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Invasive Therapies for Primary Postpartum Haemorrhage: A Population-based Study in France

their institution between August 2004 and April 2011 were included unless a fetal demise had occurred or a twin had a birthweightr1500 g. Information on maternal age, parity, gestational age, presentation, previous history of cesarean delivery, birthweight, and Apgar scores was obtained from the electronic medical records. Statistical analysis was performed using 2-tailed unpaired t test, Man-Whitney U test or w test. Among 2325 twin deliveries, 1014 were vaginal deliveries and 1311 were either an elective cesarean delivery or an emergent cesarean delivery without a trial of labor. After exclusions for a history of prior cesarean delivery or lack of documentation of fetal presentation, a total of 883 women who attempted vaginal delivery were included in the analysis. Of these 883 patients, 767 [86.9%; 95% confidence interval (CI), 84.5% to 88.9%] had vaginal delivery of both twins, 18 (2%; 95% CI, 1.3%-3.2%) had combined vaginal and cesarean delivery, and 98 (11.1%; 95% CI, 9.2%13.4%) had cesarean delivery for both twins. Although parity Z1 significantly increased the chances of achieving vaginal delivery for both twins (93.3% vs. 84.1%, P<0.001), the induction of labor significantly decreased the chances (Foley induction 74.7%; non-Foley induction 86.7%; no induction 88.9%; P<0.001). A successful trial of labor was greater for women who had a previous vaginal delivery (93.3%). Nulliparity (odds ratio, 2.38; 95% CI, 1.4-4.05) and Foley induction (odds ratio, 2.33; 95% CI, 1.38-3.91) were independent risk factors for a failed vaginal delivery trial, while maternal age >35 years, gestational age Z37 weeks, and presentation of the second twin were not associated with failure rates. Although 41% of pregnancies did not have documentation of body mass index (BMI), for those who did have BMI documented, higher BMI was associated with the need for cesarean delivery. In comparing the trial of labor group and the planned cesarean group, the labor group had more nulliparous women (69.6% vs. 63.3%, P=0.002) and gestational age was significantly more advanced (median gestational week 37 versus 36, P<0.001). The mean birthweight of twin A was significantly lower in the cesarean delivery group (2455 vs. 2496 g, P=0.017), but the mean birthweight of twin B was not significantly different between the 2 groups (2422 vs. 2415 g, P=0.625). The planned cesarean group had more women with maternal age >35 years (28.7% vs. 16.5%, P<0.001). No association was found between planned mode of delivery and low Apgar scores. The study concluded that vaginal delivery rates among women with twin pregnancies can be relatively high with history of a previous vaginal delivery increasing the chances of success and induction of labor and high BMI significantly decreasing the rate of success. Invasive Therapies for Primary Postpartum Haemorrhage: A Population-based Study in France