Analysis of risk factors related to severe postpartum hemorrhage of twin pregnancies delivered by cesarean section

Objective:To investigate the risk factors of severe postpartum hemorrhage(PPH)in cesarean section of twin pregnancy,and to provide clinical basis for pregnancy management and perioperative obstetric management of twin pregnancy.Methods:The clinical data of 631 twin pregnancies with gestational age
28 weeks delivered by cesarean section at Peking University People's Hospital(PKUPH)from January 2004 to January 2017 were retrospectively analyzed.Methods of conception,the combined weight of twins,serum albumin level before cesarean section,operation time and other factors on the amount of blood loss during cesarean section were analyzed.Results:The proportion of severe PPH was significantly higher in in vitro fertilization-embryo transfer(IVF-ET)group,the combined weight of twins>6000g group,serum albumin before cesarean section<30 g/dl group than in the natural pregnancy group,4000–6000g group,<4000g group and serum albumin
30 g/dl group respectively(P<0.05).The proportion of severe PPH in the elective surgery group of twin pregnancy was higher than that in the emergency surgery group,but the difference was not statistically significant(P>0.05).Moreover,according to the surgical indications,the emergency surgery group was divided into premature rupture of membranes(PROM),labor,fetal distress and others groups,no significant difference were detected among these groups(P>0.05).Conclusion:IVF-ET,the combined weight of twins,serum albumin before operation were significantly correlated with severe PPH of twin pregnancies delivered by cesarean section,revealing that it is necessary to strengthen pregnancy management of twin pregnancy.

Externallyvalidated nomogramfor predicting short-term pregnancy outcome of singleton pregnancies with fetal growth restriction(FGR)

Objective This studyaimed at developing an available predictive model of singleton pregnancies with fetal growth restriction(FGR)for accurate and individualised prognosis assessment.Methods The prediction nomogram was developed by using multivariable Cox regression with data for 301 singleton FGR pregnancies at Peking University People's Hospital.External validation was performed in 321eligible singleton FGR pregnancies at the Affiliated Hospital of Qingdao University.Results Absent umbilical arterial flow,fetal anomaly,history of abnormal pregnancy,non-cephalic presentation and historyof caesarean sectionwere independent prognostic factors foradverse perinatal outcomes in singleton FGR pregnancies in the training set.In the training cohort of the internal validation set,the nomogram estimated pregnancy prognosis of FGR singleton pregnancies based on these five variables,with a concordance index(C-index)of 0.859(95%Cl:0.81 to 0.90)for predicting termination of pregnancy(TOP),which included intrauterine fetal death and therapeutic lethal induction,with a C-index of 0.92(95%Cl:0.86 to 0.98)for predicting stillbirth,and a C-index of 0.87(95%Cl:0.83 to 0.92)for predicting therapeutic lethal induction with indications.Encouragingly,consistent results wereobserved in the external validation set,witha C-index of 0.776(95%Cl:0.71 to 0.84)for predicting TOP,which included intrauterine fetal death and therapeutic lethal induction,with a C-index of 0.773(95%Cl:0.70 to 0.84)for predicting stillbirth,and a C-index of 0.776(95%Cl:0.70 to 0.85)for predicting therapeutic lethal induction with indications.Furthermore,the calibrations of the nomograms predicting the 28th and 34th TOPfreegestation week strongly corresponded to theactual survivaloutcome.Conclusion This prediction model may help clinicians indecision-making for singleton pregnancies with FGR,especially for patients with a single abnormal umbilical arterial flow orfetal anomaly,without induced labour indications for these abnormalities.