Report makes five recommendations around optimised assessment and monitoring of fetal growth, management of postpartum haemorrhage and data collection.
The NMPA snapshot report, published this month, provides a detailed data regarding multiple-birth pregnancies, based on an analysis of over 8,000 women and birthing people who gave birth to twins, triplets or quads in England, Scotland and Wales in 2023.
Around 1 in every 65 pregnancies across Great Britain is a multiple birth, and most women who are pregnant with twins, triplets or more will have a healthy pregnancy and give birth to healthy babies. However, the report provided five recommendations to improve data collection, monitoring and care for women and babies.
Dr Jenny Barber, Vice President for Clinical Quality at the RCOG, commented: “The RCOG is proud to lead the National Maternity and Perinatal Audit with our partners, using data to identify good practice and areas for improvement in the care of women and babies looked after by NHS maternity services.
“The latest NMPA snapshot report explores multiple-birth pregnancies. While most women and birthing people who are pregnant with twins, triplets or more will have a healthy pregnancy and give birth to healthy babies, there is scope to improve care by looking at optimised assessment and monitoring of fetal growth, management of postpartum haemorrhage and improving multiple birth chorionicity data collection.
“We hope government departments, NICE and NIHR, maternity commissioners and networks teams will carefully consider, and act on, the recommendations set out in this report, to make a meaningful difference to outcomes for parents and babies.”
The report makes five recommendations related to the following areas:
- Postpartum haemorrhage care provision in line with relevant national guidance, including NICE and RCOG guidelines
Methods to monitor adequate fetal growth in multiple births - Assessment of optimal fetal growth in multiple births and develop birthweight centile charts for multiple births babies.
- Improving the recording of multiple birth chorionicity data
- Inclusion of assisted conception as a mandatory item in digital maternity record standards.
- NICE and RCOG guidelines recommend that chorionicity is determined in the first trimester or before 14 weeks of gestation, as essential to antenatal care planning and decision-making around labour and birth. However, chorionicity is not a standalone data field in maternity England, Scotland or Wales datasets, and chorionicity recording is not mandated in the English national Digital Maternity Record Standard, with codes highly incomplete in the 2023 data.
Key data in the NMPA snapshot report include:
- More than six in ten (64%) multiple births were preterm (between 24+0 and 36+6 weeks) compared with just 6% of singleton pregnancies.
- Among twin pregnancies, the rate of spontaneous vaginal birth (without instrumental assistance) was 13.3%, compared with 49.4% for singleton pregnancies.
- Instrumental vaginal birth (forceps or ventouse suction cup) occurred in 4.55% of twin births, versus 11.1% in singleton births.
- Caesarean birth rates were also notably higher in twin pregnancies. Planned (elective) caesarean birth occurred in 42.9% of twin pregnancies compared with 16.4% of singleton pregnancies, while unplanned (emergency) caesarean birth occurred in 36.5% of twin pregnancies, compared with 23.1% of singleton pregnancies.
- Rates of postpartum haemorrhage (PPH) were significantly higher in multiple pregnancies. Among mothers of twins, the rate was 11.6%, compared with 3.4% in singleton pregnancies, and 33.3% in triplet or higher order multiple pregnancies.
- English national Digital Maternity Record Standard (DMRS)
Notes
- For media enquiries, contact the RCOG press office: pressoffice@rcog.org.uk or +44 (0) 7986 183167
- Multiple Births outcomes of Maternity Care. Based on births in NHS maternity services in England, Scotland and Wales during 2023. (March 2026). Read the full report here.
- The report includes results for 8 301 women and birthing people who gave birth to a total of 16 597 twins, triplets or quads. Of these, 98.5% were twin pregnancies, 1.4% were triplet and 0.1% were quadruplet pregnancies
- RCOG Green top Guideline on the Prevention and Management of Postpartum Haemorrhage. Click here
- NICE guideline on Twin and triplet pregnancy NG37 can be found here.
- Find out more about NMPA here.
- Read the RCOG maternity safety policy position
- RCOG Maternity Safety programme, available here.