New report raises concerns about the quality of care over baby twin deaths

A new study investigating the quality of care provided to women whose twin babies died has revealed that improvements in care may have made a difference to the outcome for the babies in over half (54%) of the pregnancies reviewed.

Led by a team of academics, clinicians and charity representatives called MBRRACE-UK, the team looked at 50 twin pregnancies from 2017, where one or both of the babies died, and investigated whether alternative care may have made a difference to outcomes for the babies and the mother.

Twins are twice as likely to be stillborn and 3.5 times more likely to die during the first 28 days after birth, compared to babies in pregnancies with one baby.

The study also found that in two thirds of twin pregnancies, the support provided to the mother for her physical health and emotional wellbeing following the death of her child was considered poor.

Elizabeth Draper, Professor of Perinatal and Paediatric Epidemiology at University of Leicester and Lead Author of the report said: 

“Losing a child is one of the most unbearable and painful ordeals a parent can endure. We identified major sub-optimal issues in antenatal and follow-up care in half of the pregnancies we reviewed and for half of the women in the enquiry. Many of these deaths may have been prevented had better care been provided.”

The main findings from the expert enquiry included:

  • Problems with communication in almost three quarters of baby deaths;
  • Less than half of the women with a twin pregnancy were seen by a specialised, multidisciplinary team of health professionals, and almost none were seen by a specialist midwife and a specialist sonographer;
  • Issues with the quality and frequency of ultrasound scans for nearly half of the women;
  • Evidence that professionals had discussed the risks of preterm birth before 24 weeks in a twin pregnancy with only half of the women;
  • When women attended maternity triage because of an acute problem before 27 weeks of pregnancy, they were not referred for a specialist review of their care;
  • Not all parents were involved in decisions about resuscitating, stabilising and on-going care for their baby or babies;
  • Bereavement care was poor and disjointed for most parents, particularly when one baby survived;
  • Baby deaths were usually not reviewed, and if they were it was often not in any formal or structured way;
  • When a review did take place parents were not given the opportunity to be engaged in the process;
  • Half of parents did not have a follow-up meeting with their consultant to review their care, and even fewer had a letter summarising review or discussion findings.

The clinical experts looked at the care provided when mothers were pregnant; care during labour and birth; care for their babies once born; postnatal and bereavement care when one or both babies died; and any tests or investigations that took place to understand what happened and where improvements in future care are needed.

They also looked at the quality of emotional and psychological help and support provided for women, including the offer of post-mortem and the quality of local hospital reviews to understand why the baby or babies died.

Twin pregnancies have higher risks because women are more likely to have complications, such as high blood pressure and pre-eclampsia, and bleeding before or during childbirth.

The rates of stillbirth and neonatal death for twin pregnancy reduced by just under one quarter for stillbirths and by around one third for neonatal deaths over the period 2013 to 2017. Despite this, babies from twin pregnancies are still more likely to die than singleton babies. This type of death occurred in 285 pregnancies in 2017 in the UK.

Professor Sara Kenyon, Professor of Evidence Based Maternity Care at the University of Birmingham and joint author of the report said:

“We recommend that hospitals fully implement existing national guidance for the care of women with a multiple pregnancy, as well as for bereavement care and review of the death to improve care for mothers”

Professor Jenny Kurinczuk, Director of the National Perinatal Epidemiology Unit and National Programme Lead for MBRRACE-UK, and joint author of the report said:

“In general the care provided to this group of mothers and their babies was poor. The single most important action which needs to be taken is for the NICE guidance relating to twins to be followed and specialist multiple pregnancy clinics to be established. Many of the problems identified by the expert panel in the confidential enquiries would be less likely to arise if appropriate multidisciplinary care with expertise in the care for multiple pregnancies was available to all women pregnant with twins.”

The Maternal, Newborn and Infant Clinical Outcome Review Programme is run by MBRRACE-UK, a collaboration led from the National Perinatal Epidemiology Unit in Oxford with members from the University of Leicester, who lead the perinatal aspects of the work, including this enquiry, and the Universities of Birmingham and University College London, Bradford Teaching Hospitals NHS Trust, a general practitioner, and Sands, the Stillbirth and neonatal death charity.