Maternal Morbidity in Singleton versus Twin Gestations Undergoing Cesarean Delivery

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Surgical Outcomes

Background:

• Twin pregnancies are increasing, with a high rate of cesarean delivery.
• Maternal morbidity risks in twin gestations undergoing cesarean delivery require further clarification.
• Comparing maternal morbidity in twin versus singleton pregnancies undergoing cesarean delivery is crucial.

Purpose of the Study:

• To determine if twin gestations undergoing cesarean delivery have a higher risk of maternal morbidity compared to singleton pregnancies.
• To analyze maternal outcomes in twin versus singleton pregnancies undergoing cesarean delivery.
• To identify specific risks associated with cesarean delivery in twin pregnancies.

Main Methods:

• Retrospective cohort study of singleton and twin gestations undergoing cesarean delivery (2005-2023).
• Inclusion criteria excluded specific placental and uterine conditions.
• Maternal morbidity was assessed as a composite outcome, with subgroup analyses performed.

Main Results:

• No significant difference in the composite maternal morbidity outcome between singleton (0.8%) and twin (1.4%) pregnancies undergoing primary cesarean delivery (p=0.172).
• Twin pregnancies showed significantly higher estimated blood loss (EBL) and blood transfusion rates (4.7% vs. 1.8%, p<0.001).
• These findings were consistent across primary, laboring, non-laboring, and repeat cesarean delivery subgroups.

Conclusions:

• Cesarean delivery in twin gestations is not associated with increased major maternal morbidity compared to singleton gestations.
• Women with twin pregnancies undergoing cesarean delivery have significantly higher blood loss and require more transfusions.
• While major complications are similar, careful management of blood loss is essential for twin pregnancies undergoing cesarean delivery.