Seventy-one quadruplet pregnancies: management and outcome

This article reviews the epidemiology, management, and outcome of 71 quadruplet pregnancies that occurred between 1980 and 1989. A study of detailed medical questionnaires and medical records revealed that 67 (94%) of the pregnancies followed ovulation induction therapy. A majority of the pregnancies were diagnosed by 9.3 weeks' gestation and bed rest was instituted by 16.7 weeks; 14% of women had cervical cerclages. Tocolytic agents were used in 59 (83%) of the group beginning at 24.5 weeks' gestation. The mean gestational age at delivery was 31.4 weeks and the mean birth weight was 1482 gm. Cesarean sections were performed in 89% of the cases. The average maternal weight gain was 45.8 pounds. Of the 284 fetuses, there were six first-trimester losses (including one ectopic pregnancy), 10 stillbirths and 33 neonatal deaths, resulting in a stillbirth rate of 29 per 1000, and corrected neonatal and perinatal mortality rates of 37 per 1000 and 67 per 1000, respectively. Other than premature labor, the most common maternal complications were first-trimester bleeding (35%), toxemia (32%), and anemia (25%). The quadruplet fetal growth curve parallels the singleton 25th percentile until 34 weeks, when it drops below the 10th percentile. These data suggest that a majority of quadruplets are delivered after 28 weeks and a viable outcome is expected. Because of retarded growth after 34 weeks, delivery should be considered at 34 weeks in most cases.