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High-order multifetal gestations from ovulation induction therapy often lead to premature births. While many infants develop normally, significant risks of low birth weight and developmental delays persist.

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Area of Science:

  • Reproductive Medicine
  • Maternal-Fetal Medicine
  • Neonatology

Background:

  • High-order multifetal gestations (quadruplets or more) present significant challenges in obstetric care.
  • Ovulation induction therapy is a common cause of these complex pregnancies.
  • Premature labor is a near-universal complication in high-order multiples.

Purpose of the Study:

  • To evaluate the outcomes of high-order multifetal gestations (quadruplets or more) managed in a single department.
  • To assess the incidence of prematurity, birth weight, and long-term neurodevelopmental status in these infants.

Main Methods:

  • Retrospective review of 11 high-order multifetal gestations (quadruplets or more) reaching the second trimester between 1975-1989.
  • Analysis of delivery modes (vaginal vs. cesarean), gestational age at delivery, and infant birth weights.
  • Follow-up assessment of neurodevelopmental outcomes for infants surviving at least 2 years corrected for gestational age.

Main Results:

  • All 11 pregnancies resulted from ovulation induction therapy and experienced premature contractions.
  • Deliveries occurred between 25-35 weeks' gestation, with high rates of stillbirths and neonatal deaths.
  • 74% of live-born infants weighed less than 1500g; 70% of 30 followed infants developed normally, but 30% had varying degrees of developmental delay or severe handicaps.

Conclusions:

  • High-order multifetal gestations, particularly those from ovulation induction, carry substantial risks for preterm birth and adverse perinatal outcomes.
  • Long-term neurodevelopmental follow-up reveals a significant proportion of survivors experience delays or severe handicaps, necessitating specialized care.
  • Improved management strategies and counseling are crucial for pregnancies with high-order multiples.