Around 1 in 2 babies in twin pregnancies may have survived if they had received better care

Posted on January 14, 2021

New report investigating stillbirth and neonatal death in twin pregnancies finds around 1 in 2 babies may have survived if they had received better care

The Perinatal Confidential Enquiry Stillbirths and neonatal deaths in twin pregnancies report from MBRRACE-UK reveals stark differences in outcomes for twin pregnancies compared to pregnancies with one baby, with twins being 3.5 times more likely to die in the neonatal period (the first 28 days after birth) and twice as likely to be stillborn.

While twin pregnancies are often more complicated, with pregnant women more likely to experience complications like pre-eclampsia and babies more likely to be born prematurely, the report reveals many twin pregnancies are not being managed in line with best practice standards for safe care. For families where one or both babies died, the investigation has found follow up care and bereavement support was often inadequate, with some parents receiving no opportunity for key memory making experiences (such as taking photographs) and limited follow up support. Key findings show:

  • If care had been better in 54% of pregnancies it may have prevented one or both babies from dying
  • 64% of mothers received poor care following the death of their baby or babies. Better care may have meant they were better supported with their emotional and physical health following bereavement.
  • Almost half of women did not have scans as regularly as recommended and less than half of women had their antenatal care overseen by a multidisciplinary team who were experts in twin pregnancies
  • There were variations in how babies born before 26 weeks of pregnancy were managed, with instances of poor communication with families both before and after birth
  • Only a third of parents were offered bereavement counselling, and bereavement care was particularly poor for families where one baby had died and one had survived.

The enquiry is based on a review of 50 twin pregnancies from 2017 where one or both babies died. Using medical notes, the care provided to each mother and baby was assessed against the best practice care standards outlined in national care guidelines.

While neonatal care was generally found to be good, the report recommends:

  • That when babies are delivered extremely prematurely, parents are involved in joint decision making with health professionals about care decisions, including decisions around resuscitation and stabilisation.
  • Regular training should take place to make sure skills in acute resuscitation are maintained.
  • Women who are at risk of delivering their babies before 27 weeks of pregnancy should be transferred before birth to a hospital which has a Neonatal Intensive Care Unit on-site.

Caroline Lee-Davey, Chief Executive of Bliss said: ‘’Today’s findings are extremely stark and make for very difficult reading. Behind the figures in this report are families whose lives have been shattered by the death of their baby or babies. It is simply unacceptable that in more than half the cases reviewed, a death may have been prevented if care had been provided to the standard set out in clinical guidelines. The report also highlights a concerning lack of appropriate bereavement support and follow up available to parents, with practices widely variable and inconsistent.

‘’Bliss urges NHS Trusts and Health Boards to review their practices and ensure mothers and babies are given high-quality care in line with best practice throughout the perinatal pathway, from antenatal through to neonatal care. We would also encourage health services to work directly with specialist organisations like Twins Trust whose unique T-MEP quality improvement project can support services to achieve compliance with NICE Guidelines.

“It is also critical that obstetrics, maternity and neonatal services work together to drive improvements and ensure that extremely preterm babies are delivered at a hospital with a Neonatal Intensive Care Unit on-site, which is proven to give them the best chance of survival. ’’

Bliss is proud to work with Twins Trust and Sands, and other relevant organisations, to drive quality improvement in perinatal settings, and we will continue to work alongside our partners to support improved outcomes for all babies born premature or sick.

For parents affected by these issues, you can contact:

Bliss at hello@bliss.org.uk

Sands at helpline@sands.org.uk

Twins Trust support at support-team@twinstrust.org