Risk Factors for Placental Abruption Between Singleton and Twin Gestations [28L

Abstract

INTRODUCTION: The incidence of placental abruption is increased in twin when compared to singletons, but there is a paucity of data regarding other risk factors that might contribute to this increase. Our aim was to determine whether the incidence of and risk factors for abruption were different between singleton and twin deliveries. METHODS: Secondary analysis of a multicenter trial of magnesium sulfate for prevention of cerebral palsy. We included women between 18 and 39 years old, non-anomalous singleton and twin gestations, with placental abruption. Risk factors for placental abruption such as smoking, drug use, premature rupture of membranes (PPROM), chorioamnionitis and preterm labor were evaluated. Chi-square or Fisher exact test were used where appropriate. Adjusted odds ratio (aOR) with 95% confidence intervals (CI) were calculated. RESULTS: There were 20 cases of abruption among 203 twin gestations (9.8%) and 162 cases among 2,238 twin gestations (7.2%), P=.17. Of these, 153 were included. The incidence of smoking, alcohol and drug use, preeclampsia and diabetes did not differ between singleton and twin gestations. Twin gestations had significantly higher incidence of preterm labor (44% versus 13%, P<.01) and chorioamnionitis (44% versus 4%, P<.01). Fifty-seven percent (n=8) of women with abruption and chorioamnionitis carried twins. After adjusting for preterm labor, the incidence of chorioamnionitis was still significantly increased for twin gestations (aOR 17.4, CI 5.0–60.4). CONCLUSION: Twin gestations have a higher rate of abruption than singletons. However, they both have similar risk factors except that abruption was more likely to be associated with chorioamnionitis in twins.