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:

Preterm severe preeclampsia in singleton and twin pregnancies

Abstract

Objective:

We aimed to evaluate rates of delivery and clinical manifestations of preterm severe preeclampsia in singleton and twin gestations.

Study Design:

This retrospective cohort study included 86 765 deliveries from 2000 to 2009, including 3244 twins. Rates of delivery for severe preeclampsia among infants born 24 to 31+6, and 32 to 36+6 weeks gestation were calculated, and diagnostic criteria were compared.

Result:

Re-term severe preeclampsia was more common in twin pregnancies (2.4% vs 0.4%, P<0.001, relative risk 5.70 (95% confidence interval 4.47 to 7.26)). This was also true for deliveries from 24 to 31+6 (0.8% vs 0.2%, P<0.001) and 32 to 36+6 weeks (1.7% vs 0.3%, P<0.001). Diagnostic criteria and disease manifestation including hemolysis elevated liver enzymes low platelet count syndrome, abruption and growth restriction were similar between groups.

Conclusion:

Twin pregnancies are significantly more likely than singletons to be delivered preterm for severe preeclampsia. Diagnostic criteria and disease manifestation were similar in singletons and twins, at all gestational ages.

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

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

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

Figure 1

Similar content being viewed by others

References

  1. American College of Obstetricians and Gynecologists. Diagnosis and management of preeclampsia and eclampsia. ACOG Practice Bulletin No. 33. Obstet Gynecol 2002; 99: 159–167.

    Google Scholar 

  2. Bombrys AE, Barton JR, Nowacki EA, Habli M, Pinder L, How H et al. Expectant management of severe preeclampsia at less than 27 weeks’ gestation: maternal and perinatal outcomes according to gestational age by weeks at onset of expectant management. Am J Obstet Gynecol 2008; 199: 247.e1–247.e6.

    Article  Google Scholar 

  3. Alanis MC, Robinson CJ, Hulsey TC, Ebeling M, Johnson DD . Early-onset severe preeclampsia: induction of labor vs elective cesarean delivery and neonatal outcomes. Am J Obstet Gynecol 2008; 199: 262.e1–262.e6.

    Article  Google Scholar 

  4. Long PA, Oats JN . Preeclampsia in twin pregnancy- Severity and pathogenesis. Aust N Z J Obstet Gynaecol 1987; 27: 1–5.

    Article  CAS  Google Scholar 

  5. Ros HS, Cnattingius S, Lipworth L . Comparison of risk factors for preeclampsia and gestational hypertension in a population-based cohort study. Am J Epidemiol 1998; 147: 1062–1070.

    Article  CAS  Google Scholar 

  6. Santema JG, Koppelaar I, Wallenburg HCS . Hypertensive disorders in twin pregnancy. Eur J Obstet Gynecol Reprod Biol 1995; 58: 9–13.

    Article  CAS  Google Scholar 

  7. Spellacy WN, Handler A, Ferre CD . A case-control study of 1253 twin pregnancies from a 1982–1987 perinatal data base. Obstet Gynecol 1990; 75: 168–171.

    CAS  PubMed  Google Scholar 

  8. Sibai BM, Hauth J, Caritis S, Lindheimer MD, MacPherson C, Klebanoff M et al. Hypertensive disorders in twin versus singleton gestations. Am J Obstet Gynecol 2000; 182: 938–942.

    Article  CAS  Google Scholar 

  9. Barton JR, Sibai BM . Prediction and prevention of recurrent preeclampsia. Obstet Gynecol 2008; 112: 359–372.

    Article  Google Scholar 

  10. Sibai BM, Barton JR . Expectant management of severe preeclampsia remote from term: patient selection, treatment, and delivery indications. Am J Obstet Gynecol 2007; 196: 514.e1–514.e9.

    Article  Google Scholar 

  11. Catov JM, Ness RB, Kip KE, Olsen J . Risk of early or severe preeclampsia related to pre-existing medical conditions. Int J Epidemiol 2007; 36: 412–419.

    Article  Google Scholar 

  12. Hernandez-Diaz S, Toh S, Cnattingius S . Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study. BMJ 2009; 338: b2255.

    Article  Google Scholar 

Download references

Acknowledgements

No financial support was provided for this project.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to D E Henry.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

This work was previously presented at the 2011 Society for Maternal-Fetal Medicine Annual Meeting.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Henry, D., McElrath, T. & Smith, N. Preterm severe preeclampsia in singleton and twin pregnancies. J Perinatol 33, 94–97 (2013). https://doi.org/10.1038/jp.2012.74

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2012.74

Keywords

This article is cited by

Search

Quick links