既往有剖宫产史的双胎妊娠中，根据计划分娩方式的产后出血风险。

Risk of postpartum hemorrhage according to the planned mode of delivery among twin pregnancies with previous cesarean delivery.

作者信息

Loussert Lola, Schmitz Thomas, Korb Diane, Goffinet François, Ray Camille Le

机构信息

Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team - INSERM U1153, Paris, France; Department of Obstetrics and Gynecology, CHU Toulouse, Toulouse, France.

出版信息

J Gynecol Obstet Hum Reprod. 2025 Jan;54(1):102861. doi: 10.1016/j.jogoh.2024.102861. Epub 2024 Oct 6.

DOI:10.1016/j.jogoh.2024.102861

PMID:39378957

Abstract

INTRODUCTION

Both twin pregnancies and previous cesarean delivery are situations with increased risk of failed vaginal delivery. Cesarean delivery after a trial of labor is associated with an increased risk of postpartum hemorrhage Therefore, in twin pregnancies with a previous cesarean delivery, planned vaginal delivery could lead to an increased risk of postpartum hemorrhage due to an important rate of cesarean delivery after a trial of labor. Our objective was to evaluate the association between the planned mode of delivery and postpartum hemorrhage in women with twin pregnancies and a previous cesarean delivery.

METHODS

We conducted a secondary analysis of the JUMODA French population-based prospective cohort study of twin pregnancies (n = 8823). We included women with one previous cesarean and without contraindication to vaginal birth. The primary outcome was postpartum hemorrhage.

RESULTS

Among the 735 women included, 187 women (25.4%) had planned vaginal delivery and 548 (74.6%) had planned cesarean delivery. Among women with planned vaginal delivery, 125 (66.8%) had a successful vaginal delivery. The incidence of PPH was 8.2% in the planned cesarean group and 9.1% in the planned vaginal delivery group(p = 0.709). After adjustment for confounders, the planned mode of delivery was not associated with the risk of postpartum hemorrhage (adjusted relative risk 0.94, 95% CI 0.56-1.60). There were only 2 uterine ruptures, both in the planned cesarean delivery group.

CONCLUSION

In women with a twin pregnancy and a previous cesarean delivery, there is no overall association between the planned mode of delivery and the risk of postpartum hemorrhage.

摘要

引言

双胎妊娠和既往剖宫产史均会增加阴道分娩失败的风险。试产后行剖宫产会增加产后出血的风险。因此，对于有剖宫产史的双胎妊娠患者，由于试产后剖宫产率较高，计划经阴道分娩可能会增加产后出血的风险。我们的目的是评估有剖宫产史的双胎妊娠妇女计划分娩方式与产后出血之间的关联。

方法

我们对法国基于人群的双胎妊娠前瞻性队列研究JUMODA（n = 8823）进行了二次分析。我们纳入了有一次既往剖宫产史且无阴道分娩禁忌证的妇女。主要结局是产后出血。

结果

在纳入的735名妇女中，187名妇女（25.4%）计划经阴道分娩，548名（74.6%）计划剖宫产。在计划经阴道分娩的妇女中，125名（66.8%）成功经阴道分娩。计划剖宫产组产后出血发生率为8.2%，计划经阴道分娩组为9.1%（p = 0.709）。在对混杂因素进行调整后，计划分娩方式与产后出血风险无关（调整后相对风险0.94，95%可信区间0.56 - 1.60）。仅发生2例子宫破裂，均在计划剖宫产组。