by email@example.com (322 Posts), Thu Mar 15, 2007 01:46 pm
I really can not answer this one because of my unfamiliarity with IVF and other assisted reproduction techniques, and their complication rate. This patient is already at considerable risk for preeclampsia as her hypertension has been present over 5 years, and yes a twin pregnancy and perhaps a modestly elevated body mass index will increase the risk further. There is no indication of whether the patient has any degree of end-organ damage especially cardiac performance, the latter mentioned because cardiac output which increases in pregnancy increases more with twins. In essence all risks, preeclampsia, and coronary events are elevated here, and increase somewhat with twin pregnancy.
Again, no real data here, but a ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œguestimateÃƒÂ¢Ã¢â€šÂ¬Ã‚Â of 40-50% preeclampsia rate is in order, with higher likelihood that any superimposed preeclampsia will be a more severe disease. Still if motherhood is strongly desired and fetal maternal medicine as well as internist support is good the pregnancy can succeed, and while I would prefer reduction, the patient must at least be ready to follow termination advice quickly. In summary: Opinions here are guesses without too much data.