Seventy-one quadruplet pregnancies: management and outcome

Article Abstract:

The number of multiple-fetus pregnancies has increased since the introduction of fertility drugs and new reproductive technologies. But counseling patients who are pregnant with more than one fetus is hampered by the lack of information regarding the outcome of multiple pregnancies, particularly supermultiples. The epidemiology, management and pregnancy outcome of 71 quadruplet pregnancies (four fetuses each) registered with the Triplet Connection were reviewed; this is a support group for mothers of supermultiples. Ovulation induction therapy (fertility drugs) was used in 67 (94 percent) of the cases. Most of the pregnancies were diagnosed as multiple by the ninth week of pregnancy. Best rest was recommended by 16.7 weeks of pregnancy on average, and 14 percent of the women required cervical cerclage, a method which applies sutures to the cervical opening to prevent early dilation. Drugs that prevent premature labor and delivery were used by the 24th week of pregnancy in 59 pregnancies (83 percent). Most of the infants were delivered by cesarean section (89 percent) at an average of 31.4 weeks of pregnancy. The average infant birth weight was 3.3 pounds. The mothers gained an average of 45.8 pounds. Of the 284 fetuses, six were lost during the first three months of pregnancy, 10 were stillborn, and 33 died soon after birth. The overall stillbirth rate was 29 per 1,000 fetuses. The neonatal death rate was 37 out of 1,000 and the perinatal death rate was 67 out of 1,000. Premature labor was the most common complication of pregnancy, occurring in 70 patients (98 percent). Other common complications were bleeding in the first three months of pregnancy (25 patients, 35 percent), toxemia (23 patients, 32 percent), and anemia (18 patients, 25 percent). Fetal growth patterns matched those of single-fetus pregnancies until the 34th week of pregnancy, after which a drop from the 25th percentile to the 10th percentile on standard growth charts was noted. The outcome of quadruplet pregnancies is particularly good if the pregnancy continues to the 34th week of pregnancy. At that time, delivery is recommended to prevent fetal growth retardation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Statistics, Prognosis

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The outcome of triplet gestations complicated by fetal death

Article Abstract:

Little has been reported in the medical literature regarding the outcome of pregnancies with triplets during which one fetus dies prior to delivery, although it is known that the death of one fetus compromises the other in the case of twins. Therefore, the medical records of five triplet pregnancies were reviewed in which one or more fetal death occurred, out of a total of 26 triplet pregnancies delivered at one medical institution during a 10-year period. In only one of the five study cases did two fetuses die; in the remainder, one death occurred, yielding a 19.2 percent mortality. The surviving fetuses were compared with a control group of fetuses from triplet pregnancies in which all survived. The average age at which death was diagnosed was approximately 30 gestational weeks, but it had most likely occurred several weeks earlier in three cases. Delivery took place at approximately 34 weeks. Six of the placentas associated with the 26 pregnancies were monochorionic (in which one chorionic sac, the outer layer of cells in the sac surrounding the fetuses and from which the placenta ultimately develops, is shared by the multiple fetuses), and four of these were associated with fetal death. Four of the nine infants delivered were small for gestational age (SGA), that is, small for the calculated age at delivery, and one had congenital heart defects. The infant who was sole survivor of the triplet pregnancy developed retinopathy of prematurity (disease of the retina) and, ultimately, blindness, as a result of treatment for respiratory distress syndrome (insufficient respiration, often associated with prematurity). Overall, the fetuses whose co-triplets had died were more likely to be growth-retarded and to have monochorionic placentas. No differences were noted in maternal age, birth weight, cesarean deliveries, long-term health or related variables. Women pregnant with triplets should be closely monitored at a perinatal care center. However, fetal death among triplets need not prompt immediate delivery of the remaining fetuses; the decision to deliver should be based on conventional obstetrical criteria. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Complications and side effects, Fetal death

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

Article Abstract:

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.)

Evaluation, Obstetrics, Quintuplets

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