A mother holds the feet of premature twin babies.

Management of preterm labour and birth


The national investigation

Preterm birth is one of the main causes for under-five mortality (death) and disability worldwide. 60% of twin pregnancies result in premature birth.

Premature birth is associated with high levels of:

  • morbidity (long-term health conditions)
  • mortality
  • long-term disability

This investigation considers the existing knowledge and management of preterm labour and birth of twins.

Preterm is defined as babies born alive before the completion of 37 weeks of pregnancy. There are sub-categories of preterm birth, based on gestational age (length of pregnancy):

  • extremely preterm (less than 28 weeks)
  • very preterm (28 to 32 weeks)
  • moderate to late preterm (32 to 37 weeks)

There are few national guidelines and a small number of interventions available and used by obstetricians to manage the risks of preterm labour and birth in twins. However, the scientific evidence relied upon to inform the guidelines and management are predominantly based on singleton and full-term pregnancies.

We’ve identified that since 2019 a large volume of national work and research, relevant to the field of preterm labour and birth, has been commenced. Therefore, the investigation report will evidence the work currently in progress and seek to understand if it will address some of the gaps in knowledge identified by the investigation.

Reference event

The reference event in our investigation involves a woman who received obstetric led antenatal care to manage her twin pregnancy. The woman’s pregnancy was considered to be of higher risk. This was due to a previous medical intervention on her cervix which had implications for the preservation of the pregnancy.

At 26 weeks and 4 days pregnant she presented at her local NHS maternity unit with signs of imminent labour. She was transferred and treated at a hospital with additional facilities that could support the babies if born at this time.

She was discharged under the care of her local maternity unit at 29 weeks, as recommended within the national pathway. The woman then presented at her local maternity unit at 29 weeks and 5 days with further signs of imminent labour.

The twin girls were born in good condition at 29 weeks and 6 days old. However, 23 days following their birth a scan revealed brain injury in both babies.

Investigation summary

The investigation seeks to understand if the current scientific research and national initiatives will enhance knowledge in the following areas:

  • interventions to support the management of the risk of preterm labour, specifically in the scenario of a twin pregnancy
  • evidence to support the management and interventions during a preterm labour of twins
  • the reliability and effectiveness of monitoring twin babies in the context of preterm labour