Abstract
Objective
As the prevalence of twin pregnancies rises, and because of the high cesarean rate
in twin pregnancies, it is imperative to estimate the maternal morbidity in twin pregnancies
undergoing cesarean delivery. This study aims to clarify whether twin gestations undergoing
cesarean delivery are at increased risk for maternal morbidity compared with singleton
pregnancies undergoing cesarean delivery.
Study Design
This study was a retrospective cohort study of all singleton and twin gestations who
underwent cesarean delivery in a single maternal fetal medicine and obstetrical practice
from 2005 to 2023. All patients who underwent a cesarean delivery with a liveborn
were included with the exception of patients with a history of a prior myomectomy,
known placenta previa, or known placenta accreta spectrum. An electronic medical record
was used to obtain baseline characteristics and maternal outcomes. Our primary outcome
was a composite outcome for maternal morbidity. We first compared all patients undergoing
primary cesarean delivery and performed subgroup analyses of patients laboring prior
to cesarean delivery, scheduled primary cesarean section without labor, and repeat
cesarean section. Chi-squared test, Fisher exact test, and student's t -test were utilized for statistical analysis.
Results
Of the 2,872 women meeting inclusion criteria, 2,250 had singleton pregnancies while
622 had twin pregnancies. Baseline characteristics were largely similar between groups,
except for higher body mass index and incidence of preeclampsia in twin gestations.
In patients undergoing primary cesarean delivery, the composite outcome for maternal
morbidity did not significantly differ between singleton and twin pregnancies (0.8
vs. 1.4%; p = 0.172). However, secondary outcomes revealed higher blood loss in twin pregnancies,
evidenced by both elevated estimated blood loss (EBL) and increased rate of blood
transfusion (4.7 vs. 1.8%; p < 0.001). These findings remained consistent across all subgroup analyses.
Conclusion
We observed no differences in major maternal morbidities between patients undergoing
cesarean delivery for singleton or twin gestations. However, we did find significant
differences in EBL and transfusion requirements for women with twin gestations.
Key Points
There are no differences in major maternal morbidities.
This is between patients undergoing cesarean delivery for singleton versus twin gestations.
This includes with the exception of higher EBL and transfusion requirements in twin
gestations.
Keywords twin gestation - maternal morbidity - singleton gestation - cesarean delivery
