Relationship between intertwin delivery interval and postpartum hemorrhage in cesarean section: a seven-year retrospective cohort study

Abstract

Abstract Background: Intertwin delivery interval (ITDI) is defined as the interval time between the delivery of the first and the second twin and may be controlled by obstetricians during cesarean deliveries. Several studies have demonstrated the relationship between ITDI and the adverse neonatal outcomes during vaginal births. However, few studies have explored the relationship between ITDI and maternal outcomes in cesarean deliveries. We hypothesized that ITDI may influence the occurrence and the development of postpartum hemorrhage by affecting uterine contraction. The purpose of this study was to investigate the relationship between ITDI and postpartum hemorrhage, and between ITDI and the maternal adverse outcomes that related to the blood loss in women with twin pregnancies delivered by cesarean section. Methods: A retrospective cohort of 1649 pregnant women with diamniotic twins was recruited from 2016 to 2022. They were categorized into the short ITDI group (0 min < ITDI ≤ 3 min), the medium ITDI group (3 min < ITDI ≤ 6 min) and the long ITDI group (6 min < ITDI ≤ 9 min) according to the range of ITDI of the eligible individuals (0-9 min). The primary outcome including PPH and the secondary outcomes including uterotonic administration, emergency operation, severe maternal morbidity and total blood loss ≥ 1500 ml were compared among the groups, and the relationship between ITDI and these outcomes was explored. Results: Little differences were found in the rates of postpartum hemorrhage, emergency operation, severe maternal morbidity and total blood loss ≥1500 ml among the three groups (P > 0.05). No relationship was found between ITDI and postpartum hemorrhage (P > 0.05). Women with long ITDI were at a decreased risk of uterotonic administration (adjusted OR = 0.369, 95% CI = 0.228-0.597, P < 0.001). Conclusions: Although the long ITDI did not reduce the incidence of postpartum hemorrhage during the cesarean delivery, the uterotonic administration was decreased though appropriately prolonged ITDI.