Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
C-sections play role in 300% higher severe maternal morbidity in twin pregnancies
Key clinical point: Cesarean delivery accounts for 21% of the severe acute maternal morbidity in twin pregnancies.
Major finding: The odds ratio for severe acute maternal morbidity in twin versus singleton pregnancies is 4.2; 21% of that is related to cesarean delivery.
Study details: A cohort-nested case-control study of 2,500 cases and 3,650 controls.
Disclosures: The EPIMOMS study was supported by the National Research Agency and the Ile de France Regional Health Agency. Dr. Madar received a training grant from the Aquitaine Regional Health Agency. The authors reported having no other relevant financial disclosures.
Citation:
Madar H et al. Obstet Gynecol. 2019;133:1141-50.
Twin pregnancies are known to be associated with increased risk of maternal morbidity, so the findings of this “very well-designed” study by Madar et al. are “not strikingly different than what we know,” according to Ozhan M. Turan, MD, PhD.
Given the robust statistical methods used, they do, however, offer one important new detail regarding the contribution of cesarean delivery to that risk: “This study demonstrated that 20% of complications are actually directly related with cesarean delivery,” Dr. Turan said in an interview.
These data alone will do little to change practice, but paired with an increased focus on training with respect to vaginal twin delivery – including in cases of breech presentation of the second baby – they could lead to improved maternal outcomes, he explained, adding that “breech extraction can be very fast and safe in skilled hands.”
Except for the lack of information in the study about whether the twins were monozygotic or dizygotic, the study is sound, and the data may prove useful for counseling patients about the risks and benefits of vaginal versus cesarean delivery and for promoting improved training of residents, maternal-fetal medicine fellows, and junior obstetricians in vaginal twin delivery techniques, he said.
Dr. Turan is director of the division of maternal and fetal medicine and of fetal therapy & complex obstetric surgery at the University of Maryland, Baltimore County. He reported having no relevant financial disclosures.