Multifetal Gestation – Maternal and Perinatal Outcome of 112 Pregnancies

Abstract

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 ≤4. 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.

Perinatal outcome of quadruplet pregnancies in relation to chorionicity

“…6,19 However, a number of small series comprising two to 10 sets have reported perinatal losses ranging from as low as 0 to as high as 25%. 7,20 More recently, Strauss et al 8 reported survival rate of 94.5% in a series of 14 quadruplets. However, it is difficult to extrapolate our results with other populations in that data set and this study has been collected from three hospitals over a 15-year period, during which neonatal care may have changed.…”

“…Unfortunately, studies evaluating the perinatal outcome of higher order multiples have rarely addressed the type of placentation. [6][7][8] Anecdotal case reports have described quadruplet pregnancies with an MC pair after embryo transfer. 9,10 But no study has systematically evaluated the perinatal outcome in higher order pregnancies in relation to chorionicity.…”

Embarazo Triple: Complicaciones Maternas Y Perinatales

“…El embarazo múltiple se asocia a un incremento de la patología materna (9). Pocas pacientes con embarazo triple cursan sin alguna complicación.…”

“…La anemia materna según la serie de Seoud y cols (35) se presenta con una frecuencia de 23,1%, mientras que Strauss y cols informan una frecuencia de 5,3% (9). En nuestra serie se presentó anemia moderada en 7 de los 11 casos.…”

“…Esta observación fue confirmada 25 años más tarde por Zeleni (6). Sin embargo, durante los últimos años el número de embarazos múltiples ha aumentado como resultado de las técnicas de fertilización, publicándose incrementos hasta 470% (5,(7)(8)(9)(10)(11). Se presenta con mayor frecuencia en mujeres blancas no hispanas, dos veces más que las mujeres negras no hispanas, y más de tres veces que las hispanas (7).…”