The outcome of triplet, quadruplet, and quintuplet pregnancies managed in a perinatal unit: obstetric, neonatal, and follow-up data.

Multifetal gestation is associated with increased frequency of maternal complications and higher perinatal morbidity and mortality. The need for contemporary data on the outcome of multifetal gestations is further underscored when selective reduction is considered. The present study details the obstetric management, neonatal outcome, and follow-up data of 24 triplet, five quadruplet, and one quintuplet pregnancies delivered in a perinatal center. The early neonatal mortality rate was 31.6, the late neonatal mortality rate was 21, and the perinatal mortality rate was 51.5. Survival to discharge was 93%. The incidence of respiratory distress syndrome was 43%, bronchopulmonary dysplasia 6%, retinopathy of prematurity 3%, intraventricular hemorrhage 4%, and cerebral palsy 2%. Follow-up from 1 to 10 years shows that only one child is moderately handicapped, whereas 99% have no significant medical problem. Early diagnosis by ultrasonography, meticulous antenatal care, early hospitalization, delivery by cesarean section, and on-site availability of a neonatologist for each baby at the time of delivery are the probable major determinants of improved outcome.

Vasomotor responses in the hind limbs of foetal and new-born lambs to asphyxia and aortic chemoreceptor stimulation.

1. Hind limb blood flow was measured in lambs of from 91 days gestation (delivered by Caesarean section) to 1 month after birth (term is about 147 days), under chloralose anaesthesia. Vascular resistance/100 g wet wt. increased progressively with age. There was reflex femoral vascular tone from the earliest age studied, as shown by vasodilatation on cutting the sciatic nerve.2. On asphyxia by cord occlusion reflex femoral vasoconstriction began earlier and was somewhat greater in older foetal lambs. At all ages, and after denervation of the hind limb, there was vasodilatation after local ischaemia, and a vasoconstriction of delayed onset during asphyxia attributed to release of noradrenaline into the circulation. The vasoconstrictor effect of noradrenaline in immature lambs was at least as great as at term or in the new-born.3. Injections of minimal effective doses of cyanide were used to localize possible chemoreceptor sites in foetal lambs. Injection into the left atrium caused a rise of arterial pressure, femoral vasoconstriction and a complex change in heart rate (usually bradycardia) but rarely any respiratory movement. After atropine, cyanide caused a large tachycardia. All responses were much reduced or abolished by cervical vagotomy.4. Injection of the same doses of cyanide into a jugular vein, the right ventricle, pulmonary or common carotid arteries of foetal lambs caused negligible cardiovascular or respiratory effects, whereas injection into the carotids of new-born lambs caused a profound hyperpnoea.5. It is concluded that the aortic chemoreceptors are active in the foetus, are supplied from the left heart, and that they probably represent the primary defence in blood gas homeostasis by their effects on the circulation.