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Related Experiment Video

Updated: Aug 22, 2025

Model Surgical Training: Skills Acquisition in Fetoscopic Laser Photocoagulation of Monochorionic Diamniotic Twin Placenta Using Realistic Simulators
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Severe Maternal Morbidity in Twins.

Anna Binstock1, Lisa M Bodnar2, Katherine P Himes1,3

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American Journal of Perinatology
|November 8, 2022
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Severe maternal morbidity (SMM) in twin gestations is most common postpartum, primarily caused by hemorrhage. Standard screening methods for SMM in twins have low accuracy, highlighting the need for improved surveillance during the critical postpartum period.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Public Health

Background:

  • Twin gestations carry an elevated risk of severe maternal morbidity (SMM).
  • Existing data on SMM in twins often rely on screening definitions, lacking the precision of gold-standard chart reviews.
  • Understanding the precise timing and causes of SMM in twin pregnancies is crucial for targeted interventions.

Purpose of the Study:

  • To determine the timing and causes of severe maternal morbidity (SMM) in twin gestations.
  • To utilize a gold-standard definition of SMM provided by the American College of Obstetricians and Gynecologists (ACOG).
  • To evaluate the effectiveness of current screening methods for SMM in twin pregnancies.

Main Methods:

  • A retrospective analysis of twin deliveries from 1998-2013 was conducted using a perinatal database.
  • Deliveries were initially screened for SMM based on diagnostic codes, prolonged length of stay, or ICU admission.
  • True SMM cases were confirmed via medical record review using the ACOG definition, with subsequent determination of cause and timing.

Main Results:

  • Of 2,367 twin deliveries, 7% screened positive for SMM; however, only 2.4% were confirmed as true SMM cases upon chart review (34% positive predictive value).
  • The majority of SMM events (65%) occurred in the postpartum period.
  • Hemorrhage was the leading cause of SMM, followed by hypertensive and pulmonary complications.

Conclusions:

  • Current screening methods for severe maternal morbidity (SMM) demonstrate poor performance in twin pregnancies.
  • Hemorrhage, hypertensive disorders, and pulmonary complications are the primary drivers of SMM in this population.
  • The postpartum period represents a critical window for maternal health surveillance in women with twin gestations.