(842) Maternal Morbidity and Health Services Outcomes Following Combined Vaginal-Cesarean Twin Births

Objective: Maternal complications and healthcare costs of combined twin deliveries are not well defined. We sought to assess national trends and costs of combined deliveries and to analyze their association with adverse maternal outcomes.

Study Design: Monochorionic (MCDA) and dichorionic (DCDA) diamniotic twin births were abstracted from the 2016-2020 Nationwide Readmissions Database. Mode of delivery (MOD) was defined using procedure codes and combined deliveries (CoD) as having both vaginal (VD) and cesarean delivery (CD) codes in the same hospitalization. CoD trends analyses by twin type were conducted using joinpoint regression to estimate the average annual percent change (AAPC) with 95% confidence intervals (CI). Adjusted logistic regression models were performed to evaluate associations between MOD and non-transfusion severe maternal morbidity (ntSMM) and other clinical outcomes adjusting for demographic, clinical, and hospital factors. Mean hospitalization costs and postpartum length of stay (ppLOS) were stratified by MOD.

Results: Of 277,172 twin births, 72,536 (26.2%) resulted in VD, 8,845 (3.2%) in CoD, and 195,791 (70.6%) in CD. From 2016 to 2020, CoD prevalence for MCDA twins remained stable at 2.3% (AAPC 0.2%, 95% CI -2.6%, 3.0%) while decreasing significantly for DCDA twins from 3.6% to 3.2% (AAPC -2.4%, 95% CI -2.9%, -2.0%). CoD conferred higher odds of ntSMM (aOR 1.88, 95% CI 1.51- 2.34), transfusion, reoperation, wound infection, critical care interventions and intrauterine infection compared to VD (Table). Compared to CD, CoD were at higher odds of transfusion (aOR 1.63, 95% CI 1.44, 1.84), postpartum hemorrhage (aOR 1.50, 95% CI 1.34, 1.68), intrauterine infection (aOR 2.38, 95% CI 2.03, 2.79) and dilation and curettage (aOR 1.61, 95% CI 1.02, 2.53). Among the three modes of delivery, mean total costs adjusted for inflation were highest for CoD at $13,838 ($8,016 VD, $11,589 CD) with no difference in CoD versus CD ppLOS (3.3 days).

Conclusion: Combined vaginal-cesarean twin births are associated with higher odds of severe maternal complications and lead to higher hospitalization costs.