Isaac Blickstein1, Louis G Keith. 1. Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel. blick@netvision.net.il
Abstract
PURPOSE OF REVIEW: To present data related to the outcome of triplets and high-order multiple pregnancies. RECENT FINDINGS: Current frequencies of high-order multiple pregnancies in most developed countries range between 400 and 800% above the rates observed in the late 1970s. Of particular importance is the striking increase in pregnancies in older mothers. These epidemiological trends are the result of modern infertility treatments. The improved outcome of triplets may be attributed to close antenatal and perinatal care, both of which are more likely to be implemented in patients who can afford treatment for infertility. The overall odds of delivering at least one triplet infant weighing less than 1000 g is approximately 10%. The neonatal complications among triplets weighing less than 1500 g at birth are not much different from those among twins or singletons, except for a higher neonatal mortality rate. Despite this, the frequency of cerebral palsy bears a significant exponential relationship to the number of fetuses, and iatrogenic multiple births are clearly implicated in the increased cerebral palsy rate. In the past few years the perinatal mortality rate for triplets has been approximately 110/1000, three-quarters of which represent neonatal deaths. SUMMARY: Available data imply that in order to improve outcomes further, all multiple pregnancies deserve optimal perinatal care, something that is not always obtainable.
PURPOSE OF REVIEW: To present data related to the outcome of triplets and high-order multiple pregnancies. RECENT FINDINGS: Current frequencies of high-order multiple pregnancies in most developed countries range between 400 and 800% above the rates observed in the late 1970s. Of particular importance is the striking increase in pregnancies in older mothers. These epidemiological trends are the result of modern infertility treatments. The improved outcome of triplets may be attributed to close antenatal and perinatal care, both of which are more likely to be implemented in patients who can afford treatment for infertility. The overall odds of delivering at least one triplet infant weighing less than 1000 g is approximately 10%. The neonatal complications among triplets weighing less than 1500 g at birth are not much different from those among twins or singletons, except for a higher neonatal mortality rate. Despite this, the frequency of cerebral palsy bears a significant exponential relationship to the number of fetuses, and iatrogenic multiple births are clearly implicated in the increased cerebral palsy rate. In the past few years the perinatal mortality rate for triplets has been approximately 110/1000, three-quarters of which represent neonatal deaths. SUMMARY: Available data imply that in order to improve outcomes further, all multiple pregnancies deserve optimal perinatal care, something that is not always obtainable.