Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Risk Factors for Pulmonary Edema in Triplet Pregnancies

Abstract

OBJECTIVE: Multiple gestations are known to be at increased risk for pulmonary edema. Our objective was to characterize this morbidity in a cohort of triplet pregnancies.

STUDY DESIGN: Charts from triplet pregnancies managed by the Georgetown University Hospital Maternal–Fetal Medicine service were abstracted for demographic information and complications. Cases who developed pulmonary edema were compared with those who did not using Fisher exact test, χ2 and Student's t-test with p<0.05 considered significant.

RESULTS: Of 66 triplet pregnancies with complete records, 15 (22.7%) were complicated by pulmonary edema. Patients developing this condition were more likely to be receiving magnesium sulfate therapy than those who did not [14/15 (93.3%) vs 32/51 (62.7%) p=0.049]. There was no difference between patients developing pulmonary edema and those who did not in terms of maternal age (mean±SD: 34.5±6.8 vs 34±4.3 years, p=0.8) or gestational age at delivery (33.3±2.3 vs 32.8±3.5 weeks, p=0.6), but the former group had smaller babies than the latter (1739± 369 vs 1891±538 g, p=0.04). Among the patients treated with magnesium sulfate, those who developed the more severe form of pulmonary edema were more likely than those who did not to have been treated for pre-eclampsia than preterm labor (6/10 (60%) vs 7/33 (21.2%), p=0.04).

CONCLUSIONS: Pulmonary edema is a common complication of triplet pregnancy. Patients receiving magnesium sulfate, having pre-eclampsia or fetal growth restriction are at increased risk for pulmonary edema, particularly in its worst clinical presentation.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Hatjis CG, Swain M . Systemic tocolysis for premature labor is associated with an increased incidence of pulmonary edema in the presence of maternal infection. Am J Obstet Gynecol 1998;159:723–728.

    Article  Google Scholar 

  2. Sibai B, Mabie BC, Harvey CJ . Pulmonary edema in severe preeclampsia–eclampsia: analysis of 37 consecutive cases. Am J Obstet Gynecol 1987;156:1174–1179.

    Article  CAS  Google Scholar 

  3. Yeast JD, Halberstadt C, Meyer BA, Cohen GR, Thorp JA . The risk of pulmonary edema and colloid osmotic pressure during magnesium sulfate therapy. Am J Obstet Gynecol 1993;169:1566–1571.

    Article  CAS  Google Scholar 

  4. Amon E, Midkiff C, Winn H, Holcomb W, Shumway J, Artal R . Tocolysis with advanced cervical dilatation. Obstet Gynecol 2000;95:358–362.

    CAS  PubMed  Google Scholar 

  5. Zlatnik M . Pulmonary edema: etiology and treatment. Sem Perinatol 1997;21:298–306.

    Article  CAS  Google Scholar 

  6. Mastrobattista JM, Skupski DW, Monga M, Blanco JD, August P . The rate of severe preeclampsia is increased in triplet as compared to twin gestations. Am J Perinatol 1997;14:263–265.

    Article  CAS  Google Scholar 

  7. Albrecht J, Tomich P . The maternal and neonatal outcome of triplet gestation. Am J Obstet Gynecol 1996;174:1551–1556.

    Article  CAS  Google Scholar 

  8. Malone FD, Kaufman GE, Chelmow D, Athanassiou A, Nores J, D'Alton ME . Maternal morbidity associated with triplet pregnancy. Am J Perinatol 1998;15:73–77.

    Article  CAS  Google Scholar 

  9. Pritchard JA . Changes in the blood volume during pregnancy and delivery. Anesthesiology 1965;26:393–399.

    Article  CAS  Google Scholar 

  10. Elliott JP, O'Keefe DF, Greenberg P, Freeman RK . Pulmonary edema associated with magnesium sulfate and betamethasone administration. Am J Obstet Gynecol 1979;134:717–719.

    Article  CAS  Google Scholar 

  11. Ogburn PL, Hansen CA, Williams PP, Butler JC, Joseph MS, Julian TM . Magnesium sulfate and betamimetic dual agent tocolysis in preterm labor with single agent failure. J Reprod Med 1985;30:583–587.

    PubMed  Google Scholar 

  12. Ogburn PL, Julian TM, Williams PP, Thompson TR . The use of magnesium sulfate for tocolysis in preterm labor complicated by twin gestation and betamimetic-induced pulmonary edema. Acta Obstet Gynecol Scand 1986;65:793–794.

    Article  Google Scholar 

  13. Katz M, Robertson PA, Creasy RK . Cardiovascular complications associated with terbutaline treatment for preterm labor. Am J Obstet Gynecol 1981;139:605–608.

    Article  CAS  Google Scholar 

  14. Elliot HR . Pulmonary edema associated with ritodrine infusion and betamethasone administration in premature labor. BMJ 1978;2:799–800.

    Article  Google Scholar 

  15. Hawker F . Pulmonary edema associated with beta sympathomimetic treatment of premature labor. Anesth Intensive Care 1984;12:143–151.

    CAS  Google Scholar 

  16. Philipsen T, Ericksen PS, Lynggard F . Pulmonary edema following ritodrine-saline-infusion in premature labor. Obstet Gynecol 1981;58:304–308.

    CAS  PubMed  Google Scholar 

  17. Armson BA, Samuels P, Miller F, Verbalis J, Main E . Evaluation of maternal fluid dynamics during tocolytic therapy with ritrodrine hydrochloride and magnesium sulfate. Am J Obstet Gynecol 1992;167:758–765.

    Article  CAS  Google Scholar 

  18. Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Riedman SA . Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes and low platelets (HELLP syndrome). Am J Obstet Gynecol 1993;169:1000–1006.

    Article  CAS  Google Scholar 

  19. Benedetti TJ, Kates R, Williams V . Hemodynamic observations in severe preeclampsia complicated by pulmonary edema. Am J Obstet Gynecol 1985;152:330–334.

    Article  CAS  Google Scholar 

  20. Adams DM, Sholl JS, Haney EI, Tussell TL, Silver R . Perinatal outcome associated with outpatient management of triplet pregnancy. Am J Obset Gynecol 1998;178:843–847.

    Article  CAS  Google Scholar 

  21. Sassoon DA, Castro LC, Davis JL, Hobel CJ . Perinatal outcomes in triplet vs. twin gestations. Obstet Gynecol 1990;75:817–819.

    CAS  PubMed  Google Scholar 

  22. Devine PC, Malone FD, Athanassious A, Harvey-Wilkes K, D'Alton M . Maternal and neonatal outcomes of 100 consecutive triplet pregnancies. Am J Perinatol 2001;18:225–235.

    Article  CAS  Google Scholar 

  23. Lucas MJ, Leveno KJ, Cunningham FG . A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia. N Engl J Med 1995;333(4):201–205.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Poggi, S., Barr, S., Cannum, R. et al. Risk Factors for Pulmonary Edema in Triplet Pregnancies. J Perinatol 23, 462–465 (2003). https://doi.org/10.1038/sj.jp.7210968

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7210968

This article is cited by

Search

Quick links