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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.

Diabetes complicates 6 to 7% of all pregnancies in the United States. Poor glycemic control is associated with multiple immediate and long-term adverse effects on both the mother and fetus. Although uniformity exists in the antenatal management of this disease, there is a paucity of evidence-based studies upon which to dictate the optimal time of delivery among affected women. The potential risks of delayed neonatal pulmonary maturation including respiratory distress syndrome and transient tachypnea of the newborn associated with early delivery must be balanced with the increased incidence of fetal demise, overgrowth, and birth injury related to diabetes in late gestations. Even among diabetic women with optimal glycemic control, the risk of stillbirth in the third trimester is considerably higher than their normal counterparts. The current paradigm of delaying delivery to 39 weeks in women with controlled and uncomplicated diabetes has been challenged by recent evidence advocating delivery by 38 weeks to improve perinatal outcomes. However, additional well-designed and adequately powered prospective studies are needed to better understand the short- and long-term implications of the optimal timing of delivery in this high-risk population. This article reviews the most current literature regarding the optimal timing of delivery in pregnancies complicated by diabetes mellitus and gestational diabetes mellitus.