Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy

Obstetrics and gynecology 11/2013; 122(5):1122-1131.
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    ABSTRACT: We sought to estimate the association of several maternal risk factors with intrauterine growth restriction (IUGR) in twin pregnancies. This is a case-control study of 313 patients with twin pregnancies delivered greater than 24 weeks between June 2005 and January 2010. We used three definitions of IUGR: (1) either twin with a birth weight < 10th percentile for gestational age; (2) either twin with a birth weight < 5th percentile for gestational age; and (3) birth-weight discordance ≥ 20%. Using each definition of IUGR, we estimated the association between IUGR and maternal age, weight, monochorionicity, in vitro fertilization, pregnancy reduction, thrombophilia, hypertension, and diabetes. Overall, 47% of patients delivered at least one twin with a birth weight <10th percentile, 27% of patients delivered at least one twin with a birth weight <5th percentile, and 16% of patients had birth-weight discordance of ≥20%. Using any of these three definitions for IUGR in twin pregnancies, there was no significant association between IUGR and any of the risk factors examined. This remained true when we excluded all patients who delivered <34 weeks. IUGR is very common in twin pregnancies. However, in twin pregnancies, IUGR cannot be predicted by maternal risk factors.
    American Journal of Perinatology 12/2010; 28(4):267-72. DOI:10.1055/s-0030-1270116 · 1.91 Impact Factor
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    ABSTRACT: Abstract Objective: To report blood pressure (BP) across gestation in patients with twin pregnancy. Methods: Historical cohort of all twin pregnancies managed by one maternal-fetal medicine practice from 2005 - 2012. Patients with chronic hypertension were excluded. We reviewed all outpatient BP measurements taken during pregnancy and compared systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) for every 2-week interval starting at 6 weeks. All BP measurements were taken manually in the seated upright position. Results: There were 520 patients with twin pregnancies managed over the study period, 19 (3.7%) were excluded for chronic hypertension, leaving 501 patients for analysis. There were a total of 4,985 BP measurements (9.95 per patient) during pregnancy. Starting at 6 weeks' gestation, the SBP, DBP, and MAP remained stable until 30 weeks' gestation, when all three began to rise significantly until 38 weeks (p<0.001). There was no drop in BP in the second trimester. The 95(th) percentile for systolic BP did not exceed 121 mmHg until 30 weeks and the 95(th) percentile for diastolic BP did not exceed 80 mmHg until 34 weeks. The 4-10 week postpartum DBP and MAP were significantly higher than the initial DBP and MAP <10 weeks. Conclusions: In patients with twin pregnancies, the BP remains stable from 6 weeks until 30 weeks, at which time it begins to rise steadily. The 95(th) percentile for SBP and DBP prior to 30 weeks are approximately120 and 80 mmHg, respectively.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 09/2013; 27(9). DOI:10.3109/14767058.2013.845660 · 1.37 Impact Factor
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    ABSTRACT: Unlabelled: Pregnancy may precipitate acute episodes of thrombotic thrombocytopenic purpura (TTP), but pregnancy outcomes in women who have recovered from acquired TTP are not well documented. We analyzed pregnancy outcomes following recovery from TTP associated with acquired, severe ADAMTS13 deficiency (ADAMTS13 activity <10%) in women enrolled in the Oklahoma TTP-HUS Registry from 1995 to 2012. We also systematically searched for published reports on outcomes of pregnancies following recovery from TTP associated with acquired, severe ADAMTS13 deficiency. Ten women in the Oklahoma Registry had 16 subsequent pregnancies from 1999 to 2013. Two women had recurrent TTP, which occurred 9 and 29 days postpartum. Five of 16 pregnancies (31%, 95% confidence interval, 11%-59%) in 3 women were complicated by preeclampsia, a frequency greater than US population estimates (2.1%-3.2%). Thirteen (81%) pregnancies resulted in normal children. The literature search identified 382 articles. Only 6 articles reported pregnancies in women who had recovered from TTP associated with acquired, severe ADAMTS13 deficiency, describing 10 pregnancies in 8 women. TTP recurred in 6 pregnancies. Conclusions: With prospective complete follow-up, recurrent TTP complicating subsequent pregnancies in Oklahoma patients is uncommon, but the occurrence of preeclampsia may be increased. Most pregnancies following recovery from TTP in Oklahoma patients result in normal children.
    Blood 01/2014; 123(11). DOI:10.1182/blood-2013-11-538900 · 10.45 Impact Factor
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