{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T07:21:04Z","timestamp":1789802464743,"version":"4.0.1"},"reference-count":31,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp;amp; Obste"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the association between the risk of severe postpartum hemorrhage (PPH) and the annual twin delivery volume of maternity units.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>JUmeaux MODe d'Accouchement (JUMODA) was a national observational prospective population\u2010based cohort of twin deliveries in 176 French maternity units performing more than 1500 annual deliveries. Our analysis included 7348 women who delivered after 32\u2009weeks' gestation. The primary outcome was severe PPH. The exposure of interest was the volume of annual twin deliveries defined as the number of annual twin deliveries per center in the study population, divided in three terciles. We compared the risk of severe PPH in maternity units with a low or moderate annual twin delivery volume to high volume group and used a propensity score weighting approach to control for confounding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Severe PPH occurred in 3.5% of women in the low\u2010volume group (4\u201324 twin deliveries per year), 4.2% in the moderate\u2010volume group (25\u201347), and 5.0% in the high\u2010volume group (48\u2013184) (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.081). After propensity score weighting, as compared to women delivering in the high\u2010volume group, the risk of severe PPH did not significantly differ for those in the low\u2010volume group (OR 0.73, 95% CI: 0.49\u20131.07) or in the moderate\u2010volume group (OR 0.84, 95% CI: 0.63\u20131.12). Absolute risk difference was 1.64% (95% CI: \u22123.04\u20130.24) for the low\u2010 between high\u2010volume group and \u22120.72% (95% CI: \u22123.04\u20130.24) for the moderate\u2010 versus high\u2010volume group. Results were similar after stratifying by mode of delivery and when only very severe PPH was considered.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Severe PPH rates in twin pregnancies do not differ by the annual twin delivery volume of the maternity hospital, which questions the relevance of using this characteristic to limit where women can give birth, provided that a skilled obstetric and onsite anesthesiology team are available. Caution is therefore warranted when generalizing these results to other healthcare settings, particularly in low\u2010 and middle\u2010income countries, where health system organization, resource availability, may substantially differ.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70929","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T10:36:49Z","timestamp":1774607809000},"page":"1536-1546","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between annual twin delivery volume and severe postpartum hemorrhage in twin pregnancies"],"prefix":"10.1002","volume":"174","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3729-6920","authenticated-orcid":false,"given":"Victoire","family":"Pauphilet","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, H\u00f4pital Bichat, AP\u2010HP Universit\u00e9 de Paris  Paris France"},{"name":"Center for Epidemiology and Statistics Sorbonne Paris Cit\u00e9 (CRESS), Obstetric Perinatal and Pediatric Lifecourse Epidemiology Research Team, OPPaLE, INSERM, INRAE Universit\u00e9 Paris Cit\u00e9  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Goffinet","sequence":"additional","affiliation":[{"name":"Center for Epidemiology and Statistics Sorbonne Paris Cit\u00e9 (CRESS), Obstetric Perinatal and Pediatric Lifecourse Epidemiology Research Team, OPPaLE, INSERM, INRAE Universit\u00e9 Paris Cit\u00e9  Paris France"},{"name":"Maternit\u00e9 Port\u2010Royal, AP\u2010HP, AP\u2010HP Center Hospitalier, FHU PREMA Universit\u00e9 Paris Cit\u00e9  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurelien","family":"Seco","sequence":"additional","affiliation":[{"name":"Center for Epidemiology and Statistics Sorbonne Paris Cit\u00e9 (CRESS), Obstetric Perinatal and Pediatric Lifecourse Epidemiology Research Team, OPPaLE, INSERM, INRAE Universit\u00e9 Paris Cit\u00e9  Paris France"},{"name":"Clinical Research Unit Necker\/Cochin, AP\u2010HP  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Deneux\u2010Tharaux","sequence":"additional","affiliation":[{"name":"Center for Epidemiology and Statistics Sorbonne Paris Cit\u00e9 (CRESS), Obstetric Perinatal and Pediatric Lifecourse Epidemiology Research Team, OPPaLE, INSERM, INRAE Universit\u00e9 Paris Cit\u00e9  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Korb","sequence":"additional","affiliation":[{"name":"Center for Epidemiology and Statistics Sorbonne Paris Cit\u00e9 (CRESS), Obstetric Perinatal and Pediatric Lifecourse Epidemiology Research Team, OPPaLE, INSERM, INRAE Universit\u00e9 Paris Cit\u00e9  Paris France"},{"name":"Department of Obstetrics and Gynecology, Robert Debr\u00e9 Hospital, AP\u2010HP Universit\u00e9 de Paris  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Schmitz","sequence":"additional","affiliation":[{"name":"Center for Epidemiology and Statistics Sorbonne Paris Cit\u00e9 (CRESS), Obstetric Perinatal and Pediatric Lifecourse Epidemiology Research Team, OPPaLE, INSERM, INRAE Universit\u00e9 Paris Cit\u00e9  Paris France"},{"name":"Department of Obstetrics and Gynecology, Robert Debr\u00e9 Hospital, AP\u2010HP Universit\u00e9 de Paris  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the JUmeaux MODe d'Accouchement (JUMODA) study group and the Groupe de Recherche en Obst\u00e9trique et Gyn\u00e9cologie (GROG)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"issue":"2","key":"e_1_2_11_2_1","first-page":"1","article-title":"Births: final data for 2022","volume":"73","author":"Osterman MJK","year":"2024","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_11_3_1","volume-title":"French National Perinatal, Survey 2021: Births, 2\u2010Month Follow\u2010Up and Establishments. 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