title: The neonatal outcome in twin versus triplet and quadruplet pregnancies.
abstract: BACKGROUND
  To assess the risk of neonatal mortality and morbidity in twin, triplet and quadruplet pregnancies.
  
  
  METHODS
  In a retrospective study, the neonatal outcome of all twin, triplet and quadruplet gestations delivered from October 2001 to September 2006 was reviewed. The neonatal outcome of triples and quadruplets was compared with a matched group of twins for gestational age.
  
  
  RESULTS
  During a 5-year period, 511 sets of twin pregnancies, 42 sets of triplet and 5 sets of quadruplet pregnancies were studied. The mean of gestational age for twins, triplets and quadruplets were 33.92 ± 3.5 weeks, 30.92 ± 3.8 weeks and 31.60 ± 2.0 weeks, respectively, (P = 0.0001). Triplets and quadruplets weighed less than twins, (P = 0.0001). Neonatal mortality was 13.5% for twins, 26.8% for triplets and 30% for quadruplets. In vitro fertilization, use of ovulation induction agents, and cesarean delivery in the women with triplet and quadruplet were significantly higher than in those with twin pregnancies, (P = 0.0001). The mean age of mothers with triplets and quadruplets was significantly higher than with twins (P = 0.026). There was not a significant difference in respiratory and non-respiratory short outcomes between triplets, quadruplets and twins when matched for gestational age. Apgar score at 1 and 5 minutes was significantly lower in triplets and quadruplets than twins. There was no influence of birth order on neonatal mortality of triplet pregnancy. Neonatal mortality of triplet births was significantly decreased over the 5 years of the study period.
  
  
  CONCLUSIONS
  Triplets and quadruplets have a similar neonatal outcome as twins when matched for gestational age. There is no influence of birth on the neonatal mortality of triplet pregnancy. It appears that outcome is mainly dependent on gestational age.
authors.affiliation: Neonatologist, Assistant Professor of Pediatrics, Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail: nasseri@med.mui.ac.ir (Corresponding author).
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Nasseri
authors.forename: Afshin
authors.initials: A
authors.lastname: Azhir