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Multiple Gestations and Hypertensive Disorders of Pregnancy: What Do We Know?

  • Preeclampsia (VD Garovic, Section Editor)
  • Published:
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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. Low-dose 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 high-risk pregnancies, and different from singletons.

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Abbreviations

HDP:

Hypertensive disorders of pregnancy

RR:

Relative risk

ART:

Assisted reproductive technology

MZ:

Monozygotic

DZ:

Dizygotic

MCDA:

Monochorionic diamniotic

MCMA:

Monochorionic monoamniotic

DCDA:

Dichorionic diamniotic

TTTS:

Twin to twin transfusion syndrome

TAPS:

Twin anemia polycythemia sequence

TRAP:

Twin reversed arterial perfusion syndrome

s-IUGR:

Selective intrauterine growth restriction

BP:

Blood pressure

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

gHTN:

Gestational hypertension

cHTN:

Chronic hypertension

HELLP:

Hemolysis, elevated liver enzyme, and low platelets

UPC:

Urine protein creatinine ratio

IAP:

Intraabdominal pressure

ACOG:

American College of Obstetrics and Gynecology

SMFM:

Society for Maternal and Fetal Medicine

USPTFS:

United States Preventive Task Force Services

MFMU:

Maternal-Fetal-Medicine Units

BPP:

Biophysical profile

NST:

Non-stress test

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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  1. Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Kavita Narang & Linda M. Szymanski

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Narang, K., Szymanski, L.M. Multiple Gestations and Hypertensive Disorders of Pregnancy: What Do We Know?. Curr Hypertens Rep 23, 1 (2021). https://doi.org/10.1007/s11906-020-01107-4

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