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The Management and Outcome of Higher Order Multifetal Pregnancies: Obstetric, Neonatal and Follow-up Data

Published online by Cambridge University Press:  21 February 2012

Mark H. Yudin
Affiliation:
University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology.
Elizabeth V. Asztalos*
Affiliation:
University of Toronto, Toronto, Ontario, Canada; Departments of Newborn and Developmental Pediatrics and Neonatology; Women's College Campus of Sunnybrook and Women's College Health Sciences Center.
Ann Jefferies
Affiliation:
University of Toronto, Toronto, Ontario, Canada; Departments of Newborn and Developmental Pediatrics and Neonatology; Mount Sinai Hospital.
Jon F.R. Barrett
Affiliation:
University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology; Women's College Campus of Sunnybrook and Women's College Health Sciences Center.
*
*Address for Correspondence: Elizabeth V. Asztalos, MD., Sunnybrook and Women's College Health Sciences Center, Women's College Campus, 76 Grenville Street, Room 466, Toronto, Ontario M5S 1B2, Canada.

Abstract

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The objective of this study was to describe current obstetric, neonatal, and long-term neurodevelopmental outcomes of higher order multifetal gestations (≥ 3 fetuses) in the 1990s. We also intended to identify a target gestational age at which neonatal and neurodevelopmental morbidities are low. Records from all multifetal pregnancies (≥ 3 viable fetuses ≥ 20 weeks gestation) delivered at the two perinatal centers in Toronto, Ontario, Canada during the study period (January 1, 1990–December 31, 1996) were reviewed. Data were collected on obstetric, neonatal, and long-term neurodevelopmental outcomes. Follow up data were gathered regarding the presence of a severe deficit in four categories (vision, hearing, cognition, and motor skills). Statistical analysis was performed to determine a gestational age at which a significant decrease in deficit occurred. During the study period 165 multifetal pregnancies were delivered. This resulted in 511 fetuses, of which 496 were live births. Of these 496 infants, 453 survived to discharge. Follow up data were obtained on 332 (73.3 per cent) infants. Infant survival increased with gestational age, and was approximately 90 per cent or greater at 26 weeks or more. Of all infants followed, the proportion of those without deficit increased with increasing gestational age, such that the per cent without deficit was 96.9 at 31 weeks or greater. Of all infants followed, 301 (90.7 per cent) had no deficit. Statistical analysis revealed a significant difference in long-term neurodevelopmental outcome between infants born before and after 28 weeks gestation. The incidence of a major deficit was 44.1 per cent for those born earlier than and 5.4 per cent for those born later than this gestational age (p = 0.001). In our cohort, survival figures were high. Even in lower gestational groupings, survival was high, but not without serious concerns about severe morbidity. This information is useful when counseling parents of higher order multifetal pregnancies.

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Copyright © Cambridge University Press 2001
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