Maternal and neonatal outcome in triplet, quadruplet and quintuplet gestations following ART: a 11-year study.

OBJECTIVES: To review the maternal and fetal outcome of triplet, quadruplet and quintuplet gestations following ART, which were managed at a hospital over 11 years. STUDY DESIGN: Retrospective chart review of 150 triplet, 27 quadruplet, and 6 quintuplet pregnancies between January 2001 and December 2011. 25 women aged 50-56 years with triplet pregnancies, were excluded due to lack of data. No prophylactic interventions were used. RESULTS: 300 triplets, 108 quadruplets, and 30 quintuplets were born. The mean maternal age was 30.2 years (SD 4.2 years). Mean gestational age delivery was 32.2 weeks (SD 4.2 weeks). Maternal complications included preterm labor 114 (86 %), prematurity 115 (87 %), anemia 44 (33 %) gestational diabetes 35 (27 %), preeclampsia 33 (25 %), post partum hemorrhage 13 (10 %). Preterm labor was diagnosed in 84 (84 %) triplets, 32 (97 %) of quadru- and quintuplet pregnancies (P > 0.05). Prematurity and preterm labor were major determinants. Of the 438 fetuses born there were 57 (13 %) still births, 77 (18 %) neonatal deaths. 32 (7 %) were early neonatal deaths, 45 (10 %) late neonatal deaths. The majority died due to extreme low birth weight. 75 (17 %) neonates had low apgar score of <7 at 5 min. 22 (5 %) infants had congenital anomalies. Severe respiratory distress syndrome, perinatal asphyxia, very early preterm delivery and perinatal mortality were higher in quadru- and quintuplets (P < 0.05). CONCLUSION: Preterm labor and preterm prematurity were the commonest complications. Neonatal mortality and morbidity was significantly increased in quadru- and quintuplets. Prophylactic interventions were not used in an attempt to prevent preterm labor.

Maternal and perinatal outcome of eclampsia over a decade at a tertiary hospital in Kuwait.

AIMS: To determine maternal and perinatal outcome of eclampsia patients over a decade. METHODS: Analysis of case records of all eclampsia cases from January 2005 to December 2014. RESULTS: There were 30 cases of eclampsia. The most significant risk factors for developing pre-eclampsia are unbooked cases (97%), nulliparity, young age, marriage ≤4 months, history of pre-eclampsia in previous pregnancy, remarriage, preexisting diabetes mellitus, interval between pregnancies ≥10 years, positive family history. The incidence of eclampsia was 0.05%, antepartum eclampsia 15 (50%), intrapartum 6 (20%) and postpartum 9 (30%) with no maternal deaths, and 1 perinatal death. Perinatal mortality was 33.3/1000. 22 (73%) patients received magnesium sulphate (MgSO4) and 8 patients (27%) received Diazepam, of which 1 had recurrence of convulsions. All 15 antepartum cases were delivered by cesarean section as were 2 intrapartum. 13 (43%) of women delivered vaginally. Only 6 (20%) patients were of low socio-economic status and were primary school educated. Severe maternal complications occurred in 8 (27%), with abruptio placentae being the most common 3 (38%). CONCLUSIONS: Incidence of eclampsia was low, with no maternal deaths. MgSO4 was found to be highly effective. Lack of antenatal care is a major risk factor.