Perinatal outcomes and challenges in higher-order multiple gestations: insights from a retrospective analysis at a...

Higher-order multiple gestations (HOM), defined as pregnancies with three or more fetuses, have increased due to assisted reproductive technologies (ART). However, they are associated with significant maternal and fetal risks, including preterm birth and complications from monochorionic placentation.

To evaluate maternal and neonatal outcomes in HOM pregnancies managed at a tertiary care center in the UAE, assess the impact of chorionicity, and examine the role of ART in these high-risk pregnancies.

A retrospective study was conducted on 102 cases of HOM pregnancies over four years. Data on maternal demographics, conception methods, obstetric complications, and neonatal outcomes were collected and analyzed. Chorionicity was determined using ultrasound and placental histopathology.

ART was the primary mode of conception (57.8%), particularly in dichorionic triamniotic (DCTA) pregnancies (81%). Preterm delivery was prevalent, with 45% of births after 32 weeks and 12.7% before 28 weeks. Neonatal mortality was higher in DCTA pregnancies (10.6%) compared to trichorionic triamniotic (TCTA) pregnancies (5%), with a relative risk (RR) of 2.12. Postpartum hemorrhage affected 70.8% of mothers, but serious maternal morbidity was rare.

Higher-order multiple pregnancies challenge obstetricians and neonatologists. Addressing prematurity, optimizing management protocols, fertility practices, and counselling can improve maternal and perinatal outcomes effectively.