Preeclampsia in multiple pregnancy.

BACKGROUND

Preeclampsia is one of the most common pregnancy-induced complications, and results in a large number of maternal deaths. How pregnancy incites or aggravates hypertension remains unresolved; despite decades of intensive research directed to hypertensive disorders, they remain among the most important unresolved problems in obstetrics. The incidence of preeclampsia is increased in multiple pregnancies, and several preeclampsia-related fetal risks may be particularly hazardous to the babies of multiple gestations.

METHODS

The records of 561 women with multiple pregnancies delivered consecutively at Mackay Memorial Hospital were reviewed retrospectively. Thirteen mild cases and 39 severe cases of preeclampsia in multiple pregnancies were compared with 52 control cases of multiple pregnancies without preeclampsia, but matched for maternal age and parity. The categories for comparison included parity, gestational age, time of onset of preeclampsia, route of delivery, mean birth weight, growth discordancy, maternal complications, neonatal morbidity and mortality.

RESULTS

The incidence of preeclampsia in our consecutive series of 561 multiple pregnancies was 9.3% compared with 1.8% in singleton pregnancies (p < 0.0001). In primiparas with multiple pregnancies, the incidence of preeclampsia was 12.2% compared with 6.2% (p < 0.05) in multiparas. Breech presentation was the most common indication for Cesarean section in all groups. The preeclamptic group had a significantly higher rate of Cesarean section compared with the control group (p < 0.006), with prolonged labor and fetal distress were the two main reasons for this difference. Severe preeclamptic patients had babies with significantly lower mean birth weights (p < 0.05), higher incidence of intrauterine growth retardation (p < 0.025) and neonatal respiratory distress syndrome (p < 0.0008) compared with those of the control group. All seven cases with maternal complications were in the severe preeclamptic group.

CONCLUSIONS

An unfavorable perinatal outcome was found to be associated with severe, but not with mild, preeclampsia in multiple pregnancies.