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OBJECTIVE To estimate the incidence and effect of pregnancy-related hypertensive conditions on multiple gestations. METHODS Women with 1-4 fetuses enrolled in an outpatient perinatal services program at 28 or more weeks of gestation were identified. Those without a prior diagnosis of hypertension at enrollment and who delivered at more than 28 weeks of gestation were included in the analysis. The incidence of all pregnancy-related hypertensive conditions, diagnosis of severe hypertensive conditions (hemolysis, elevated liver enzymes and low platelets syndrome; disseminated intravascular coagulation; eclampsia; low platelets; renal failure; and abruption), and interventional delivery related to hypertension were estimated, and compared according to fetal number. RESULTS Data were analyzed for 34,374 singleton, twin, triplet, and quadruplet gestations. The incidence of pregnancy-related hypertensive conditions increased with multifetal gestations as compared with singletons (12.7-19.6% for multifetal gestations compared with 6.5% for singletons, P < .001). The incidence of severe pregnancy-related hypertensive conditions was significantly increased in twin (1.6%) and triplet (3.1%) gestations as compared with singletons (0.5%, P < .001). Quadruplet pregnancies were not significantly higher than triplet gestations for these complications. The need for early delivery related to hypertension was greater with increasing fetal number through triplet gestations. By logistic regression, higher fetal number, nulliparity, and advanced maternal age were each independently associated with the development of pregnancy-related hypertensive conditions. CONCLUSION Mild and severe pregnancy-related hypertensive disease increases progressively with advancing fetal number from singleton to triplets but is not further increased in quadruplet pregnancies. Multifetal pregnancies should be observed closely for onset of gestational hypertensive disease. LEVEL OF EVIDENCE II-2.

The purpose of this study was to assess factors associated with perception of uterine contractions.A database of ambulatory uterine activity monitoring was examined. All patients having singleton pregnancies evaluated between March 1997 and March 2002 were eligible for analysis. Data were divided into 4 groups by maternal prepregnancy body mass index (BMI): lean (20 kg/m(2)), normal (or=20 to25 kg/m(2)), overweight (or=25 to30 kg/m(2)), and obese (or=30 kg/m(2)). The percentage of contractions perceived during observation was compared between groups. Variables interrogated included maternal weight and parity. Statistical analysis included t test, analysis of variance (ANOVA), and linear regression.Data from 7808 patients (556,382 hr) were analyzed. A significant reduction in perception of contractions occurred with increasing BMI between each classification, P.001. A significant reduction in perception of contractions was also noted between nulliparous and multiparous patients at each weight classification, P.001.Obese, nulliparous patients have the greatest difficulty perceiving contractions. Such data may help explain unattended birth or late presentation for care in this group.