title: Maternal and neonatal outcome in triplet, quadruplet and quintuplet gestations following ART: a 11-year study.
abstract: OBJECTIVE
  To review the maternal and fetal outcome of triplet, quadruplet and quintuplet gestations following ART, which were managed at a hospital over 11 years.
  
  
  METHODS
  Retrospective chart review of 150 triplet, 27 quadruplet, and 6 quintuplet pregnancies between January 2001 and December 2011. 25 women aged 50-56 years with triplet pregnancies, were excluded due to lack of data. No prophylactic interventions were used.
  
  
  RESULTS
  300 triplets, 108 quadruplets, and 30 quintuplets were born. The mean maternal age was 30.2 years (SD 4.2 years). Mean gestational age delivery was 32.2 weeks (SD 4.2 weeks). Maternal complications included preterm labor 114 (86 %), prematurity 115 (87 %), anemia 44 (33 %) gestational diabetes 35 (27 %), preeclampsia 33 (25 %), post partum hemorrhage 13 (10 %). Preterm labor was diagnosed in 84 (84 %) triplets, 32 (97 %) of quadru- and quintuplet pregnancies (P > 0.05). Prematurity and preterm labor were major determinants. Of the 438 fetuses born there were 57 (13 %) still births, 77 (18 %) neonatal deaths. 32 (7 %) were early neonatal deaths, 45 (10 %) late neonatal deaths. The majority died due to extreme low birth weight. 75 (17 %) neonates had low apgar score of <7 at 5 min. 22 (5 %) infants had congenital anomalies. Severe respiratory distress syndrome, perinatal asphyxia, very early preterm delivery and perinatal mortality were higher in quadru- and quintuplets (P < 0.05).
  
  
  CONCLUSIONS
  Preterm labor and preterm prematurity were the commonest complications. Neonatal mortality and morbidity was significantly increased in quadru- and quintuplets. Prophylactic interventions were not used in an attempt to prevent preterm labor.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University, Safat, P.O. Box 24923, Kuwait, 13110, Kuwait, rachana_chibber@yahoo.co.uk.
authors.forename: Rachana
authors.initials: R
authors.lastname: Chibber
authors.forename: Mohamed
authors.initials: M
authors.lastname: Fouda
authors.forename: Wael
authors.initials: W
authors.lastname: Shishtawy
authors.forename: Mariam
authors.initials: M
authors.lastname: Al-Dossary
authors.forename: Jassim
authors.initials: J
authors.lastname: Al-Hijji
authors.forename: Ali
authors.initials: A
authors.lastname: Amen
authors.forename: Asiya Tasneem
authors.initials: AT
authors.lastname: Mohammed
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000209:etiology*; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D007730:Kuwait / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology*; D011272:Pregnancy, Multiple; D011296:Prenatal Diagnosis; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology