title: Outcomes of multifetal pregnancies.
abstract: OBJECTIVE
  To determine the outcomes of multifetal pregnancies and to compare maternal and neonatal complications between spontaneously conceived and assisted reproductive therapy.
  
  
  METHODS
  A retrospective analysis was conducted of the information from medical records relating to all multifetal pregnancies. The outcomes were analyzed and used for a comparison between spontaneous and assisted multifetal pregnancies.
  
  
  RESULTS
  There were 387 multifetal pregnancies during the study period, which was 1.3% of all the deliveries; 334 cases (86.3%) were spontaneous conceptions and 53 cases (13.7%) were the result of assisted reproductive therapy. Higher-order fetuses (> or =3) represented 8% of all multifetal pregnancies, 13% in the spontaneous group and 87% in the assisted group. The overall cesarean delivery rate was 73.9%. The assisted reproductive therapy group had a cesarean rate of 90.6% compared with 71.3% in the spontaneous group (P = 0.008). The assisted multifetal pregnancy group had more preterm labors and a longer maternal hospital stay than the spontaneous group. One maternal death occurred in the assisted group. The main causes of early neonatal death were prematurity, infection and congenital malformation. The newborns in the assisted group had more complications than the spontaneous group; most notable were respiratory distress syndrome, newborn intensive care admission, infection and longer hospital stay (6 days vs 15 days, P < 0.001). More complications occurred in higher-order fetuses than with twins.
  
  
  CONCLUSIONS
  Assisted multifetal pregnancies were more likely to be delivered by cesarean section and had a higher rate of higher-order fetuses, preterm birth and neonatal prematurity-related complications with a longer hospital stay in both mothers and newborns, than spontaneous multifetal pregnancies.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand. ounjai.k@psu.ac.th
authors.forename: Ounjai
authors.initials: O
authors.lastname: Kor-anantakul
authors.forename: Chitkasaem
authors.initials: C
authors.lastname: Suwanrath
authors.forename: Thitima
authors.initials: T
authors.lastname: Suntharasaj
authors.forename: Chatpavit
authors.initials: C
authors.lastname: Getpook
authors.forename: Roengsak
authors.initials: R
authors.lastname: Leetanaporn
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008423:Maternal Age; D007744:Obstetric Labor Complications / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies