Twice the Joy, but Added Risk: Exploring Twin Birth Outcomes at the East Suffolk and North Essex NHS Foundation Trust Maternity Service, England

Background and aim Twin pregnancy carries higher maternal and neonatal risk than singleton pregnancy, and local data on chorionicity and national benchmarking remain limited. This study primarily aims to describe maternal characteristics, timing and mode of birth, and maternal and neonatal outcomes of twin deliveries in a two-site NHS maternity service. Secondary, hypothesis-generating aims were to explore factors associated with cesarean birth and early delivery and to make an indicative comparison with UK national audit data. Materials and methods We conducted a retrospective, descriptive, and analytical cross-sectional study of 55 women who delivered twins (110 fetuses) between October 2, 2025, and June 18, 2026, following STROBE and RECORD guidance. Key proportions are presented with 95% CIs. Timing of birth was assessed against chorionicity-specific National Institute for Health and Care Excellence (NICE) windows. Analyses were exploratory and unadjusted, and no formal comparison with national data was made. Results Mean maternal age was 31.8 ± 5.7 years. Of the 55 pregnancies, 46 (83.6%) were dichorionic diamniotic (DCDA), nine (16.4%) were monochorionic diamniotic (MCDA), and 10 (18.2%) followed assisted conception. Mean gestation at delivery was 36.1 ± 1.6 weeks; 33 women (60.0%) delivered before 37 weeks. Compared with chorionicity-specific NICE windows, 24 of 46 DCDA pregnancies (52.2%) delivered before 37+0 weeks, and seven of nine MCDA pregnancies (77.8%) before 36+0 weeks. Cesarean birth of both twins occurred in 42 women (76.4%; 95% CI 63.7-85.6): 24 (43.6%) elective and 18 (32.7%) unscheduled. Postpartum hemorrhage (≥500 mL after vaginal birth or ≥1000 mL after cesarean) occurred in 19 women (34.5%), and composite maternal morbidity in 18 (32.7%). Mean birthweight was 2417 ± 457 g; nine of 53 pairs (17.0%) had ≥20% birthweight discordance. At least one twin was admitted to the neonatal unit (any level of care) in 20 of 54 pregnancies (37.0%), including four of four (100%) born before 34 weeks. One fetus (one of 110, 0.9%) died in utero at 23+3 weeks; there were no neonatal or maternal deaths. Conclusions Preterm birth, cesarean birth, postpartum hemorrhage, and neonatal unit admission were common in this twin population. With 55 women, CIs were wide, so the study cannot show whether local outcomes differ from national data. Early delivery of MCDA twins relative to the NICE window and the reasons recorded for cesarean birth warrant local review. Structured documentation of the planned mode of birth, the reasons for the decision, cesarean urgency, neonatal level of care, and indications for admission would support more reliable audits.