MATERNAL AND PERINATAL OUTCOMES OF MULTIPLE PREGNANCY FOLLOWING IVF-ET

Objective: To analyze the course of pregnancy and perinatal outcome in 31 twins, 22 sets of triplets and five quadruplet clinical pregnancie s following conventional in vitro fertilization (IVF) and intracytopla smic sperm injection (ICSI) procedures and in relation to 58 singleton pregnancy following the same procedure. Merl?ods: Retrospective analy sis of maternal and neonatal medical records of 58 singleton, 31 twin, 22 triplet and five quadruplet pregnancies diagnosed at 7-8 weeks ges tation following 561 embryo transfer procedures in 628 oocyte collecti ons at the IVF Center in the Maternity Hospital, Kuwait from July 1994 to December 1996. Results: The clinical pregnancy rate in 628 cycles proceeding to oocyte collection was 32.6%, there being 58 singletons ( 50.6%), 31 twins (33.5%), 22 triplets (10.8%) and five quadruplets (2. 5%). Early complicated outcomes included 47 miscarriages (23.7%), four ectopic pregnancies (1.9%) and one hydatidiform mole. The spontaneous fetal reduction rate was 20.6% in twin, 45.5% in triplet and 40% in q uadruplet pregnancies. There was a significantly higher maternal and n eonatal complication rate in the triplet group compared to singletons and twins, including threatened miscarriage, pre-eclampsia, antepartum hemorrhage, longer hospital stay and preterm labor. The chance of ope rative delivery was higher in high-order multiple pregnancy (HOMP). Th e major neonatal complications were related to prematurity. Neonatal m orbidity and mortality were significantly higher in the triplet group. The need for admission to the Special Care Baby Unit (SCBU) and the N eonatal Intensive Care Unit (NICU) was significantly higher in HOMP. H owever, there were no statistically significant differences in the per inatal mortality in relation to the degree of HOMP. Conclusion: Matern al complications, perinatal and neonatal morbidity after 2 years activ ities in the IVF Center have been reviewed leading to changes in polic ies of management, notably a reduction in the number of embryos transf erred. (C) 1998 International Federation of Gynecology and Obstetrics.