Twin pregnancies: birth injury and clinical negligence claims

Although many twins are born perfectly healthy, there are increased risks when it comes to pregnancy-related complications.

Pregnancies involving twins or multiple babies do carry higher risks compared to the birth of a single child. Often, women who are pregnant with two or more babies will need special attention and more monitoring than most mums.

Twin or multiple (pregnancy) can occur in approximately one in 60 pregnancies. It is common for these babies to be born perfectly healthy. However, if something goes wrong during pregnancy and/or birth due to a lack of care and attention from the medical team, the consequences can be catastrophic, if not fatal, to one or both babies.

Types of twin pregnancy

There are different types of twin pregnancy and these all come with differing levels of risks. Medical professionals can usually advise you which type of pregnancy you are experiencing between 11 and 14 weeks. From here, the number of appointments or scans, as well as a birthing plan, should be decided.

The lowest risk pregnancy is with Dichorionic Diamniotic twins (DCDA). This means that each twin has their own placenta and their own separate amniotic sac. Non-identical twins and a third of identical twins will be DCDA.

Monochorionic Diamniotic twins (MCDA) share a placenta but exist within their own amniotic sacs. Two-thirds of twins will be MCDA within the womb and are at the greatest risk of developing something called twin-to-twin transfusion syndrome (TTTS).

One per cent of pairs of identical twins will be Monochorionic Monoamniotic (MCMA). This is the rarest type of twin pregnancy. Because they share both a placenta and an amniotic sac it puts them at higher risk of life-threatening injuries due to cord entanglement.

Medical professionals, once made aware of the type of pregnancy, should monitor, and give you regular care throughout the pregnancy which is key to minimising and hopefully preventing any birth injury to either mum or babies. Complications can be better managed if they are detected early on.

You may also be referred to a specialist regional centre for foetal medicine.

Risks of twin pregnancy

While there are conditions that can arise in any pregnancy, they are more common in twin or multiple pregnancies. In addition, there are complications that only arise in twin or multiple pregnancies which do require medical attention and monitoring. Twins or triplets have a higher risk of being born prematurely (before 37 weeks) and having a low birthweight.

Twin-to-twin transfusion syndrome affects 10-15 per cent of monochorionic twins and can have serious consequences. It is caused by abnormal connecting blood vessels in the twins’ placenta which can then transfuse blood disproportionately. This means that one twin will experience slower growth and a greater blood volume will result in the other. This then puts strain on the baby’s heart and if this is not picked up early on, the results can cause significant brain injury and potentially be fatal for one or both twins.

There is also a higher risk of cerebral palsy in twin or multiple pregnancies due to a variety of factors. One of which is Hypoxic-Ischemic Encephalopathy (HIE) which is caused by insufficient oxygen travelling to the babies’ brains. Low birth weights as well as the fact that many twins are born prematurely also add to the risk factors of cerebral palsy.

There is a risk of birth injury to the mother occurring during the pregnancy, but also during the delivery – these are more common in twin and multiple pregnancies. Some risks may also affect the babies so they must be detected and managed.

Hypertension and pre-eclampsia are an increase in blood pressure. This is common in twin and multiple pregnancies and can be particularly serious. It is crucial that your blood pressure is monitored regularly during your pregnancy.

Clinical negligence claims

The Royal College of Obstetricians and Gynaecologists recommend that you should be offered extra ultrasound scans during your twin pregnancy.

• DCDA twin scans should be offered every 4 weeks from 24 weeks
• MCDA AND MCMA twins should be offered every 2 weeks from 16 weeks
• Triplets or more will depend on your specific circumstances

At Coodes, we understand that pregnancy and childbirth can be a difficult experience. Sadly, in some cases, standards of care may slip, and this can result in injury or even fatality. If you or your child(ren) have suffered an injury, disability, or fatality because of substandard care and/or treatment, then our highly experienced clinical negligence team may be able to help. They have successfully secured compensation for mothers and children affected.

Our Birth Injury solicitors are experienced in dealing with cases of twin and multiple pregnancy and understand the risks involved. The time limits surrounding clinical negligence claims vary depending on a variety of factors. More information can be found on our website.

Few firms offer Legal Aid to clients, but Coodes can help with this, and it may be available for cases of clinical negligence surrounding birth injuries. More information can be found here.

Next Steps

Please seek medical advice if you are concerned about the health and well-being of either yourself or your children. If you are currently experiencing a twin or multiple pregnancy and have questions or concerns, please contact your midwife or GP.

If you believe you were handled negligently when in the care of your antenatal team, our team are here to help you. Get in touch with us today.