Twin Growth Discordance and Risk of Postpartum Hemorrhage: A Retrospective Cohort Study

Xiuhong Cao; Ye Luo; Shuangqiong Zhou; Qingsong Zhao; Xuewei Qin; Zhiqiang Liu; Zhendong Xu

doi:10.3389/fmed.2022.876411

Twin Growth Discordance and Risk of Postpartum Hemorrhage: A Retrospective Cohort Study

Front Med (Lausanne). 2022 May 25:9:876411. doi: 10.3389/fmed.2022.876411. eCollection 2022.

Authors

Xiuhong Cao¹, Ye Luo², Shuangqiong Zhou¹, Qingsong Zhao¹, Xuewei Qin³, Zhiqiang Liu¹, Zhendong Xu¹

Affiliations

¹ Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
² Department of Research and Education, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
³ Department of Obstetrics, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.

Abstract

Background: In recent years, the incidence of postpartum hemorrhage has increased globally. Multiple pregnancies and cesarean sections are well-known risk factors for postpartum hemorrhage. No studies have evaluated the associations between fetal growth anomalies and postpartum hemorrhage in women with twin pregnancies undergoing cesarean section. This study aimed to identify the relationship between fetal growth anomalies and postpartum hemorrhage in women with twin pregnancies undergoing cesarean section.

Methods: This retrospective single-center study included 3,180 women with twin pregnancies at a tertiary hospital between August 2013 and July 2020. Singleton reference charts were used to assess fetal growth restriction at birth. Discordant growth was defined as an intertwin birth weight difference of ≥20%. Logistic regression analyses were used to evaluate the association between fetal growth anomalies and postpartum hemorrhage. Additionally, sensitivity analysis of abnormal placenta and stratification by twin chorionicity were conducted.

Results: The overall incidence of postpartum hemorrhage was 4.3%. Twin growth discordance, especially with fetal growth restriction, was associated with an increased risk of postpartum hemorrhage (adjusted odds ratio [AOR] = 1.62, 95% confidence interval [CI], 1.05-2.51, P = 0.031; AOR = 1.71; 95% CI, 1.08-2.70, P = 0.022; AOR = 1.98, 95% CI, 1.21-3.25, P = 0.006, respectively). After stratification, this relationship persisted in dichorionic twins (OR = 1.71, 95% CI, 1.04-2.82, P = 0.036; OR = 1.90, 95% CI, 1.13-3.21, P = 0.016; OR = 2.48, 95% CI, 1.41-4.38, P = 0.002, respectively). However, no significant association was observed in monochorionic twin pregnancies.

Conclusion: Growth discordance, especially complicated by fetal growth restriction, was associated with an increased risk of postpartum hemorrhage in women with twin pregnancies undergoing cesarean section, and was more evident in patients with dichorionic twins.

Keywords: cesarean section; chorionicity; fetal growth restriction; growth discordance; postpartum hemorrhage; twin pregnancy.