Clinical Analysis of Multiple Gestation Including Triplets and Quadruplets

Abstract

Objective: To investigate the youngest gestational age associated with the highest survival rate and the lowest major morbidity rate in triplets and quadruplets. Methods: Retrospective review of charts was performed to record the gestational age (GA), birth weight (BW), mode of delivery, mortality and neonatal complications of triplets and quadruplets. The cut off levels of GA and BW for survival and neonatal complications were determined by receiver operating characteristic curve. Results: All triplets and quadruplets who had been admitted to our neonatal intensive care unit from January 1995 to May 2005, were enrolled in this study. There was a total of 32 sets of triplets and 2 sets of quadruplets. Their mean GA was 31.4±3.2 weeks, mean BW 1527±492gms and mean hospitalization 37.5±30 days. The overall mortality rate was 8.4%. There were significant differences in GA and BW between infants who survived and those who died but there was no significant difference in the mode of delivery, or whether they were inborn or out born. The cut off values at which mortality significantly increased were GA ＜ 30 weeks (OR: 26.8; confidence interval: 3.1, 232.3) and BW＜1200gms (OR, 24.32; confidence interval: 2.81, 210.12). The cut off levels at which severe intraventricular hemorrhage significantly increased were GA＜29 weeks (OR: 32.47; confidence interval: 3.80, 277.51) and BW＜120gms (OR, 11.97; confidence interval: 2.29, 62.50). The cut off levels at which severe chronic lung disease significantly increased were GA＜28 weeks (OR: 37; confidence interval: 6.67, 205.1) and BW＜1100gms (OR, 172.66; confidence interval: 15.78, 1888.55). The cut off levels at which severe retinopathy of prematurity significantly increased were GA＜28 weeks (OR: 61; confidence interval: 5.75, 659.39) and BW＜1000gms (OR: 76; confidence interval: 6.82, 846.99). Conclusion: In triplet or quadruplet pregnancies, the pregnancy should continue to as close to 30 weeks as possible to prevent neonatal mortality. In order to prevent severe morbidity in premature babies, the gestational age should not be shorter than 28 weeks.