Mckay

Ovid: Pregnancy-Related Mortality Among Women With Multifetal Pregnancies.

12/06/11 15:54

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Obstetrics & Gynecology Número: Volume 107(3), March 2006, pp 563-568 Copyright: © 2006 The American College of Obstetricians and Gynecologists Tipo de publicación: [Original Research] DOI: 10.1097/01.AOG.0000200045.91015.c6 ISSN: 0029-7844 Registro: 00006250-200603000-00006[Original Research]

Pregnancy-Related Mortality Among Women With Multifetal Pregnancies
MacKay, Andrea P. MSPH1 ; Berg, Cynthia J. MD, MPH 2 ; King, Jeffrey C. MD3 ; Duran, Catherine 1 ; Chang, Jeani 2

Información sobre el autor
From the 1 Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland; 2 Divisionof Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; and 3 Department of Obstetrics and Gynecology, New York Medical College, New York, New York. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control andPrevention. Corresponding author: Andrea P. MacKay, MSPH, National Center for Health Statistics, 3311 Toledo Road, Room 6121, Hyattsville, MD 20782; e-mail: anm3@cdc.gov.

Abstract
OBJECTIVE: To examine the relative risk of pregnancy-related mortality between multifetal pregnancies and singleton pregnancies. METHODS: We used data from the Centers for Disease Control and Prevention’s PregnancyMortality Surveillance System to examine singleton and multifetal pregnancy-related deaths among women with a live birth or fetal death from 1979–2000. The plurality-specific (singleton or multifetal) pregnancy-based mortality ratio was defined as the number of pregnancy-related deaths per 100,000 pregnancies with a live birth. We analyzed the risk of death due to pregnancy for singleton andmultifetal pregnancies by age, race, education, marital status, and cause of death. RESULTS: Of 4,992 pregnancy-related deaths in 1979–2000, 4.2% (209 deaths) were among women with multifetal pregnancies. The risk of pregnancy death among women with twin and higher-order pregnancies was 3.6 times that of women with singleton pregnancies (20.8 compared with 5.8). The leading causes of death were similarfor women with singleton pregnancies and women with multifetal pregnancies: embolism, hypertensive complications of pregnancy, hemorrhage, and infection. CONCLUSION: Women with multifetal pregnancies have a significantly higher risk of pregnancy-related death than their counterparts with singleton pregnancies; this holds true for all women regardless of age, race, marital status, and level ofeducation. LEVEL OF EVIDENCE: II-2

The number and rate of multiple births have increased dramatically during the past 2 decades, in part due to trends in older child bearing and increased use of fertility-enhancing therapies.1,2 Between 1979 and 2000, the twin birth rate increased 55%, and the rate for triplet and other higher-order births increased 388%. Growth in multifetal birth rates was mostmarked among women aged 30 years and older. Multifetal pregnancies are of clinical and public health concern because of the elevated risks for the mother and child. Infants born in multiple deliveries have a higher incidence of preterm birth and low birthweight and are at a greater risk of infant death.3–5 Similarly, multifetal pregnancies are associated with an increased risk of morbidity for themother, including increased rates of preeclampsia, cardiac morbidity, amniotic fluid or thromboembolism, the need for obstetric intervention, postpartum hemorrhage, hysterectomy, blood transfusion, prolonged hospital stay, and pregnancy-related death.5,6

We used data from the Centers for Disease Control and Prevention’s (CDC) Pregnancy Mortality Surveillance System to conduct an analysis of...