Multiple Gestations and Hypertensive Disorders of Pregnancy: What Do We Know?
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PREECLAMPSIA (VD GAROVIC, SECTION EDITOR)
Multiple Gestations and Hypertensive Disorders of Pregnancy: What Do We Know? Kavita Narang 1 & Linda M. Szymanski 1 Accepted: 10 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The occurrence of hypertensive disorders of pregnancy (HDP) including gestational hypertension, chronic hypertension, preeclampsia, and eclampsia is proportional to the number of fetuses: singletons 6.5%, twins 12.7%, and triplets 20.0%. Literature on HDP in multifetal gestation is sparse compared with singletons. We aim to summarize the current evidence on HDP, specifically in twins. Recent Findings HDP occurs more frequently, at an earlier gestational age, and can present more severely and atypically in twin pregnancies. HDP in twins carries a higher risk of maternal/fetal morbidity and mortality including renal failure, stroke, cardiac arrest, pulmonary edema, placental abruption, cesarean delivery, fetal growth restriction, and iatrogenic preterm delivery. Lowdose aspirin (60–150 mg) should be initiated in all multifetal pregnancies to reduce the risk of preeclampsia. Summary To improve outcomes and reduce inherent risks associated with multiple gestations, twins should be managed as highrisk pregnancies, and different from singletons. Keywords Hypertensive disorders . Pregnancy . Multifetal gestation . Twin pregnancy . Preeclampsia . Aspirin
Introduction The incidence of multifetal gestations in the USA, especially twins, has nearly doubled in the last four decades [1]. From 1980 to 2009, the rate increased from 18.9 to 33.3 per 1000 livebirths [2]. This number was stable between 2009 and 2012, and then peaked at 33.9 in 2014, parallel to the use of assisted reproductive technology (ART) and older maternal age at conception, where multifetal gestations are more likely to occur [3•]. The number decreased slightly to 32.6 by 2018 [4], due to more stringent protocols on number of embryos transferred during ART. Epidemiological studies on twinning in other developed countries showed similar rates [5]; and, while data in developing countries are limited, Asia and Latin America have the lowest rates of 6 to 9 per 1000
This article is part of the Topical Collection on Preeclampsia * Linda M. Szymanski [email protected] 1
Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
livebirths and Central Africa has rates as high as 18 per 1000 livebirths [6]. Unfortunately, women with multifetal gestations experience more complications in pregnancy. When considering all hypertensive disorders that may complicate pregnancy, including gestational hypertension (gHTN), chronic hypertension (cHTN), preeclampsia, and eclampsia, the occurrence is proportional to the total number of fetuses, with singletons at 6.5%, twins at 12.7%, and triplets at 20.0% [7]. The relative risk (RR) of preeclampsia specifically in twin pregnancies is 2.6 compared with singleton gest
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