Primary Postpartum Hemorrhage in Twin Pregnancy Delivery

Background: Twin pregnancies are associated with increased maternal and neonatal risks, and primary postpartum hemorrhage remains one of the most significant complications during delivery. While cesarean section is often perceived as carrying greater risk of hemorrhage compared to vaginal birth, data remain inconsistent across populations, necessitating further evaluation in local healthcare settings. Objective: To determine the frequency of primary postpartum hemorrhage in twin pregnancies and compare its occurrence between vaginal and cesarean deliveries. Study design: Descriptive study. Duration and place of study: The study was conducted from June to November 2024 at the Department of Obstetrics and Gynaecology, Khyber Teaching Hospital, Peshawar. Methodology: Eighty-five women with ultrasound-confirmed twin pregnancies beyond 36 weeks of gestation were enrolled through consecutive sampling. Patients underwent either vaginal or cesarean delivery. Blood loss was measured by weighing sponges, pads, and clots, with thresholds of ≥500 ml for vaginal and ≥1000 ml for cesarean delivery used to define primary postpartum hemorrhage. Demographic data, clinical parameters, and obstetric details were recorded. Results: The mean maternal age was 29.4±7.4 years, with mean gestational age of 38.0±1.2 weeks. Primary postpartum hemorrhage occurred in 15 (17.6%) women overall, with similar rates in vaginal (18.4%) and cesarean (17.0%) deliveries (p=0.866). Mean blood loss was significantly higher following cesarean birth (755.2±247.3 ml) compared to vaginal delivery (396.1±170.3 ml, p<0.001). Conclusion: Primary postpartum hemorrhage was a frequent complication in twin pregnancies, with comparable frequency across both delivery modes.