Is the Route of Delivery a Meaningful Issue in Triplets and Higher Order Multiples?

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Abstract
The incidence of higher order multiple pregnancies has increased during the past 20 years, mainly due to the increasing availability of ovulation-inducing agents and secondarily to use of techniques of assisted reproduction. Parallel with this, the incidence of cesarean deliveries increased substantially in developed countries. The popularity of abdominal delivery resulted partly from the somewhat dogmatic belief that cesarean section may relieve intrapartum fetal distress and thereby improve perinatal outcome. Not surprisingly, the question was raised as to whether cesarean section would improve the historically poor neonatal outcome of triplets. This concern was the origin of the extensive use of cesarean section in higher order multiple births. Recent data have suggested, however, that a less invasive approach might be safer and more effective.

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