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PubMed1992

[Triplets and quadruplets in Switzerland, 1985-1988].

To determine the incidence of multiple births and associated morbidity and mortality, we collected in a retrospective study all the multiple births (twins excluded) in Switzerland from 1985 to 1988. In all we followed 77 sets of triplets and 9 sets of quadruplets, representing an annual incidence of 1/3968 births for the triplets and 1/33,947 births for the quadruplets. The incidence of induced pregnancies increased in the period 1985 to 1988. The principal complications were premature contractions and preeclampsia. Only 56% of the children were born in a hospital with a neonatal intensive care unit. The mean gestational age was 33 0/7 weeks (ranging from 25 0/7 to 38 5/7) for the triplets, and 30 5/7 weeks (ranging from 27 5/7 to 36 3/7) for the quadruplets. The mean birthweight was 1787 g (ranging from 560 to 3000 g) for the triplets and 1189 g (ranging from 590 to 1980 g) for the quadruplets. RDS was found to be the principal neonatal pathology (65.5% of triplets and 85.2% of quadruplets) with 18.8% of triplets and 61.8% of quadruplets requiring ventilation. The mortality rate in our study was 8.9% for triplets and 14.7% for quadruplets.

Birth Weight↗
PubMed1991

[Birth of triplets and quadruplets in Sweden].

The management of 86 women who were delivered of triplets and 7 women who were delivered of quadruplets between 1985 and 1989 is reviewed. The incidence of triplets and quadruplets was 16.3 and 1.3 per 100,000 deliveries. All of the quadruplets and 45 per cent of the triplets were a result of medical induction of ovulation (IVF 14 per cent). The average gestational age (weeks) and the mean birth weight (gram) was 33.4 +/- 2.3/1930 +/- 450 for the triplets, and 30.0 +/- 3.8/1365 +/- 385 for the quadruplets. Cesarean section was the mode of delivery in 84 per cent of the triplets and 5 of 7 of the quadruplets. The perinatal mortality was 4.7 per cent among the triplets and 14.3 per cent among the quadruplets.

Birth Weight↗
PubMed1991

Outcome of triplet and quadruplet pregnancies resulting from in vitro fertilization.

Analysis of the outcome of 26 sets of triplet and five sets of quadruplet pregnancies resulting from in vitro fertilization (IVF) shows an high incidence of antenatal complications including first trimester bleeding (53.3 and 80%), premature onset of labour (92.3 and 67%), pregnancy-induced hypertension (28.6 and 67%) and gestational diabetes mellitus (38.5 and 33%), respectively. Intra-uterine growth retardation occurred in 7.6 and 0%, while third trimester bleeding complicated 7.6 and 0% of triplet and quadruplet pregnancies, respectively. These patients were hospitalized for a mean of 22.9 +/- 19.4 and 56.0 +/- 30.5 days, respectively. The mean gestational age at delivery for triplet and quadruplet pregnancies was 31.8 +/- 2.7 and 30.3 +/- 0.6 weeks, while the mean birth weight was 1663 +/- 423 and 1232 +/- 181 g, respectively. These neonates stayed in the hospital for a mean of 28.1 +/- 16.2 and 69.6 +/- 15.5 days, respectively. The corrected perinatal mortality was 2.2% for triplets and 0% for quadruplets. These data can be used in counseling patients with triplet and quadruplet pregnancies especially those resulting from IVF.

Adult↗
PubMed1992

Outcome of twin, triplet, and quadruplet in vitro fertilization pregnancies: the Norfolk experience.

