Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-24T03:58:40.403Z Has data issue: false hasContentIssue false
  • English
  • Français

Variable Outcome in Quintuplets Pregnancy Based on Obstetric Care

Published online by Cambridge University Press:  21 February 2012

Grzegorz H. Bręborowicz ,
Anna Dera ,
Marta Szymankiewicz ,
Mariola Ropacka-Lesiak  and
Wiesław Markwitz
Grzegorz H. Bręborowicz
Affiliation:
Department of Perinatology and Gynecology, Poznan University of Medical Sciences, Poland
Anna Dera*
Affiliation:
Department of Perinatology and Gynecology, Poznan University of Medical Sciences, Poland
Marta Szymankiewicz
Affiliation:
Department of Neonatology, Poznan University of Medical Sciences, Poland
Mariola Ropacka-Lesiak
Affiliation:
Department of Perinatology and Gynecology, Poznan University of Medical Sciences, Poland
Wiesław Markwitz
Affiliation:
Department of Perinatology and Gynecology, Poznan University of Medical Sciences, Poland
*
ADDRESS FOR CORRESPONDENCE: Anna Dera, Department of Perinatology and Gynecology, Poznan University of Medical Sciences, Ul. Polna 33, Poznan 60–535, Poland. E-mail: [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The incidence of multiple pregnancies has increased dramatically over the last few years in developed countries, largely attributed to delayed childbearing and the increasing use of assisted reproduction technologies and ovulation inducing hormones. Relatively few countries have population-based statistics covering birth statistics. Of those that do, the numbers of quintuplet pregnancies rose sharply in the nineties while, at the same time, their delivery rates decreased greatly because of the use of fetal reduction. Fetal reduction is not possible or legal in some countries, Poland being one of them, and therefore obstetricians are faced with the challenges of quintuplet deliveries. Conservative treatment and management is difficult, and outcomes often vary greatly. Despite this, expert care provided at tertiary care centers can positively influence outcomes. The objective of this article is to present different care options and their consequences in two illustrative cases, as well as to establish a set of obstetric care and management goals that would allow prolongation of the gestation time. Quintuplet pregnancy is rare but poses relevant clinical problems to both the obstetrician and the neonatologist. It should be managed with close cooperation between all concerned. Due to the extreme and invariable risk of premature delivery associated with quintuplet pregnancies, we recommend early diagnosis, adequate prenatal care at one tertiary medical center, routine hospitalization and bed rest, repeated ante partum ultrasound surveillance with tests of fetal well-being, tocolytic therapy at first signs of the risk of premature labor, and specialized neonatology care after delivery.

Keywords

quintupletspregnancy
Type
Articles
Information
Twin Research and Human Genetics , Volume 14 , Issue 6 , December 2011 , pp. 580 - 585
Copyright
Copyright © Cambridge University Press 2011

