PERINATAL OUTCOMES OF MULTIPLE BIRTHS

Objective. To study perinatal outcomes in women with multiple pregnancy achieved by different methods. Subjects and methods. A retrospective continuous clinicostatistical analysis of primary medical records was made in 94 puerperas with multiple births (including 5 triple ones) given in the obstetric departments of the Center in 2008. According to the multiple pregnancy-achieving methods, the women were divided into 3 groups: 1) 34 (36.2%) women with spontaneous pregnancy, 2) 50 (53.2%) with pregnancy achieved by assisted reproductive technologies; 3) 10 (10.6%) with pregnancy due to ovulation induction. Results. Statistically significant differences were found between the groups in a number of gynecological diseases: infertility, oligomenorrhea, endometriosis, or polycystic ovary syndrome. The leading obstetric complications were threatening miscarriage, isthmic-cervical insufficiency, early toxicosis, and preeclampsia. Abdominal delivery occurred in 76.5, 98.0, and 80.0% in Groups 1, 2, and 3, respectively. The group rate of preterm labors was 55.9, 64.0, and 70%, respectively. There were 184 (96.3%) and 9 (4.7%) live and still births, respectively, including 58 (61.7%) and 36 (38.3%) same- and different-sex twin pairs, respectively, among the twin births and 2 and 3 same- and different-sex triple pairs among the triple births. Mild, moderate, and severe asphyxia was noted in 49.2, 9.3, and 7.8%, respectively. Stillbirth rates were 26.3%; early neonatal and perinatal mortality rates were 5.4% and 31.7%, respectively. Conclusion. The main cause of fetal and neonatal deaths is extreme immaturity and intragatric hemorrhages. The high rates of perinatal mortality and its components are associated with preterm labor and prematurity. The onrush of neonatal intensive care in the past decade has determined the substantial reduction of early neonatal mortality.

multiple pregnancy, spontaneous pregnancy, pregnancy induced by assisted reproductive technologies, ovulation induction, stillbirth rates, early neonatal and perinatal mortality