Twin Pregnancy and Preeclampsia

My daughter was born three years ago by emergency cesarean at 28 weeks due to severe pre-eclampsia. I am now pregnant with twins after taking Clomid, but I weigh 350 pounds. What are the chances of pre-eclampsia occurring in this pregnancy? Do many women with a history of pre-eclampsia carry twins to term? Can you put me in touch with such a support group? Also, when is the latest time that I can travel? I live in England, but am planning to travel to the United States, and don't want to be stuck in England due to a complication.

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

I'm not sure what part of England you are in, but don't despair. Much ob/Gyn research and many publications come from England, and I would imagine that you could find -- or have found -- excellent care.

Regarding preeclampsia: It tends to recur in about one third of clients. As you know, the combination of your past history, multiple gestation and weight makes your pregnancy one of high risk for gestational diabetes, preterm labor and pregnancy-induced hypertension (PIH).

If I were to give unbiased advice -- not considering the financial or emotional burden induced by such plans -- I would tell you to either stay put for the duration of your pregnancy or fly home now. You plan to move -- an extremely high stress event, even if you do nothing, at a time when your risk of preterm labor and fetal and maternal complications would be quite high. If you must return during this time, make sure you have a relationship already established with a perinatologist or obstetrician in the United States. Keep him or her updated after every visit to your current obstetrician. Carry a copy of your most recently updated medical record with you.

I don't have any specific figures regarding incidences of preterm delivery with twins after pre-eclampsia. Usually, pre-eclampsia alone does lead to a slightly increased rate of preterm birth. Hypertension alone does not. And approximately 30 to 50 percent of multiple gestations end spontaneously before 37 weeks (40 weeks being full term).

Obesity alone is not related to an increase in preterm birth, but obese women experience more perinatal mortality than those of normal weight, and suffer more complications and fetal loss with bigger weight gains. Midwives generally do not provide services for women with such histories, but I feel that your needs go beyond the physical. If you can find a nurse-midwife in England, I would talk to her.

Midwifery is alive and well in England, but it tends to be more of a subservient midwifery than found here in the United States. That means they might be more likely to refer you to a physician, and you already have one of those.

The American College of Nurse- Midwives has a directory of practices and may be able to help you locate one in England or in the area you will be moving to. You can contact a midwife at: American College of Nurse-Midwives, 818 Connecticut Ave. NW, Suite 900, Washington, DC 20006; telephone (202) 728-9860; fax (202) 728-9897; email info@acnm.org I hope all goes well for you.

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