OBJECTIVE: To review the maternal morbidity and neonatal morbidity and mortality associated with in vitro fertilization (IVF) multiple pregnancies. DESIGN: Retrospective analysis of data collected from office and hospital records and from questionnaires sent to patients, their obstetricians, and pediatricians. SETTING: Patients (all with private insurance carriers) enrolled in an academic IVF program (The Jones Institute for Reproductive Medicine). PATIENTS, PARTICIPANTS: All IVF pregnancies resulting in one or more gestational sacs on the initial ultrasound at 6 to 7 weeks were reviewed. MAIN OUTCOME MEASURES: The frequency and severity of obstetrical and neonatal complications and the perinatal mortality of IVF twins, triplets, and quadruplets were compared. These were also compared with non-IVF multiple pregnancies. RESULTS: From 1982 to 1990, 629 IVF pregnancies progressed beyond 20 weeks; 115 twins (18.3%), 15 triplets (2.4%), and 4 quadruplets (0.6%). There was a high incidence of antenatal complications such as abortions (30.3%, 42%, and 20%), premature labor (41.5%, 92.3%, and 75%), pregnancy-induced hypertension (17.0%, 38.6%, and 50%), and gestational diabetes mellitus (3.1%, 38.5%, and 25%) for twins, triplets, and quadruplets, respectively. The mean gestational age at delivery was 35.5 +/- 3.7, 31.8 +/- 2.7, and 31.0 +/- 1.7 weeks, respectively. There was also a proportionate progressive increase in neonatal complications. The mean weights were 2,473 +/- 745, 1,666 +/- 441 and 1,414 +/- 368 g, respectively. Twins (22.7%), 64.1% of triplets, and 75% of quadruplets needed admission to the neonatal intensive care unit and remained for an average of 12.0 +/- 2.3, 17.4 +/- 14.0, and 57.8 +/- 17.9 days, respectively. There was no difference in the mean Apgar scores or the incidence of congenital malformations in the three groups. The corrected perinatal mortality rates were 38.5, 0.0, and 0.0 per thousand live births, respectively. CONCLUSION: Triplet and quadruplet IVF pregnancies have increased obstetrical and neonatal complications compared with IVF twins. The perinatal mortality and the incidence of congenital malformations are, however, comparable in all three groups.

Adult↗
PubMedDate not supplied

Breastfeeding success with preterm quadruplets.

Although the incidence of triplet and quadruplet birth has increased in the United States, few research-based guidelines are available for assisting mothers of these multiple births with breastfeeding. The purpose of this case study is to report a successful breastfeeding experience of a mother with preterm quadruplets. The quadruplets were born by cesarean delivery at 34 weeks' gestation and weighed from 1,820 g to 2,240 g. In-hospital breastfeeding experiences were managed by the authors, according to research-based guidelines for breastfeeding preterm neonates and infants. During the first month after discharge of the four newborns, the mother breastfed 12-34 times daily. Mean daily weight gains for the quadruplets during this time varied from 30 g to 54 g, indicative of adequate maternal milk supply. Nurses in maternity and neonatal specialties can apply the findings from this study to similar cases of mothers who want to breastfeed multiple neonates or infants.

Aftercare↗
PubMed1990

Seventy-one quadruplet pregnancies: management and outcome.

This article reviews the epidemiology, management, and outcome of 71 quadruplet pregnancies that occurred between 1980 and 1989. A study of detailed medical questionnaires and medical records revealed that 67 (94%) of the pregnancies followed ovulation induction therapy. A majority of the pregnancies were diagnosed by 9.3 weeks' gestation and bed rest was instituted by 16.7 weeks; 14% of women had cervical cerclages. Tocolytic agents were used in 59 (83%) of the group beginning at 24.5 weeks' gestation. The mean gestational age at delivery was 31.4 weeks and the mean birth weight was 1482 gm. Cesarean sections were performed in 89% of the cases. The average maternal weight gain was 45.8 pounds. Of the 284 fetuses, there were six first-trimester losses (including one ectopic pregnancy), 10 stillbirths and 33 neonatal deaths, resulting in a stillbirth rate of 29 per 1000, and corrected neonatal and perinatal mortality rates of 37 per 1000 and 67 per 1000, respectively. Other than premature labor, the most common maternal complications were first-trimester bleeding (35%), toxemia (32%), and anemia (25%). The quadruplet fetal growth curve parallels the singleton 25th percentile until 34 weeks, when it drops below the 10th percentile. These data suggest that a majority of quadruplets are delivered after 28 weeks and a viable outcome is expected. Because of retarded growth after 34 weeks, delivery should be considered at 34 weeks in most cases.

Adult↗
PubMed1992

Triplet, quadruplet and quintuplet pregnancies. Management and outcome.

