Document Detail

Aggressive perinatal care for high-order multiple gestations: Does good perinatal outcome justify aggressive assisted reproductive techniques?
MedLine Citation:
PMID:  10454665     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The purpose of this study was to determine the factors that must be considered for appropriate counseling of patients with high-order multiple gestations.
STUDY DESIGN: A retrospective chart review was carried out from all high-order multiple gestations that were managed by a single perinatology group from February 1993-June 1998. Twin pregnancies that did not result from fetal reduction procedures were used as a control group.
RESULTS: Clinical outcome data were analyzed from 9 quadruplet, 25 triplet, 19 reduced twin, and 24 nonreduced twin pregnancies. Women with quadruplet pregnancies were admitted more frequently at an early gestational age, the infants were delivered earlier, and the maternal and neonatal hospital days were longer than for triplet and reduced and nonreduced twin gestations. Triplet pregnancies had an earlier gestational age at delivery (32.3 vs 34.2 weeks), a higher incidence of preterm labor (87% vs 68%), and a higher percentage of neonatal intensive care unit admissions (94% vs 59%) than reduced twin gestations. Reduced twins were hospitalized longer (16.4 vs 9.8 days), were delivered earlier (34.2 vs 36.2 weeks), had a higher incidence of preterm labor (68% vs 29%), and had a greater percentage of neonatal intensive care unit admissions (59% vs 21%), a greater percentage of birth weight <1500 g, and a greater frequency of respiratory distress syndrome (16% vs 2%) than nonreduced twins. There was no difference in neonatal survival and neurologic morbidity when all groups were compared.
CONCLUSION: Although early delivery and prolonged (maternal and neonatal) hospitalization were common with quadruplets and triplets, maternal and neonatal outcomes were excellent. The decision for reduction from triplets to twins may not necessarily change pregnancy outcome but should still be discussed as an option for the parents. Continued efforts need to be made to reduce the overall number of iatrogenic high-order multiple gestations.
J L Angel; C S Kalter; W J Morales; C Rasmussen; L Caron
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  181     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  1999 Aug 
Date Detail:
Created Date:  1999-09-15     Completed Date:  1999-09-15     Revised Date:  2014-07-29    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  253-9     Citation Subset:  AIM; IM    
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MeSH Terms
Gestational Age
Infant Mortality
Infant, Low Birth Weight
Infant, Newborn
Intensive Care, Neonatal
Length of Stay
Perinatal Care*
Pregnancy Outcome*
Pregnancy Reduction, Multifetal
Pregnancy, Multiple*
Reproductive Techniques*
Respiratory Distress Syndrome, Newborn / epidemiology
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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