18. Characteristics of hypertension disorders in twin compared with singleton pregnancies
Main Article Content
Abstract
The aim of this study was to determine the clinical characteristics and perinatal outcomes of hypertension disorders in twin pregnancy compared with singleton pregnancy. A cross-sectional study was conducted on 166 women with hypertension disorders in pregnancy (HDP) at the National Hospital of Obstetrics and Gynecology from March 2023 to June 2023. Of 166 women met the study criteria, 37 (23.3%) and 129 (77.7%) had twin and singleton pregnancies, respectively. Women with twin pregnancy were less likely to have a headache than women with singleton pregnancy (2.7% vs 17.8%; p = 0.021). There was no significant difference in the maternal adverse outcomes (eclampsia, abruptio placentae, and HELLP syndrome) between twins and singletons. Women with twin pregnancy had significantly higher rates of preterm delivery compared with singleton pregnancy (73.0% vs 54.3%; p = 0.042). However, the prevalence of fetal distress and intrauterine growth restriction in singleton pregnancies were higher than in twin pregnancies, with a statistically significant difference (13.2% vs 0%; p = 0.02 and 26.4% vs 10.8%; p = 0.047). The majority of birth weight in twin pregnancies was in the 1500 – 2499 gram range (59.5%), while the majority of birth weight in singleton pregnancies was more than 2500 gram (53.5%). Our study showed that women with hypertension disorders in singleton pregnancies have significantly higher prevalence of headache than in twin pregnancies. HDP have more severe fetal adverse outcomes (fetal distress and intrauterine growth restriction) in singleton than in twin pregnancies.
Article Details
Keywords
Hypertension disorders in pregnancy, twin pregnancies, singleton pregnancies
References
2. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122(5):1122-1131. doi:10.1097/01.AOG.0000437382.03963. 88
3. Steegers EAP, von Dadelszen P, Duvekot JJ, et al. Pre-eclampsia. Lancet Lond Engl. 2010;376(9741):631-644. doi:10.1016/S0140-6 736(10)60279-6
4. Mersha AG, Abegaz TM, Seid MA. Maternal and perinatal outcomes of hypertensive disorders of pregnancy in Ethiopia: systematic review and meta-analysis. BMC Pregnancy Childbirth. 2019;19(1):458. doi:10.1186/s12884 -019-2617-8
5. Kumar M, Singh A, Garg R, et al. Hypertension during pregnancy and risk of stillbirth: challenges in a developing country. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2021;34(23):3915-3921. doi:10.1080/14767058.2019.1702943
6. Committee on Practice Bulletins - Obstetrics, Society for Maternal - Fetal Medicine. Practice Bulletin No. 169: Multifetal Gestations: Twin, Triplet, and Higher-Order Multifetal Pregnancies. Obstet Gynecol. 2016;128(4):e131-146. doi:10.1097/AOG.0000 000000001709
7. Foo JY, Mangos GJ, Brown MA. Characteristics of hypertensive disorders in twin versus singleton pregnancies. Pregnancy Hypertens. 2013;3(1):3-9. doi:10.1016/j.preghy. 2012.05.005
8. Aviram A, Berger H, Abdulaziz KE, et al. Outcomes Associated With Hypertensive Disorders of Pregnancy in Twin Compared With Singleton Gestations. Obstet Gynecol. 2021;138(3):449-458. doi:10.1097/AOG.00000 0 0000004506
9. Sibai BM, Hauth J, Caritis S, et al. Hypertensive disorders in twin versus singleton gestations. Am J Obstet Gynecol. 2000;182(4):938-942. doi:10.1016/S0002-9378 (00)70350-4
10. Connolly KA, Factor SH, Getrajdman CS, et al. Maternal clinical disease characteristics and maternal and neonatal outcomes in twin and singleton pregnancies with severe preeclampsia. Eur J Obstet Gynecol Reprod Biol. 2016;201:36-41. doi:10.1016/j.ejo grb.2015.11.031
11. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020;135(6):e237. doi:10.1097/AOG.0000000000003891
12. Ni Y, Cheng W. Clinical characteristics of early-onset pre-eclampsia in singleton versus multiple pregnancies. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2016;132(3):325-328. doi:10.1016/j.ijgo.2015.0 7.029
13. Block HS, Biller J. Neurology of pregnancy. Handb Clin Neurol. 2014;121:1595-1622. doi:10.1016/B978-0-7020-4088-7.00105 -X
14. Bdolah Y, Lam C, Rajakumar A, et al. Twin pregnancy and the risk of preeclampsia: bigger placenta or relative ischemia? Am J Obstet Gynecol. 2008;198(4):428.e1-6. doi:10.1016/j.ajog.2007.10.783
15. Aviram A, Giltvedt MK, Sherman C, et al. The role of placental malperfusion in the pathogenesis of preeclampsia in dichorionic twin and singleton pregnancies. Placenta. 2018;70:41-49. doi:10.1016/j.place nta.2018.09.002
16. Henry DE, McElrath TF, Smith NA. Preterm severe preeclampsia in singleton and twin pregnancies. J Perinatol Off J Calif Perinat Assoc. 2013;33(2):94-97. doi:10.1038/jp.2012.74
17. Norwitz ER, Edusa V, Park JS. Maternal physiology and complications of multiple pregnancy. Semin Perinatol. 2005;29(5):338-348. doi:10.1053/j.semperi.2005.08.002
18. Rao A, Sairam S, Shehata H. Obstetric complications of twin pregnancies. Best Pract Res Clin Obstet Gynaecol. 2004;18(4):557-576. doi:10.1016/j.bpobgyn.2004.04.007
19. Proctor LK, Kfouri J, Hiersch L, et al. Association between hypertensive disorders and fetal growth restriction in twin compared with singleton gestations. Am J Obstet Gynecol. 2019;221(3):251.e1-251.e8. doi:10.1016/j.ajog. 2019.04.022
20. O’Brien M, Baczyk D, Kingdom JC. Endothelial Dysfunction in Severe Preeclampsia is Mediated by Soluble Factors, Rather than Extracellular Vesicles. Sci Rep. 2017;7(1):5887. doi:10.1038/s41598-017-06178-z