Association between annual twin delivery volume and severe postpartum hemorrhage in twin pregnancies

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- and middle-income countries, where health system organization, resource availability, may substantially differ.