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CC BY-NC-ND 4.0 · AJP Rep 2020; 10(03): e330-e334
DOI: 10.1055/s-0040-1715170
Original Article

Duration of the Third Stage of Labor and Estimated Blood Loss in Twin Vaginal Deliveries

Julie R. Whittington 
1   Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
Megan Pagan
1   Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
Kristen Daugherty
1   Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
Kelly Cummings
2   Department of Obstetrics and Gynecology, Marshall Health, Huntington, West Virginia
,
Songthip T. Ounpraseuth
3   Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
Lauren Eads
1   Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
Everett F. Magann
1   Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Abstract

Objective The main aim of this study was to characterize the duration of the third stage of labor and estimated blood loss in twin vaginal deliveries.

Study Design This was a retrospective case–control study. The data was collected from deliveries at the University of Arkansas for Medical Sciences in Little Rock, Arkansas, from January 2013 to June 2017. Women were identified who had twin gestation, were delivered vaginally, and whose maternal age was greater than 18 years old. Women were excluded if they had an intrauterine fetal demise, delivered either/both fetuses via cesarean, history of a previous cesarean or a fetus with a congenital anomaly. If a subject met criteria to be included in the study, the next normal singleton vaginal delivery was used as the control subject.

Results There were 132 singleton vaginal deliveries and 133 twin vaginal deliveries analyzed. There was no significant difference in the length of the third stage of labor between twin and singleton vaginal deliveries except in the 95th percentile of the distribution. Mothers delivering twins had an increase in third-stage duration by 7.618 minutes (95% confidence interval [CI]: 0.73, 14.50; p = 0.03) compared with those who delivered singletons. The twin group had a higher estimated blood loss than singleton deliveries. The increase in blood loss in the twin group was 149.02 mL (95% CI: 100.2, 197.8), 257.01 mL (95% CI: 117.9, 396.1), and 381.53 mL (95% CI: 201.1, 562.1) at the 50th, 90th, and 95th percentiles, respectively. When the third stage of labor was at the 90th percentile or less in twin pregnancy (14 minutes), estimated blood loss was less than 1000 mL.

Conclusion Twin pregnancy is a known risk factor for postpartum hemorrhage. As the duration of the third stage prolongs, the risk for hemorrhage also increases. We recommend delivery of the placenta in twin pregnancies by 15 minutes to reduce this risk.

Key Points

  • The third stage is longer in twin pregnancy at extremes.

  • Twin placentas should be delivered by 15 minutes.

  • Manually extract the placenta when third stage is prolonged.

Keywords

postpartum hemorrhage - twin pregnancy - third stage of labor - placental removal

Financial Disclosure

No funding or financial support was received for this work.


Disclaimer

The opinions or assertions contained herein are the private views of the authors and are not to be construed as the official policy of the Department of the Army, Department of Defense, or the US government.




Publication History

Received: 13 April 2020

Accepted: 16 May 2020

Article published online:
23 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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