The management and outcome of 46 pregnancies, 37 triplets, 7 quadruplets and 2 quintuplets, were analysed. Management of pregnancies, initiated upon diagnosis of multiple pregnancy, included bed rest, beta-mimetic agents, dexamethasone late in the second trimester and selective cerclage. The mean gestational age at labor was 235 days in triplet pregnancies, 241 for quadruplets and 220 days for quintuplets. Fifty-four percent of the deliveries were by cesarean section and the remainder per vaginam. The mean weight of the neonates was 1809 g for the triplets, 1837 g for quadruplets and 1284 g for the quintuplets. The mean overall Apgar score was 8.13, total perinatal mortality 14.8% and 9.4% in cases more than 28 weeks. There was no statistically significant difference in the outcome for triplets born vaginally or by cesarean section. In recent years there has been a pronounced reduction in neonatal mortality, dropping from 17.3% during 1970-78 to 5.9% from 1979 to 1983 (p less than 0.05), probably due to the improved neonatal treatment.

Adult↗
PubMed1992

Quadruplet pregnancy: contemporary management and outcome.

Quadruplets are occurring more frequently as assisted-reproduction techniques improve fertility in couples previously unable to conceive. Ten quadruplet pregnancies cared for in one perinatal practice over 5 years had excellent outcome. The mean gestational age at delivery was 32.5 weeks, compared with approximately 30 weeks in the literature. There were no perinatal deaths and no long-term morbidity. Our patients were compared with a series of 57 consecutive patients with quadruplet pregnancies monitored by a home monitoring system. Parity of 1 or more appeared to improve outcome. Pregnancy-induced hypertension occurred in nine of our pregnancies and necessitated delivery in seven instances. Fetal distress was responsible for two deliveries and uncontrollable preterm labor for only one. Key points in our management protocol include prophylactic use of low-dose aspirin, home contraction monitoring, use of terbutaline pump tocolysis, and bed rest at home starting at 16 weeks.

Adult↗
PubMed1989

Management and outcome of 21 triplet and quadruplet pregnancies.

The course of gestation and the outcome of fifteen triplet and six quadruplet pregnancies are reviewed. Twenty pregnancies followed induction of ovulation and only one was spontaneous. Bed rest, the use of beta-mimetics and betamethasone, and prolonged hospitalisation were part of the management. Elective cervical suture was not used. The most frequent antenatal complications were preterm labor, preterm rupture of membranes and pregnancy-induced hypertension. The median gestational age was 33.5 weeks in the triplets and 32 weeks in the quadruplets. The overall perinatal and neonatal mortality was 4.9%. The neonatal complications resulted from prematurity and sepsis.

Adult↗
PubMedDate not supplied

Triplet and quadruplet pregnancies--a forthcoming challenge also for the 'general' obstetrician.

Data from 14 triplet and 2 quadruplet pregnancies (50 infants) during the period 1974-1988 were analysed. The perinatal mortality rate was only 6%, despite a preterm delivery rate of 88%. Preterm delivery was more common in young (less than or equal to 29 years) multiparous women. Perinatal complications were, as expected, strongly associated with immaturity. Respiratory problems of the infants occurred significantly more often among women delivered by elective Cesarean section than among those planned for vaginal delivery, but the mean gestational duration was 1 week longer in the latter group. Few problems arise in infants weighing 2000 g or more, or at delivery at 34 weeks or later, and under optimal conditions it would therefore seem safe to allow these women to give birth vaginally. Nor did birth order affect the outcome for infants born vaginally. It is recommended that quadruplets be delivered by Cesarean section because of the difficulty of ensuring satisfactory fetal surveillance in labor.

Adult↗
PubMed1989

Is elective cerclage justified in the management of triplet and quadruplet pregnancy?

