OBSTETRIC MANAGEMENT OF HIGH-ORDER MULTIPLE PREGNANCIES

High-order multiples are increasingly common as a result of assisted r eproductive technologies and represent pregnancies at exceptional risk . This article discusses the antepartum management of high-order multi ples, which has in general been highly individualized and poorly studi ed. Care for high-order multiples should include preterm birth prevent ion education, the frequent assessment of maternal symptoms and cervic al status by a consistent provider, individualized modification of act ivity, attention to maternal nutrition, ultrasonography for the assess ment of fetal anatomy and intra-uterine growth and anticipation of mat ernal complications. Interventions such as prophylactic cerclage, uter ine activity monitoring, prophylactic tocolysis or hospitalization hav e not improved outcome when used routinely, and guidelines for selecti ve use will be presented. Specialized care for high-order multiples sh ould be directed at identifying congenital anomalies, maximizing fetal growth and preventing early preterm birth, the effect of which will b e to improve perinatal outcome for these exceptional pregnancies.