Risk of Postpartum Hemorrhage Based on Planned Mode of Delivery in Twin Pregnancies Following a Previous Cesarean Delivery

Twin pregnancies and previous cesarean delivery are associated with increased risk of failed vaginal delivery while cesarean delivery after a trial of labor is linked to an increased risk of postpartum hemorrhage. Therefore, because there is a significant rate of caesarean delivery following a trial of labour, planned vaginal birth in twin pregnancies with a prior caesarean delivery may raise the risk of postpartum haemorrhage. 

The study examined the relationship between planned mode of delivery and postpartum hemorrhage in women with twin pregnancies who have had a previous cesarean delivery. The analysis included data from 735 women with one prior cesarean, focusing on postpartum hemorrhage as the primary outcome.

The findings of this study revealed:

• Among the included women, a total of 25.4% had planned vaginal delivery and 74.6% had planned cesarean delivery.
• A total of 66.8% had a successful vaginal delivery among women with planned vaginal delivery.
• The incidence of postpartum hemorrhage was similar in both groups: 8.2% for planned cesarean and 9.1% for planned vaginal delivery.
• After adjusting for confounding factors, the planned mode of delivery was not linked to an increased risk of postpartum hemorrhage.
• Additionally, there were only two cases of uterine rupture, both in the cesarean delivery group.

In conclusion, for women with twin pregnancies and a prior cesarean, the planned mode of delivery does not significantly affect the risk of postpartum hemorrhage.

Source: Loussert L, Schmitz T, Korb D, Goffinet F, Ray CL; JUMODA study group and the GROG. Risk of postpartum hemorrhage according to the planned mode of delivery among twin pregnancies with previous cesarean delivery. J Gynecol Obstet Hum Reprod. 2024 Oct 6;54(1):102861. doi: 10.1016/j.jogoh.2024.102861. Epub ahead of print. PMID: 39378957.