The outcome of triplet, quadruplet, and quintuplet pregnancies managed in a perinatal unit: obstetric, neonatal, and follow-up data

The use of fertility drugs has increased the incidence of multiple pregnancies, those involving more than two fetuses. The outcome of a multiple pregnancy depends on the number of fetuses and the quality of medical care given to the mother and the fetuses. Improved diagnostic methods, improved neonatal care and the use of selective termination to reduce the number of fetuses carried to term, has influenced the outcome of multiple pregnancies. An evaluation of 24 triplet, five quadruplet and one quintuplet pregnancies from one hospital over a 10-year period was conducted. The rate of death occurring during the first seven days of life was 31.6 per 1000 live infants and the late mortality (the rate of death occurring between seven and 28 days after birth) was 21. The perinatal death rate (during pregnancy and one week after birth) was 51.5. The number of infants surviving and discharged from the hospital was 98 percent. Respiratory distress syndrome, a breathing disorder caused by immature lung tissue, affected 43 percent of the infants. Bronchopulmonary dysplasia, abnormal tissue in the breathing structures, was present in six percent. Other complications included disorders of the eye (retinopathy of immaturity) in three percent, bleeding in the brain (intraventricular hemorrhage) in four percent and cerebral palsy in two percent. Only one child had a moderate handicap (spastic diplegia) at follow-up 10 years later. The remaining 99 percent of the infants had no evidence of further medical problems. A favorable outcome of multiple pregnancies is improved by early diagnosis, meticulous care during pregnancy, continuous monitoring of fetal well-being, early hospitalization, cesarean delivery and the immediate availability of a neonatologist during delivery. Although selective termination of fetuses in multiple pregnancies may be an option in some obstetrical cases, the 90 percent survival rate of multiple pregnancies does not support this type of management. (Consumer Summary produced by Reliance Medical Information, Inc.)