TRIPLET AND QUADRUPLET PREGNANCIES AND MANAGEMENT

  • 1 January 1981
    • journal article
    • research article
    • Vol. 57  (4) , 458-463
Abstract
The rate of multiple pregnancies with more than 2 fetuses significantly increased since the introduction of ovulation induction agents. From 1970 through 1978, there were 19 triplets and 6 quadruplets in this department, indincidences of 1:1696 and 1:5370, respectively. Of the 25 multiple pregnancies, 18 [72%] followed treatment with ovulation induction agents and 7 were spontaneous. The diagnosis of more than 2 fetuses was made earlier in the induced than in the uninduced pregnancies. Management, initiated upon diagnosis, included bed rest, highprotein diet, .beta.-mimetic agents, progestins, dexamethasone late in the 2nd trimester and selective cerclage. The mean gestational age was 34 wk in the triplets and 35 wk in the quadruplets. Of the deliveries, 44% were by cesarean section ad the remainder were by vaginal delivery. The mean weight of the neonates was 1807 g in the triplets and 1950 g in the quadruplets. The mean overall Apgar score was 8.16, and the perinatal mortality was 18.5%, corrected (more than 28 wk) to 13.7%. The main neonatal complications resulted from prematurity, and the maternal complication notes was postpartum hemorrhage necessitating hysterectomy in 2 patients. The preferable mode of delivery cannot be stated. Fetal outcome was similar in vaginal and cesarean deliveries among the various gestational age groups.