Risk Factors for Postpartum Hemorrhage After Elective Cesarean Delivery for Twin Pregnancy

Abstract Objective: To identify the high risk factors associated with postpartum hemorrhage (PPH) after selective cesarean delivery of twins. Methods: This retrospective cohort study included all women with twin gestations who choosed an elective cesarean delivery after 28 weeks of gestation at Women's Hospital of Zhejiang University School of m from September 2014 to April 2019. The Women with an intrauterine fetal demise one or both of twins were excluded.A total of 532 wemen were analysed,they were classified as PPH group(n=70) and No PPH group(n=462). Estimated blood loss greater than or equal to 1000 ml was defined as Postpartum hemorrhage(PPH).Univariate and multivariate logistic regression analysis were performed to assess the independent risk factors.Results: Of the 532 twin pregnant women, PPH occurred in 13.2% (n=70). There were statistically signifcant diferences in preeclampsia (P=0.005), premature rupture of membranes(P<0.001), placental adhesion (P<0.001), placenta previa (P<0.001), hemoglobin (Hb)< 100 g/L（P=0.003)）, hematocrit (HCT)< 0.39（P=0.004）.However, the indepedent risk factors for PPH after selective cesarean delivery for twin pregnancy were preeclampsia (OR3.538, p < 0.05), premature rupture of membranes (OR17.9, P < 0.05), placental adhesion (OR5.71, p < 0.05) and placenta previa (OR10, p < 0.05). Conclusions: preeclampsia , premature rupture of membranes , placental adhesion and placenta previa were risk factors for postpartum hemorrhage after elective cesarean section for twin pregnancy. Risk factor identification and prevention should be a priority.