Guidance
This guideline covers the care that should be offered to women with a twin or triplet pregnancy in addition to the routine care that is offered to all women during pregnancy. It aims to reduce the risk of complications and improve outcomes for women and their babies.
It should be read in conjunction with NICE’s guideline on antenatal care. For information on other related topics, see our women's and reproductive health summary page.
Recommendations
This guideline includes new and updated recommendations on:
- fetal complications
- screening and preventing preterm birth
- timing of birth
- mode of birth
- fetal monitoring during labour
- analgesia
- managing the third stage of labour
It also includes recommendations on:
- determining gestational age and chorionicity (the number of outer membranes that surround the babies)
- delivery of care, including specialist antenatal appointments
- general care
- maternal complications
- indications for referral to a tertiary level fetal medicine centre
Who is it for?
- Healthcare professionals
- Commissioners and providers
- Women with a twin or triplet pregnancy and their families and carers
Is this guideline up to date?
May 2022: We have checked the evidence and plan to update section 1.5 on the use of progesterone for preventing preterm birth. For more information, see the surveillance decision. For progress on the update, see the guideline in development page.
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.