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CARS Archives



Multiple pregnancies and fetal reduction (3)
Title: Aggressive perinatal care for high-order multiple gestations: Does good perinatal outcome justify aggressive assisted reproductive techniques?
Author: J. Angel, et al.
Address: Tampa, Florida
Source: American Journal of Obstetrics and Gynecology 181: 253-259 (August) 1999
Summary: A retrospective chart review was carried out from all high-order multiple gestations that were managed by a single perinatology group from Feb. 1993-June 1998 to determine the factors that must be considered for appropriate counseling of patients with high-order gestations. Clinical outcomes were analyzed from 9 quadruplet, 25 triplet, 19 reduced twin, and 24 nonreduced twin pregnancies. Women with quadruplet pregnancies were admitted more frequently at an early gestational age, the infants were delivered earlier, and the maternal and neonatal hospital days were longer than for triplet and reduced and nonreduced twin gestations. Triplets had an earlier gestational age at delivery, a higher incidence of preterm labor, and a higher percentage of neonatal intensive care unit admissions than reduced twin gestations. Reduced twins were hospitalized longer, were delivered earlier, had a higher incidence of preterm labor, and had a greater percentage of neonatal intensive care unit admissions, a greater percentage of birth weight and a greater frequency of respiratory distress syndrome than nonreduced twins. There was no difference in neonatal survival and neurologic morbidity when all groups were compared. Although early delivery and prolonged hospitalization were common with quadruplets and triplets, maternal and neonatal outcomes were excellent.
Comment: Clearly multiple gestations will always be a part of therapy with our present fertility promoting technologies. Still, the best method is to avoid rather than treat multiple gestations. Presently, the two greatest advances that could be made in the field of reproductive medicine would be to reduce transfer rate after IVF to no more than two embryos and for insurance companies to recognize infertility as a disease and cover therapy. The societal and economic benefit would be enormous.

 

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