Women pregnant with twins or triplets: the care you should expect

Most women having twins or triplets have a healthy pregnancy and can follow much of the same antenatal advice as women having a single baby. However, there is a higher chance of complications for both the mother and babies that means women need to be monitored more closely during pregnancy, labour and birth.

We want this guideline to make a difference to women having twins or triplets and their families by making sure:  

  • you find out early that you are carrying twins or triplets and whether any of your babies share a placenta (see types of twin and triplet pregnancy below)
  • your care during pregnancy and birth is planned carefully around any possible risk of complications for you and your babies
  • your antenatal team is experienced in caring for women having twins or triplets
  • you can be referred quickly to a specialist fetal medicine centre if you have complications.

The check-ups, tests and advice described in this guideline are in addition to the usual pregnancy care and advice in NICE’s guideline on antenatal care for uncomplicated pregnancies.

Types of twin and triplet pregnancy

As soon you know you are having twins or triplets it is important to find out whether your babies share a placenta. This is called the ‘chorionicity’ of your pregnancy. Finding out the chorionicity early is important because babies who share a placenta have a higher risk of health problems. If your babies share a placenta it means they are identical ('monozygotic'). It is still possible for babies who do not share a placenta to be identical, but most are non-identical ('dizygotic').

Twins

Twins can be dichorionic (they have separate placentas) or monochorionic (they share a placenta).

Triplets

For triplet pregnancies there are more possible combinations:

  • Trichorionic – each baby has a separate placenta
  • Dichorionic – two of the babies share a placenta and the third baby is separate
  • Monochorionic – all three babies share a placenta.

Sharing an amniotic sac

It is possible for twins and triplets to share an amniotic sac as well as a placenta. These are the highest-risk pregnancies but they are also very rare and if this occurs you should have specialist care during your pregnancy. Ask your care team for more information.

Making decisions together

Decisions about treatment and care are best when they are made together. Your care team should give you clear information, talk with you about your options and listen carefully to your views and concerns.

They should also:

  • involve you and your partner or family in decisions at every stage
  • explain fully the purpose of any screening and tests they are offering you, and what the results mean
  • respect what matters to you and talk to you about your plans and hopes for the birth of your babies early on
  • make sure that if a complication happens during your pregnancy, labour or birth you understand what’s happening and how this might affect your birth plan.

If you can’t understand the information you are given, tell your care team.

Read more about making decisions about your care.

Where can I find out more?

The NHS website has more information about twin and triplet pregnancy.

The organisations below can give you more advice and support.

NICE is not responsible for the content of these websites.

To share an experience of care you have received, contact your local Healthwatch.

We wrote this guideline with people involved in supporting women with a twin or triplet pregnancy and their families. All the decisions are based on the best research available.

ISBN: 978-1-4731-3514-7


This page was last updated: 04 September 2019