This guideline covers care for pregnant women and pregnant people with a twin or triplet pregnancy in addition to routine care during pregnancy and labour. It aims to reduce the risk of complications and improve outcomes.

It should be read in conjunction with NICE’s guidelines on antenatal care, intrapartum care and fetal monitoring. For information on other related topics, see our women's and reproductive health summary page.

In April 2024, we reviewed the evidence and made new and updated recommendations on screening for and preventing preterm birth.


This guideline includes new and updated recommendations on:

It also includes recommendations on:

Who is it for?

  • Healthcare professionals
  • Commissioners and providers
  • Pregnant women and pregnant people with a twin or triplet pregnancy and their families and carers

Guideline development process

How we develop NICE guidelines

This guideline updates and replaces multiple pregnancy: antenatal care for twin and triplet pregnancies (NICE guideline CG129, September 2011). It also updates recommendations on multiple pregnancy in section 1.2.2 of NICE’s guideline on caesarean section (CG132).

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.