Am J Perinatol 2004; 21(8): 439-445
DOI: 10.1055/s-2004-835960
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

The Origins and Outcomes of Triplet and Quadruplet Pregnancies in Nova Scotia: 1980 to 2001

Krista A. Cassell1 , Colleen M. O’Connell2 , Thomas F. Baskett1
  • 1Department of Obstetrics and Gynaecology
  • 2Perinatal Epidemiology Research Unit, Dalhousie University, Halifax, Nova Scotia, Canada
Further Information

Publication History

Publication Date:
06 December 2004 (online)

ABSTRACT

The objective of this study was to determine the rate, origin, maternal and perinatal outcomes, and the associated hospital costs of higher order multiple births in one Canadian province. All higher order multiple pregnancies (triplets and above) in Nova Scotia over a 22-year period (1980 to 2001) were reviewed, and the maternal and perinatal outcomes and hospital costs were compared with singletons and twins in the same hospital population. During the 22-year period, 116,785 infants were delivered, including 3448 twins, 99 triplets, and 16 quadruplets. Of the higher order multiple gestations, 51.4% were conceived through infertility therapy. When compared with mothers of either singletons or twins, mothers of higher order gestations were significantly older, had longer antepartum and postpartum hospital stays, were more likely to have cesarean delivery, preterm labor, preeclampsia, and require intensive care unit admission. Triplets and quadruplets had significantly higher rates of preterm delivery, major anomalies, neonatal intensive care, respiratory distress syndrome, intrauterine growth restriction, serious morbidity, 5-minute Apgar scores ≤ 3, and neonatal death than twins or singletons. The estimated hospital costs for this population ranged from $6750 for a singleton pregnancy to $278,400 for a quadruplet pregnancy. Maternal morbidity, perinatal morbidity and mortality, and hospital costs are significantly increased in higher order births compared with both twins and singletons.

REFERENCES

  • 1 Millar W J, Wadhera S, Nimrod C. Multiple births: trends and patterns in Canada, 1974-1990.  Health Rep. 1992;  4 223-250
  • 2 Canadian Institute of Child Health .The Health of Canada's Children: A CICH Profile. 3rd ed. Ottawa, Ontario; Canadian Institute of Child Health 2000: 29
  • 3 Martin J A, Hamilton B E, Ventura S J, Menacker F, Park M M. Births: final data for 2000.  Natl Vital Stat Rep. 2002;  50 1-101
  • 4 Keith L, Oleszczuk J J. Iatrogenic multiple birth, multiple pregnancy and assisted reproductive technologies.  Int J Gynaecol Obstet. 1999;  64 11-25
  • 5 Russell R B, Petruii J R, Damus K, Mattison D R, Schwarz R H. The changing epidemiology of multiple births in the United States.  Obstet Gynecol. 2003;  101 129-135
  • 6 Lynch A, McDuffie R, Murphy J, Faber K, Leff M, Orleans M. Assisted reproductive interventions and multiple birth.  Obstet Gynecol. 2001;  97 195-200
  • 7 Centers for Disease Control and Prevention. Contribution of assisted reproductive technology and ovulation-inducing drugs to triplet and higher-order multiple births-United States, 1980-1997.  JAMA. 2000;  284 299-300
  • 8 Callahan T L, Hall J E, Ettner S L, Christiansen C L, Greene M F, Crowley W F. The economic impact of multiple gestation pregnancies and the contribution of assisted-reproduction techniques to their incidence.  N Engl J Med. 1994;  331 244-249
  • 9 Wilcox L S, Kiely J L, Melvin C L, Martin M C. Assisted reproductive technologies: estimates of their contribution to multiple births and newborn hospital days in the United States.  Fertil Steril. 1996;  65 361-366
  • 10 Kaufman G E, Malone F D, Harvey-Wilkes K B, Chelmow D, Penzias A S, D’Alton M E. Neonatal morbidity and mortality associated with triplet pregnancy.  Obstet Gynecol. 1998;  91 342-348
  • 11 Ho M L, Chen J Y, Ling U P et al.. Changing epidemiology of triplet pregnancy: etiology and outcome over twelve years.  Am J Perinatol. 1996;  13 269-275
  • 12 Lipitz S, Frenkel Y, Watts C, Ben-Rafael Z, Barkai G, Reichman B. High-order multifetal gestation: management and outcome.  Obstet Gynecol. 1990;  76 215-218
  • 13 Luke B, Keith L G. The contribution of singletons, twins and triplets to low birth weight, infant mortality and handicap in the United States.  J Reprod Med. 1992;  37 661-666
  • 14 Devine P C, Malone F D, Athanassiou A, Harvey-Wilkes K, D’Alton M E. Maternal and neonatal outcome of 100 consecutive triplet pregnancies.  Am J Perinatol. 2001;  18 225-235
  • 15 Albrecht J L, Tomich P G. The maternal and neonatal outcome of triplet gestations.  Am J Obstet Gynecol. 1996;  174 1551-1556
  • 16 Senat M V, Ancel P Y, Bouvier-Colle M H, Breart G. How does multiple pregnancy affect maternal mortality and morbidity?.  Clin Obstet Gynecol. 1998;  41 78-83
  • 17 Kramer M S, Platt R W, Wen S W et al.. A new and improved population-based Canadian reference for birth weight for gestational age.  Pediatrics. 2001;  108 E35
  • 18 Cunningham F C, Gant N F, Leveno K J et al.. In: Williams Obstetrics, 21st ed. Norwalk, CT; Appleton and Lange 2001: 1195-1198
  • 19 Malone F D, Chelmow D, Athanassiou A, D’Alton M E. Impact of gestational age at delivery on the economics of triplet pregnancy.  J Matern Fetal Med. 1999;  8 256-261
  • 20 Collins J A, Graves G R. The economic consequences of multiple gestation pregnancy in assisted conception cycles.  Hum Fertil (Camb). 2000;  3 275-283

Thomas F BaskettM.B. 

Department of Obstetrics and Gynaecology, Dalhousie University

5980 University Avenue, Room 6039, Halifax

Nova Scotia, Canada B3J 3G9

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