November 30th, 2023

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Analysis of Risk Factors of Postpartum Hemorrhage in Twin Pregnancy at Different Time Periods
Authors:  Lin Lin, M.D., Xia Xu, M.D., Liping Huang, B.S., Lichun Chen, B.S., Zhaodong Liu, M.D., and Jianying Yan, M.D.
  OBJECTIVE: To analyze the risk factors of postpartum hemorrhage (PPH) in twin pregnancy at different time periods.

STUDY DESIGN: A total of 288 cases of twin pregnancy with PPH were included in this study. The amount of bleeding and bleeding peak were compared among the 7 periods of placental expulsion and postpartum period within 0–30 minutes, 30–60 minutes, 1–2 hours, 2–4 hours, 4–6 hours, and 6–24 hours. Multivariate linear regression analysis was used to analyze the relationship of blood loss at different time periods with related conditions of pregnancy and childbirth and platelet and fibrinogen content before delivery.

RESULTS: The period of greatest postpartum bleeding is placental expulsion, followed by 2–4 hours postpartum and 30–60 minutes postpartum. For the peak time of bleeding, 79.86% of the peak bleeding occurred in placental expulsion, which was significantly higher than other postpartum periods, followed by 0–30 min-utes postpartum and 2–4 hours postpartum. Furthermore, age and weight gain during pregnancy were related influencing factors of the incidence of peak PPH in twin pregnancy (p<0.05). Moreover, BMI at admission and gestational weeks were positively correlated with the amount of PPH in placental expulsion (p<0.05). However, BMI at admission and polyhydramnios were positively correlated with the amount of PPH within 30–60 minutes postpartum (p<0.05).

CONCLUSION: Attention should be paid to prevent bleeding when the placenta is delivered in twin pregnancy. The dynamic monitoring of the bleeding in the 24 hours postpartum should be paid attention to, especially in older mothers and women with large weight gain during pregnancy.
Keywords:  placental expulsion, postpartum hemorrhage, risk factors, twin pregnancy
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