Multifetal gestation - Maternal and perinatal outcome of 112 pregnancies

Purpose: Multifetal pregnancy reduction is a widespread `therapy'
to diminish the risk of prematurity and adverse outcome for the
survivors in higher order multiple gestation. The aim of our study
was to determine the maternal and neonatal outcome of multifetal
pregnancies under a conservative pregnancy management. Study
Design: A retrospective review of 112 multifetal pregnancies is
presented. All higher order multiple pregnancies delivered after 25
weeks of gestation and managed at a single institution between 1982
and 1999 are included. Results: Triplets, quadruplets and
quintuplets were delivered at a mean gestational age of 31 + 5, 29
+ 5 and 28 + 4 weeks, respectively. The perinatal mortality was 14
for triplets and 36 for quadruplets. No quintuplet died in the
perinatal period. Respiratory distress syndrome occurred in 23% of
triplets, 65% of quadruplets and 75% of quintuplets, intracranial
hemorrhage was diagnosed in 14% of triplets, 15% of quadruplets and
10% of quintuplets and retinopathy of prematurity was found in 10%
of triplets, 9% of quadruplets and 25% of quintuplets. Discussion:
Despite a low neonatal mortality, morbidity of higher order
multiple gestations remains significant. Mortality and morbidity
are related to preterm delivery but do not exceed the rates of
singletons or twins of an identical gestational age. Favorable
prognostic landmarks are a gestational age >30 weeks and a
number of fetuses per pregnancy less than or equal to4. Conclusion:
The risks of multifetal pregnancies are significant. Therefore,
evidence-based counseling of couples seeking treatment for
infertility and prevention of higher order multiple pregnancies
through the prudent use of reproductive techniques attains
paramount importance. Copyright (C) 2002 S. Karger AG, Basel.