Abstract
Background: Naturally occurring high-order multiple (HOM) pregnancies are rare (1 - 7 per 10,000) even in Nigeria noted to have the highest twinning rates. Worldwide multiple pregnancies are increasing and are associated with increased adverse maternal outcomes. Materials and Methods: This was a retrospective study of all patients with HOM pregnancy in Prime Medical Consultants between Jan 2004 to Dec 2013. We identified all the patients with high-order multiple pregnancy and extracted relevant data from the ante-natal and labour ward records, theatre records, and patients case notes. Demographic characteristics, gestational age at delivery, preterm rupture of membranes, preterm labour, hypertensive disease in pregnancy, proteinuria, anaemia, and postpartum haemorrhage were data extracted from the records. Results: The incidence of HOM pregnancy in this hospital was 0.24%. The mean maternal age was 35.7 ± 1.81 years. Over 85% of all the high-order multiple pregnancies in this hospital were from in-vitro fertilization and embryo transfer treatments for infertility. About 11% of the HOM pregnancy ended as spontaneous miscarriages. The mean gestational age at birth was 31 ± 1.5 weeks, and primary postpartum haemorrhage (22.2%) was the most common maternal adverse outcome from birth. Conclusion: The high incidence of HOM pregnancy in this hospital was mainly from in-vitro fertilization and embryo transfer. The HOM pregnancies are associated with high occurrence of preterm labour, caesarean sections and primary postpartum haemorrhage.
Highlights
The high-order multiple (HOM) pregnancies are associated with high occurrence of preterm labour, caesarean sections and primary postpartum haemorrhage
In Nigeria, about 35% of institutional deliveries occur in private medical institutions [6] and there has been an increase in the incidence of multiple births and HOM pregnancy in current day obstetric practice
The other 16 sets (89%) of HOM pregnancy were through fertility treatment with in-vitro fertilization and embryo transfer
Summary
Natural high-order multiple pregnancies (i.e. pregnancies with more than two foetuses in-utero) are uncommon. In Nigeria, about 35% of institutional deliveries occur in private medical institutions [6] and there has been an increase in the incidence of multiple births and HOM pregnancy in current day obstetric practice. Occurring high-order multiple (HOM) pregnancies are rare (1 - 7 per 10,000) even in Nigeria noted to have the highest twinning rates. Over 85% of all the high-order multiple pregnancies in this hospital were from in-vitro fertilization and embryo transfer treatments for infertility. The mean gestational age at birth was 31 ± 1.5 weeks, and primary postpartum haemorrhage (22.2%) was the most common maternal adverse outcome from birth. Conclusion: The high incidence of HOM pregnancy in this hospital was mainly from in-vitro fertilization and embryo transfer. The HOM pregnancies are associated with high occurrence of preterm labour, caesarean sections and primary postpartum haemorrhage
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