Titre du document / Document title

Geburtshilfliche Besonderheiten höhergradiger Mehrlinge : Fluch oder mehrfacher Segen ? = Special features in obstetrics of multifetal gestation : Doom or multiple blessing ?

Auteur(s) / Author(s)

STRAUSS A. ⁽¹⁾ ; KNITZA R. ⁽¹⁾ ; OTT M. ⁽¹⁾ ; GENZEL-BOROVICZENY O. ⁽²⁾ ; VERSMOLD H. ⁽³⁾ ; HEPP H. ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe im Klinikum Grosshadern der Ludwig-Maximilians-Universität München, ALLEMAGNE
⁽²⁾ Neonatologie, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe im Klinikum Grosshadern der Ludwig-Maximilians-Universität München, ALLEMAGNE
⁽³⁾ Kinderklinik Benjamin Franklin Universitätsklinikum der Freien Universität Berlin, ALLEMAGNE

Résumé / Abstract

Through modern reproductive techniques Hellin's rule, approximating multiple births, is no longer applicable. Consequently perinatal centres have been facing an increasing number of multifoetal pregnancies during the last 15 years. The foetal outcome of 81 multifoetal pregnancies, delivered between January 1, 1980 and June 30, 1995 at the Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe im Klinikum Grosshadern, Munich, Germany, illustrates both the risk as well as the chance for healthy survival under the applied management protocol. Mean gestational ages at delivery were 221 days (31 + 4 weeks) for triplets, 213 days (30 + 3 weeks) for quadruplets and 200 days (28 + 4 weeks) for quintuplets, mean birth weight was 1400 g, 1100g and 1080 g respectively. 96.4% of the triplets survived (188/195), 70% (137/195) could be discharged home without medical problems. 98.1% (51/52) of the quadruplets and 80% (12/15) of the quintuplets survived, 67% (35/52) and 53% (8/15) respectively without health impairment. Respiratory distress syndrome, intracranial hemorrhage, retinopathy of prematurity, persistent Ductus arteriosus, necrotising enterocolitis and hydrocephalus are primary causes of neonatal morbidity. Serious neurological sequels such as developmental retardation and cerebral palsy were noted in 4 (6%) and 5 (8%) of the quadruplets and quintuplets. Health impairment and mortality show a clear association to gestational age under 30 weeks but do not differ significantly in frequency or distribution from single or twin neonates of equal gestational age and management. A threshold regarding prognosis seems to be the number of foetuses 4 versus 5 and the gestational age before or after 210 days (30 weeks). Before 32 weeks of gestation the indication for delivery was most often due to foetal problems. With progressing duration of pregnancy the risk for maternal complications rises and may warrant termination of pregnancy in the face of a usually uncomplicated postnatal course of foetuses born after 32 weeks of gestation at a perinatal centre. The presented data suggest that an individually adapted, liberal indication for delivery by caesarean section after 32 weeks is the safest management scheme for mother and foetuses.

Revue / Journal Title

Geburtshilfe und Frauenheilkunde   ISSN 0016-5751   CODEN GEFRA2 

Source / Source

1997, vol. 57, n^o9, pp. 500-509 (26 ref.)

Langue / Language

Allemand

Editeur / Publisher

Thieme, Stuttgart, ALLEMAGNE  (1939) (Revue)

Mots-clés anglais / English Keywords

Multiple pregnancy ; Delivery ; Complication ; Gestational age ; Cesarean section ; Female ; Prognosis ; Clinical management ; Newborn ; Fetus ; Mother ; Human ; Surgery ;

Mots-clés français / French Keywords

Gestation multiple ; Accouchement ; Complication ; Age gestation ; Césarienne ; Femelle ; Pronostic ; Conduite à tenir ; Nouveau né ; Foetus ; Mère ; Homme ; Chirurgie ;

Mots-clés espagnols / Spanish Keywords

Gestación múltiple ; Parto ; Complicación ; Edad gestacional ; Cesárea ; Hembra ; Pronóstico ; Actitud médica ; Recién nacido ; Feto ; Madre ; Hombre ; Cirugía ;

Localisation / Location

INIST-CNRS, Cote INIST : 4872, 35400006932991.0050