Twins and multiples — an unaddressed signal
Prosecution claim
The prosecution treated the 17 indicted infants as, in substance, a homogeneous cohort for purposes of the shift-rota chart and the mortality pattern. The fact that a disproportionately high number of them were from twin or multiple-birth pregnancies was not foregrounded as relevant to clinical explanation.
Counter-evidence
Independent analysis published on lucyletby.org documents that at least 11 of the 17 indicted babies were twins or multiples, and that 4 co-twins (not in the indictment) had already died in utero. That makes the cohort overwhelmingly a twin/multiple cohort rather than a general neonatal-unit cohort. Twin and multiple pregnancies carry substantially higher perinatal mortality, particularly at the edge of viability; where monochorionic complications such as twin-to-twin transfusion syndrome (TTTS) are in play, natural mortality climbs further. The specific clinical histories — antiphospholipid syndrome, TTTS requiring fetal surgery, ruptured placentas, co-twins previously ectopic — establish that the indicted cohort was preselected for high risk before Ms Letby saw any of them.
When 11 of 17 indicted babies are twins or multiples, and 4 more co-twins died before birth, the cohort is not typical of the unit. It is typical of twin pregnancies referred for specialist care — where mortality is, by reference to the national literature, expected to be substantially elevated.
What the jury heard
The jury heard individual case histories but were not walked through the cohort as a twin/multiples cohort. The shift chart implied the pattern of presence was unusual against a general-neonatal-unit baseline.
What the Panel says
The Panel's case-by-case reviews include specific twin-pregnancy context where relevant (Child J's TTTS, Child Q's co-twin surgery, Children A & B's APS-complicated pregnancy). The Panel concludes these clinical contexts, taken case by case, explain the deteriorations without deliberate harm.
What independent experts add
- Independent analysis at lucyletby.org ('Triplets to singletons', July 2025) documents the full twin/multiple composition of the indictment cohort.
- Perinatal-mortality statistics for twin pregnancies, especially where monochorionic complications are in play, diverge sharply from single-pregnancy statistics — by factors of 3× to 5× in the published literature.
- Liverpool Women's Hospital was the regional specialist referral centre for high-risk twin pregnancies; referral patterns into the Countess of Chester changed in late 2014, bringing in a subset of twin pregnancies whose acuity exceeded the unit's Level-2 designation.