Complications in High Order Multiple Pregnancies

Abstract

Purpose: In this retrospective study 43 pregnancies with high order multiples (triplets and quadruplets) were analysed. Results: The most prevalent complication in this cohort of 38 triplet and 5 quadruplet pregnancies was premature labour (74.4%). Patients came for delivery to the hospital in only 14% of pregnancies - in the other 86% patients were sent to the hospital already days or weeks before delivery because of a higher pregnancy risk. In 58.1% of cases anemia was diagnosed before delivery. After a median of 15 days children were delivered in the 32 + 5 week of gestation (median). All children were born premature. 18.6% of patients received transfusions due to anemia, in 72.1% prostaglandins were administered due to atonia. Furthermore, 11.6% of patients were transferred to an intensive care unit, one patient died due to severe HELLP syndrome. The mean birth weight of 114 triplet and 20 quadruplet children was 1575 g (median). 118 children were referred to a neonatal intensive care unit. With respect to perinatal complications 47.8% of children showed respiratory distress syndrome, 10.5% had intracranial bleeding. Follow-up data could be collected from 51 out of 124 surviving children. In 9.8% of these cases a severe disability was diagnosed. In total, 18.6% of all families were affected by at least one dead child or by at least one child with a severe disability. Conclusion: Neonatal morbidity as well as maternal data are comparable to data from other, similiar cohorts. Data regarding neonatal outcome show additional risks compared to singleton pregnancies. Since the gestational age at delivery of high order multiples did not change during the last decades, good success rates could be achieved regarding perinatal mortality. However, the best and optimal approach is the avoidance of high order multiple pregnancies as well as of multiple pregnancies in all assisted reproductive procedures and all procedures with ovulation induction. Strategies are discussed, which might be helpful to achieve this goal.