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.