The main complication in multiple gestation with more than two fetuses is prematurity, with its concomitant increase in perinatal mortality and morbidity. Clearcut indications as to management of these pregnancies are lacking, and the efficiency of elective cerclage is controversial. Twelve triplets and three quadruplets out of 27 multiple pregnancies were electively sutured and compared to 10 triplets and two quadruplets without this procedure. Otherwise, both groups were managed uniformly regarding bed-rest, beta-mimetic drugs and dexamethasone for the enhancement of fetal lung maturity. Mean duration of pregnancy in patients with cerclage was 35 weeks, significantly longer than those who did not undergo this procedure (30.7 weeks) (p < 0.01). Furthermore, in the former group, the mean neonatal weight was significantly higher (p < 0.01), mean Apgar scores were better, significantly lower rates of respiratory distress syndrome occurred (p < 0.05), perinatal mortality rate was significantly reduced (p < 0.01) and the mean hospitalization period was shorter (p < 0.025). It seems that elective cervical suture is a definite contribution to the successful management of multiple pregnancies with more than two fetuses.

Apgar Score↗
PubMed1991

[Anesthetic management of caesarean section for the delivery of quadruplets].

Multiple gestation pregnancies are accompanied with risks for both mother and fetuses. Morbidity and mortality of both of them are increased compared with singleton pregnancies. We have presented a case of a 30-year-old parturient with quadruplets. The pregnancy had been complicated by premature labour, anemia, toxemia, coagulopathy, pulmonary congestion and malpresentation. On the 29th week of pregnancy, an elective Caesarean section was scheduled. There is no ideal anesthetic technique for quadruplets. In this case general anesthesia was chosen, because she had coagulopathy. The anesthesia and postoperative course were uneventful. The patient and the four babies had no complication nor sequela on their discharge. The anesthetic considerations for multiple gestation pregnancies were also discussed.

Adult↗
PubMed1978

Maternal serum alpha-fetoprotein levels in triplet and quadruplet pregnancy.

Maternal serum alpha-fetoprotein (AFP) levels were higher in six triplet pregnancies and three quadruplet pregnancies than in control singleton pregnancies matched for maternal age, parity and time of gestation at which the serum sample was taken. Between 12 and 23 weeks of pregnancy, the average AFP levels among the triplet pregnancies was three times that found in the singleton pregnancies, and the level in the quadruplet pregnancies was even higher. Maternal serum AFP levels appear to be associated with the number of fetuses in utero.

Female↗
PubMed1977

Quadruplet hallucinations. Phenotypic variations of a schizophrenic genotype.

This article provides an in-depth analysis of hallucinations in monozygous quadruplets concordant for schizophrenia. Since all four are genetically identical, deviations among them with regard to various aspects of hallucinations probably represent the effects that nongenetic factors can produce in hallucinating schizophrenics. Concordance probably represent the effects of genetic factors. We present here findings based on this research strategy, and a brief review of the literature on hallucinations.

Adult↗
PubMed1978

Anaesthetic considerations in caesarean section for quadruplets.

A case of a caesarean delivery with epidural analgesia of a term parturient with quadruplets is presented. Maternal considerations of hypotension, respiratory embarrassment and aspiration of gastric content and foetal considerations of prematurity and impaired placental function are discussed relative to the use of general anaesthesia or epidural analgesia.

Adult↗
PubMed1990

The outcome of triplet, quadruplet, and quintuplet pregnancies managed in a perinatal unit: obstetric, neonatal, and follow-up data.

Multifetal gestation is associated with increased frequency of maternal complications and higher perinatal morbidity and mortality. The need for contemporary data on the outcome of multifetal gestations is further underscored when selective reduction is considered. The present study details the obstetric management, neonatal outcome, and follow-up data of 24 triplet, five quadruplet, and one quintuplet pregnancies delivered in a perinatal center. The early neonatal mortality rate was 31.6, the late neonatal mortality rate was 21, and the perinatal mortality rate was 51.5. Survival to discharge was 93%. The incidence of respiratory distress syndrome was 43%, bronchopulmonary dysplasia 6%, retinopathy of prematurity 3%, intraventricular hemorrhage 4%, and cerebral palsy 2%. Follow-up from 1 to 10 years shows that only one child is moderately handicapped, whereas 99% have no significant medical problem. Early diagnosis by ultrasonography, meticulous antenatal care, early hospitalization, delivery by cesarean section, and on-site availability of a neonatologist for each baby at the time of delivery are the probable major determinants of improved outcome.

Child Development↗