Korb D, et al. - In women with twin pregnancies, authors assessed the relationship between the planned mode of delivery and severe acute maternal morbidity. In twin pregnancies, planned mode of delivery did not have an overall association with severe acute maternal morbidity. After planned cesarean delivery, higher risk of severe acute maternal morbidity may be seen in women older than 35 years.

Methods

• Experts, in this planned secondary analysis of the JUmeaux MODe d'Accouchement cohort, a national prospective population-based study of twin deliveries conducted from February 2014 to March 2015 in 176 hospitals performing more than 1,500 annual deliveries in France, included women with twin pregnancies at 24 weeks of gestation or greater with two live fetuses.
• They excluded the women delivering before 24 weeks of gestation, those with recognized indications for cesarean delivery, and those with severe acute maternal morbidity symptomatic before labor to limit confounding by indication.
• A composite measure of intra- or postpartum severe acute maternal morbidity was included in the primary outcome.
• In order to control for potential confounding by indication, multivariate Poisson regression models and propensity score matching were used.
• They conducted the analyses for the overall study cohort as well as stratified by maternal age in years (younger than 30, 30–34, 35 years or older).
• They did not make any adjustments for multiple comparisons.

Results

• As per data, among the 8,124 women included in this analysis, 3,062 (37.7%) had planned cesarean deliveries and 5,062 (62.3%) had planned vaginal deliveries, of whom 4,015 (79.3%) delivered both twins vaginally.
• Findings did not suggest any significant overall association between the planned mode of delivery and severe acute maternal morbidity (6.1% in the planned cesarean delivery group and 5.4% in the planned vaginal group; adjusted relative risk 1.00, 95% CI 0.81–1.24).
• In women 35 years or older, for those with planned cesarean delivery, the risk of severe acute maternal morbidity was significantly higher than planned vaginal delivery (7.8% vs 4.6%, adjusted relative risk 1.44, 95% CI 1.02–2.06).
• Similar results were yielded by propensity score and secondary analyses.