A guide to multiple births and twin pregnancies

18 December 2023


Twin pregnancies, as with all multiple pregnancies, carry greater risks for the mother and baby than single pregnancies. Having twins increases the risk of many of the complications of pregnancy, such as intrauterine growth restriction, pre-eclampsia, and gestational diabetes. Twin pregnancies also have complications of their own, such as twin-to-twin transfusion syndrome, cord entanglement, PVL and premature birth. (PVL stands for Periventricular leukomalacia, a form of brain injury where there is damage to the white matter of the brain - the part which transmit messages from the nerve cells - which causes cysts to form.) These complications can increase the risk of brain injury and cerebral palsy in one or both twins.

Cerebral palsy is a condition that affects movement, posture, and coordination. It is caused by damage to the brain before, during or shortly after birth. Cerebral palsy can have a significant impact on the quality of life of the affected child and their family, resulting in the need for lifelong care and support.

Because of the higher risk of premature birth, twins are also at higher risk of developing PVL, which is usually seen in babies born early - before 32 weeks or of low-birth weight. PVL occurs when the brain is deprived of blood and oxygen, or when there is inflammation or infection. PVL can cause motor, cognitive, and socio-behavioural impairments, and can increase the risk of cerebral palsy.

When a child suffers cerebral palsy because of negligence or substandard care during pregnancy, labour or delivery, they may be entitled to claim compensation for their injury and losses. The compensation can help cover the costs of medical treatment, therapy, equipment, education, accommodation, and care that the child may need throughout their life.

Types of Twin Pregnancy

There are different types of twin pregnancy, they are categorised according to whether the twins share a placenta and membranes.

DCDA (dichorionic diamniotic) (non-identical) twins each have their own placenta and separate inner and outer membranes. DCDA twins are at lower risk than other types of twins, but still require careful monitoring and planning for delivery.

MCDA (monochorionic diamniotic) (identical) twins share one placenta and have one outer and two separate inner membranes. MCDA twins are at high risk of twin-to-twin transfusion syndrome (TTTS), a life-threatening condition where there is an imbalance of blood flow between the twins through the shared placenta. TTTS can cause one twin to become anaemic and the other to become overloaded with blood, leading to heart failure and brain damage (you can read more about TTTS in our article here).

MCMA (monochorionic monoamniotic) (identical) twins share one placenta and both the inner and outer membranes. MCMA twins are at a higher risk of cord entanglement which can be life threatening and consequently require regular monitoring.

All twin pregnancies require careful monitoring and regular reviews to enable any complications to be identified at the earliest opportunity. Where complications occur, there may be treatment options, but they may carry risks, and should be discussed before proceeding. If the treatment options are not provided or discussed properly, there could be a claim for compensation for failing to obtain informed consent.

Claims for compensation involving twin pregnancy are particularly difficult to prove. There are very few reported cases involving twin pregnancy. The case of IBC v Southend University Hospital NHS Foundation Trust 2017 involved an MCDA twin pregnancy where delivery was negligently delayed at 36 weeks after symptoms of itchy hands and feet were ignored. In this case, one twin died and the other suffered brain damage.

We are currently investigating a case where the pregnancy involves MCDA twins and twin to twin transfusion syndrome which resulted in one twin suffering PVL.

Despite the provision of excellent care, pregnancies carry an inherent risk of injury, and are typically managed by highly experienced obstetricians. In evaluating such claims, it is crucial to meticulously examine the quality of care provided. This involves a comprehensive analysis of medical records to determine if any lapse in care coincided with the timing of the injury.

Identifying the cause of the injury can be challenging, as PVL can often be the result of an event that goes unnoticed or undocumented; also the way in which it develops and the time it takes to develop are not fully understood. However, experts advising on our cases suggest that the PVL cysts typically take about 14 days to develop.

The potential success of a claim largely depends on the post-birth scans. These scans are evaluated retrospectively, with the timing, quality, and frequency of the scans being key factors. Additionally, the quality of the medical records and the expertise of the instructed professionals also play a significant role.


Families affected by cerebral palsy and brain damage can find additional support from charities such as:

  • Scope: the main UK charity for people with cerebral palsy and their families. They provide information, advice, support, and services to help people with cerebral palsy live independently and achieve their goals. They also campaign for social change and raise awareness of the issues facing people with cerebral palsy. You can call their helpline on 0808 800 3333 or Email: [email protected] or visit their website at https://scope.org.uk
  • Cerebra: a charity that supports children with brain conditions, including cerebral palsy and PVL, and their families. They offer research, resources, grants, legal advice, and events to help children with brain conditions and their families overcome challenges and enjoy life. You can call their helpline on 0800 328 1159 or Email: [email protected] or visit https://cerebra.org.uk/.
  • Action Cerebral Palsy: a coalition of charities and organisations that work to improve the lives of children and young people with cerebral palsy in the UK. They educate the public, professionals, and politicians about the issues facing children and young people with cerebral palsy and provide information and support to affected families. They also fund research and campaign for better intervention, care, education, and support for children and young people with cerebral palsy. You can contact them by email [email protected] or go to https://actioncp.org
  • Bliss: supports babies born premature or sick, and their families. They offer information, advice, support, and services to help babies and their families through the challenges of neonatal care. They also fund research and campaign for better care and outcomes for babies born premature or sick. Some of these babies may have PVL or cerebral palsy because of their early birth or complications. You can call their family support helpline on 02073781122 or [email protected] for general information or [email protected] for emotional support and information, or visit https://bliss.org.uk

If you would like to speak to a member of our team about an injury resulting from a multiple birth or twin pregnancy, speak to Andrea Rusbridge. Andrea is a clinical negligence specialist with 35 years’ experience, including with cerebral palsy, birth injury, obstetrics and gynaecology claims.



This information is for educational purposes only and does not constitute legal advice. It is recommended that specific professional advice is sought before acting on any of the information given. © Shoosmiths LLP 2024

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