Asked by: Giles Watling (Conservative - Clacton)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps he is taking to ensure that maternity units implement the recommendations in the MBRRACE Perinatal Confidential Enquiry into stillbirths and neonatal deaths in twin pregnancies.
Answered by Nadine Dorries
Through the Maternity Transformation Programme, a range of interventions are being implemented to support the delivery of maternity and neonatal care according to clinical guidelines, as recommended in the MBRRACE Perinatal Confidential Enquiry into stillbirths and neonatal deaths in twin pregnancies, and to improve perinatal outcomes.
Every National Health Service maternity service is actively implementing elements of the Saving Babies Lives Care Bundle which sets out specific care pathways that can affect twin/multiple pregnancies including prevention of fetal growth restriction and preterm birth. Multidisciplinary fetal medicine clinics are being established across England, which aim to ensure that high risk women have timely access to specialist advice and care at all stages of pregnancy.
Asked by: Jim Shannon (Democratic Unionist Party - Strangford)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps his Department is taking to prevent deaths in twin babies.
Answered by Jackie Doyle-Price
In 2017, the Department funded the Twins and Multiple Births Association (TAMBA) Maternity Engagement Project. TAMBA’s work has contributed to findings in the recent MBRRACE-UK Perinatal Mortality Surveillance Report, released last year, showing the stillbirth rate for United Kingdom twins almost halving between 2014-16, a fall of 44%. In addition, neonatal deaths among UK twins has dropped 30%.
To reduce variance in the levels of maternity care across trusts, all maternity services now have one obstetrician, one midwife and one board level Maternity Safety Champion jointly responsible for championing maternity safety, spreading learning and encouraging best practice within their organisations. This includes adherence to National Institute for Health and Care Excellence guidelines on issues such as antenatal care for multiple pregnancies.
Every maternity service in the National Health Service is actively implementing elements of the Saving Babies’ Lives Care Bundle, which is designed to tackle stillbirth and early neonatal death. The Care Bundle is undergoing review by an expert oversight group, who are currently reviewing how new Care Bundle elements can contribute to improving outcomes for twin and multiple pregnancies. The NHS Long Term Plan highlights our aim of rolling out the Care Bundle across every maternity unit in England in 2019.
The Maternity Transformation Programme is addressing safety in maternity services, including reducing inequalities in outcomes regarding twin and multiple births through various channels. The programme is supporting Local Maternity Systems to implement best practice care by working with the National Perinatal Epidemiology Unit, which has developed the Perinatal Mortality Review Tool to support standardised perinatal mortality reviews across NHS maternity and neonatal units in England, Scotland and Wales. All trusts in England are now using the tool to identify the factors associated with stillbirth and neonatal death, including within multiple pregnancies.
Asked by: Lord Alton of Liverpool (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government, further to the Written Answer by Earl Howe on 23 January 2013 (HL4388), whether the Human Fertilisation and Embryology Authority still considers that multiple pregnancy poses "the single greatest health risk associated with fertility treatment"; what records they hold on foetal reduction in the first trimester and early in the second trimester; what assessment they have made of the impact of such procedures on the incidence of complications otherwise associated with multiple pregnancy; and what was the average mortality rate of (1) singleton, (2) twin, and (3) triplet, pregnancies in the United Kingdom over each year of the past decade for which records are available.
Answered by Earl Howe - Deputy Leader of the House of Lords
The Human Fertilisation and Embryology Authority (HFEA) has advised that it and all of the relevant professional bodies support the One at a time initiative, which aims to reduce the incidence of multiple births following in-vitro fertilisation (IVF). The consensus statement signed in 2011 states that “Multiple births is the single biggest risk to the health and welfare of children born following fertility treatment”:
www.oneatatime.org.uk/images/2011-05_Multiple_Births_Consensus_Statement_-_FINAL.pdf
The HFEA holds records on foetal reductions carried out in the first trimester and early in the second trimester following each cycle of IVF or donor insemination in the UK.
When developing its policy on multiple births the HFEA commissioned an Expert Group on Multiple Births after IVF, which concluded that the prevention of multiple pregnancies through single embryo transfer should be preferred to multifetal pregnancy reduction.
Information on average mortality rates for singleton, twin and triplet pregnancies is not collected centrally. The information that is available is shown in the following table.
Stillbirths and linked infant deaths rates: babies born in each year 2002 to 2011, plurality, England and Wales 1,2,3,4 | ||||||||||||
| Stillbirth |
| Infant | |||||||||
Year | Singletons | Twins | Triplets |
| Singletons | Twins | Triplets | |||||
2002 | 5.3 | 15.7 | 44.6 | 4.7 | 23.1 | 40.6 | ||||||
2003 | 5.4 | 17.6 | 52.5 | 4.7 | 23.5 | 63.7 | ||||||
2004 | 5.4 | 14.8 | 51.8 | 4.5 | 21.6 | 61.8 | ||||||
2005 | 5.1 | 13.2 | 29.7 | u | 4.4 | 23.5 | 54.1 | |||||
2006 | 5.1 | 11.8 | 24.2 | u | 4.4 | 21.7 | 67.0 | |||||
2007 | 5.0 | 11.2 | 19.7 | u | 4.2 | 19.9 | 50.3 | |||||
2008 | 4.9 | 11.6 | 28.7 | u | 4.1 | 20.0 | 55.2 | |||||
2009 | 4.9 | 12.2 | 31.5 | u | 4.0 | 20.1 | 34.9 | u | ||||
2010 | 4.9 | 11.4 | 15.8 | u | 3.8 | 18.4 | 62.1 | |||||
2011 | 5.0 | 10.9 | 15.5 | u | 3.7 | 18.8 | 21.7 | u | ||||
Notes:
1 Stillbirths per 1,000 live births and stillbirths. Infant deaths per 1,000 live births. | ||||||||||||
2 Excludes babies born to non-residents. | ||||||||||||
3 Rates based on between 3 and 19 deaths (inclusive) are distinguished by 'u' as a warning that their reliability may be affected by the small number of events. 4 Information is not available for Scotland and Northern Ireland. | ||||||||||||
Source: Office for National Statistics | ||||||||||||