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Maternal Morbidity and Mortality Associated With Multiple Gestations

From the Latin American Center for Perinatology and Human Development, Division of Health Promotion and Protection, Pan American Health Organization, World Health Organization, Montevideo, Uruguay, and Department of Women’s and Children’s Health Section of International Maternal and Child Health, University of Uppsala, Stockholm, Sweden.

Address reprint requests to: Agustin Conde-Agudelo, MD Hospital de Clinicas, piso 16 Casilla de Correo 627 11000 Montevideo Uruguay E-mail: condeagu{at}clap.ops-oms.org

Objective: To test the hypothesis that women with multiple gestations are at increased risk of adverse maternal outcomes.

Methods: We studied the association between multiple gestation and frequency of adverse maternal outcomes in 885,338 pregnancies recorded in the Perinatal Information System database of the Latin American Center for Perinatology and Human Development, Montevideo, Uruguay, between 1985 and 1997. Relative risks (RRs) were adjusted for 14 potential confounding factors through multiple logistic regression models.

Results: There were 15,484 multiple gestations. Among parous women, multiple gestation was associated with a twofold increase in risk of death compared with singleton gestations [adjusted RR 2.1; 95% confidence interval (CI) 1.1, 3.9]. Compared with singleton gestations, women with multiple gestations had adjusted RRs of 3.0 (95% CI, 2.9, 3.3) for eclampsia, 2.2 (95% CI, 1.9, 2.5) for preeclampsia, and 2.0 (95% CI, 1.9, 2.0) for postpartum hemorrhage. Likewise, there was significant association between multiple gestation and increased incidence of preterm labor, anemia, urinary tract infection, puerperal endometritis, and cesarean delivery. The incidences of premature rupture of membranes, third-trimester bleeding, and gestational diabetes mellitus were not statistically different for singleton and multiple gestations.

Conclusion: Multiple gestation increases the risk of significant maternal morbidity and mortality.

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