Objective: To characterize the strength and patterns of association between birth weights and severe postpartum hemorrhage in twin pregnancies.
Methods: This was a secondary analysis of the JUMODA (JUmeaux Mode d'Accouchement) cohort, a national, prospective, population-based study of twin deliveries, conducted from February 2014 to March 2015 in France. We excluded patients with a fetal death, medically indicated termination of pregnancy, antepartum hemorrhage, placenta previa, placental abruption, or missing birth weight. The primary outcome was severe postpartum hemorrhage , defined as a postpartum hemorrhage requiring at least one of the following: transfusion of 4 or more units of red blood cells, uterine artery embolization, uterine balloon tamponade, vascular ligation, uterine suture, emergency hysterectomy, admission to an intensive care unit, or postpartum hemorrhage considered severe by the obstetrician or leading to maternal death. The exposure was the sum of the birth weights of the two twins. To assess the association between the sum of twins' birth weights and severe postpartum hemorrhage, we used multilevel multivariable modified Poisson regression modeling. Analyses were conducted for the overall population and by planned and actual mode of delivery.
Results: A total of 8,373 patients were analyzed. Severe postpartum hemorrhage occurred in 4.5% (379/8,372, 95% CI 4.1-5.0), from 2.1% (15/722) for a sum of twins' birth weights less than 3,000 g up to 8.8% (12/136) for a sum exceeding 6,500 g. In the multivariable analysis, the association between the sum of the twins' birth weights and severe postpartum hemorrhage was linear, with an adjusted relative risk of severe postpartum hemorrhage of 1.36 (95% CI 1.24-1.49) for each 500-g increase in the sum of twins' birth weights.
Conclusion: In twin pregnancies, the risk of severe postpartum hemorrhage increased linearly with the sum of the twins' birth weights.
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http://dx.doi.org/10.1097/AOG.0000000000004993 | DOI Listing |
Cureus
December 2024
Obstetrics and Gynecology, Maternity and Children Hospital, Hail, SAU.
Globally, obesity prevalence has progressively increased and is now at epidemic levels; this trend is mirrored in women of childbearing age. There is a high level of evidence that maternal obesity is associated with a range of adverse pregnancy complications and neonatal outcomes, such as hypertensive disorders of pregnancy, gestational diabetes mellitus (GDM), large for gestational age (LGA) fetuses, premature birth, stillbirth, cesarean section, and postpartum hemorrhage, among certain others. This systematic review aimed to comprehensively evaluate the relationship between maternal obesity and health outcomes for both mothers and infants.
View Article and Find Full Text PDFJAMA Netw Open
January 2025
Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland.
Importance: Characterizing hospital-level factors associated with adverse outcomes following operative vaginal delivery (OVD) is crucial for optimizing obstetric care.
Objective: To assess the association between hospital OVD volume and adverse outcomes.
Design, Setting, And Participants: This was a retrospective cohort study of OVDs in California between 2008 and 2020.
Can J Anaesth
January 2025
Department of Anesthesia and Pain Management, Mount Sinai Hospital, Mount Sinai Toronto, ON, Canada.
Purpose: Class III obesity (body mass index [BMI] ≥ 40 kg·m) is associated with high rates of Cesarean deliveries and postpartum hemorrhage, with increased maternal and fetal morbidity. The doses of oxytocin and carbetocin are two to four times higher at Cesarean delivery in patients with class III obesity. We sought to investigate the efficacy of carbetocin 80 µg iv compared with oxytocin 1 IU iv (plus infusion) at elective Cesarean delivery in parturients with class III obesity.
View Article and Find Full Text PDFHemasphere
January 2025
Department of Pediatric Hematology and Oncology Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam Rotterdam The Netherlands.
Limited data are available on VWF activity (VWF:Act) and factor VIII (FVIII:C) levels during delivery after VWF/FVIII concentrate administration in women with von Willebrand disease (VWD). We aimed to evaluate treatment with a specific VWF/FVIII concentrate on factor levels in women with VWD during delivery and the postpartum period. A retrospective single-center study was conducted between January 1, 2008, and August 1, 2022.
View Article and Find Full Text PDFCureus
January 2025
Obstetrics and Gynaecology, University of Leeds, Leeds, GBR.
Introduction: Simulation-based learning is a critical component in medical education, particularly for high-risk scenarios like obstetric emergencies. This study utilized Gagné's nine-step instructional model to design and evaluate a clinical simulation session on postpartum hemorrhage (PPH) management for fourth-year medical students.
Methods: The session was structured using Gagné's instructional events, including engaging case vignettes, multimedia presentations, guided practical activities, and immediate feedback.
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