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The incidence of twins in England and Wales is approximately 15.9/1000 maternities. Despite strategies to reduce the number of multiple births there has been very little reduction in numbers. Twin pregnancies are associated with increased maternal and neonatal morbidity. Monochorionic twins are even more complex in view of the shared placenta that may lead to such complications as twin-to-twin transfusion syndrome and selective fetal growth restriction. Early diagnosis and determination of chorionicity is imperative to plan antenatal management, ultrasound surveillance and timing and mode of delivery. In addition parents should be counselled regarding the risks of prematurity, as 60% will be delivered early, either spontaneously or as a result of obstetric intervention. Twin pregnancy should be managed in a multi-disciplinary setting ideally in a specialist obstetric clinic where complications may be recognised early and interventions employed in a timely manner. Twin deliveries can also be complicated and where possible a senior obstetrician should oversee the delivery who is trained to manage any potential complications. The largest numbers of litigation cases in twin pregnancies arise from babies suffering hypoxic ischaemic damage where CTG interpretation during labour has been an issue.

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Kilby, M.D., Thomson, P.J. (2018). Twins. In: Jha, S., Ferriman, E. (eds) Medicolegal Issues in Obstetrics and Gynaecology. Springer, Cham.

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