References

Adams, D. M., Sholl, J. S., Haney, E. I., Russel, T. L., & Silver, R. K. (1998). Perinatal outcome associated with outpatient management of triplet pregnancy. American Journal of Obstetrics and Gynecology, 178, 843–847.Google ScholarPubMed
Albrecht, J. L., & Tomich, P. G. (1996). The maternal and neonatal outcome of triplet gestations. American Journal of Obstetrics and Gynecology, 174, 1551–1556.CrossRefGoogle ScholarPubMed
Ayres, A., & Johnson, T. (2005). Management of Multiple Pregnancy: Prenatal Care — Part I. Obstetric and Gynecological Survey, 60, 527–537.CrossRefGoogle ScholarPubMed
Barkehall-Thomas, A., Woodward, L., & Wallace, E. M. (2004). Maternal and neonatal outcomes in 54 triplet pregnancies managed in an Australian tertiary centre. Australian and New Zealand Journal of Obstetrics and Gynecology, 44, 222–227.CrossRefGoogle Scholar
Bernasko, J., Lee, R., Pagano, M., & Kohn, N. (2006). Is routine prophylactic cervical cerclage associated with significant prolongation of triplet gestation? Journal of Maternal-Fetal and Neonatal Medicine, 19, 575–578.CrossRefGoogle ScholarPubMed
Boulot, P., Hedon, B., & Pelliccia, G. (1993). Effects of selective reduction in triplet gestation. Fertility and Sterility, 60, 497–503.CrossRefGoogle ScholarPubMed
Boulot, P., Hedon, B., Pelliccia, G., Peray, P., Laffargue, F., & Viala, J. L. (1993). Effects of selective reduction in triplet gestation. Fertility and Sterility, 60, 497–503.CrossRefGoogle ScholarPubMed
Crowther, C. A., & Han, S. (2010). Hospitalization and bed rest for multiple pregnancy. Cochrane Database Systematic Reviews 7, CD000110.Google Scholar
Daw, E. (1978). Triplet pregnancy. British Journal of Obstetrics and Gynecology, 85, 505–507.CrossRefGoogle ScholarPubMed
Dommergues, M., Mahieu-Caputo, D., Mandelbot, L., Huon, C., Moriette, G., & Dumez, Y. (1995). Delivery of uncomplicated triplet pregnancies: Is the vaginal route safer? A case-control study. American Journal of Obstetrics and Gynecology, 172, 513–517.Google ScholarPubMed
Evans, M. I., Dommergues, M., Johnson, M. P., & Dumez, Y. (1995). Multifetal pregnancy reduction and selective termination. Current Opinion in Obstetrics and Gynecology, 7, 126–129.CrossRefGoogle ScholarPubMed
Gregic, O., Ivanisevic, M., Djelmis, J., Lucinger, D., & Krile, L. (2009). Successful pregnancy and delivery of two sets of monozygotic twins after intracystoplasmic sperm injection and embryo transfer: case report and literature review. Fertility and Sterility, 92, 392, e5–8.Google Scholar
Henriksen, T., Hedegaard, M., & Secher, N. J. (2005). Standing at work and premature delivery. International Journal of Obstetrics and Gynecology, 102, 198–206.Google Scholar
Ho, M. L., Chen, J. Y., Ling, U. P., Chen, J. H., Huang, C. M., Chang, C. C., & Su, P. H. (1996). Changing epidemiology of triplet pregnancy: Etiology and outcome over twelve years. American Journal of Perinatology, 13, 269–275.CrossRefGoogle ScholarPubMed
Itzkowic, D. (1979). Survey of 59 triplet pregnancies. British Journal of Obstetrics and Gynecology, 86, 23–28.CrossRefGoogle ScholarPubMed
Kaufman, G., Malone, F. D., Harvey-Wilkes, K., Chelmow, D., Penzias, A. S., & D'Alton, M. (1998). Neonatal morbidity and mortality associated with triplet pregnancy. Obstetrics and Gynecology, 91, 342–348.CrossRefGoogle ScholarPubMed
Komaromy, B., & Lampe, L. (1977). Value of bed rest in twin pregnancy. International Journal of Gynecology and Obstetrics, 15, 262–266.CrossRefGoogle Scholar
Kraemer, B., Becker, S., Kagan, K. O., Hahn, M., Rajab, T. K., Wallwiener, D., Kraemer, E., & Abele, H. (2009). Twenty-six triplet pregnancies: A retrospective analysis. Archives of Gynecology and Obstetrics, 279, 455–461.CrossRefGoogle ScholarPubMed
Lazar, P., Gueguen, S., Dreyfus, J., Renaud, R., Pontonnier, G., & Papiernik, E. (1984). Multicentred controlled trial of cervical cerclage in women at moderate risk of preterm delivery. British Journal of Obstetrics and Gynecology, 91, 731–735.CrossRefGoogle ScholarPubMed
Lipitz, S., Reichman, B. N., Uval, J., Shalev, J., Achiron, R., Barkai, G., Lusky, A., & Mashiach, S. (1994). A prospective comparison of triplet pregnancies managed expectantly or by multifetal reduction to twins. American Journal of Obstetrics and Gynecology, 170, 874–879.CrossRefGoogle ScholarPubMed
Lipitz, S., Reichman, B., Paret, G., Modan, M., Shalev, J., Serr, D. M., Mashiach, S., & Frenkel, Y. (1989). The improving outcome of triplet pregnancies. American Journal of Obstetrics and Gynecology, 161, 1279–1284.CrossRefGoogle ScholarPubMed
Loucopoulus, A., & Jewelewicz, R. (1982). Management of multifetal pregnancies. Sixteen years' experience at the Sloane Hospital for women. American Journal of Obstetrics and Gynecology, 143, 902–905.Google Scholar
Ron-El, R., Mor, Z., Weinraub, Z., Schreyer, P., Bukovsky, I., Dolphin, Z., Goldberg, M., & Caspi, E. (1992). Triplet, quadruplet and quintuplet pregnancies management and outcome. Acta Obstetrica Gynecologica Scandinavia, 71, 347–350.CrossRefGoogle ScholarPubMed
Salihu, H. M., Aliyu, M. H., Kirby, R. S., & Alexander, G. R. (2004). Effect on advanced maternal age on early mortality among quadruplets and quintuplets. American Journal of Obstetrics and Gynecology, 190, 383–388.CrossRefGoogle ScholarPubMed
Skrablin, S., Kuvacic, I., Jukic, P., Kalafatic, D., & Peter, B. (2002). Hospitalization versus outpatient care in the management of triplet gestations. International Journal of Obstetrics and Gynecology, 77, 223–229.CrossRefGoogle Scholar
Skrablin, S., Kuvacic, I., Pavicic, D., Kalafatic, D., & Goluza, T. (2000). Maternal neonatal outcome in quadruplet and quintuplet versus triplet gestations. European Journal of Obstetrics and Gynecology Reproductive Biology, 88, 147–152.CrossRefGoogle ScholarPubMed
Stone, J., & Berkowitz, R. L. (1995). Multifetal pregnancy reduction and selective termination. Seminars in Perinatology, 19, 363–374.CrossRefGoogle ScholarPubMed
Teitelman, A. M., Welch, L. S., Hellenbrand, K. G., & Bracken, M. B. (1990). Activity on preterm birth and low birth weight. American Journal of Epidemiology, 131, 104–113.CrossRefGoogle ScholarPubMed
To, M. S., Skentou, C., Cicero, S., Liao, A. W., & Nicolaides, K. H. (2000). Cervical length a 23 weeks in triplets: Prediction of spontaneous preterm delivery. Ultrasound Obstetrics and Gynecology, 16, 515–518.Google ScholarPubMed
Welsh, A., & Nicolaides, K. (2002). Cervical screening for preterm delivery. Current Opinion in Obstetrics and Gynecology, 14, 195–202.CrossRefGoogle ScholarPubMed