), as a consequence of a significant increase in preterm birth between 34 and 37\u2009weeks' gestation (39.3% <jats:italic>vs<\/jats:italic> 27.0%; <jats:italic>P<\/jats:italic>\u2009=\u20090.002), but not before 34\u2009weeks (<jats:italic>P<\/jats:italic>\u2009=\u20090.473).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A  significant reduction of &gt;\u200970% in the stillbirth rate in twin pregnancies was noted after implementation of the NICE guidance. This reduction was statistically significant in monochorionic, but not dichorionic, twin pregnancies. The improvement in twin pregnancy outcome was achieved without a concomitant increase in NND, admission to the NICU or emergency Cesarean section. \u00a9 2020 The Authors. <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic> published by John Wiley &amp; Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.22051","type":"journal-article","created":{"date-parts":[[2020,4,18]],"date-time":"2020-04-18T18:35:10Z","timestamp":1587234910000},"page":"566-571","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Reduction in twin stillbirth following implementation of <scp>NICE<\/scp> guidance"],"prefix":"10.1002","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2802-7670","authenticated-orcid":false,"given":"A.","family":"Khalil","sequence":"first","affiliation":[{"name":"Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust University of London  London UK"},{"name":"Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute St George's University of London  London UK"},{"name":"Twins Trust Centre for Research and Clinical Excellence St George's Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Giallongo","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2393-7501","authenticated-orcid":false,"given":"A.","family":"Bhide","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8143-2232","authenticated-orcid":false,"given":"A. T.","family":"Papageorghiou","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5531-4301","authenticated-orcid":false,"given":"B.","family":"Thilaganathan","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust University of London  London UK"},{"name":"Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,9,12]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"2018","volume-title":"MBRRACE\u2010UK Perinatal Mortality Surveillance Report, UK Perinatal Deaths for Births from January to December 2016","author":"Draper ES"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20107"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15517"},{"key":"e_1_2_6_5_1","volume-title":"Multiple Pregnancy: The Management of Twin and Triplet Pregnancies in the Antenatal Period","year":"2011"},{"key":"e_1_2_6_6_1","unstructured":"National Institute for Health and Care Excellence.Multiple pregnancy: twin and triplet pregnancies. 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