HIGHER MULTIPLE BIRTHS AND THE MODERN MANAGEMENT OF INFERTILITY IN BRITAIN - FOR THE BRITISH-ASSOCIATION-OF-PERINATAL-MEDICINE

Objective To assess prospectively the number of triplet and higher multiple births born in 1989 and their methods of conception. To assess obstetric factors and the effect of these pregnancies on neonatal medical services. Design All consultant paediatricians received a monthly card asking whether they had been involved in the management of triplet and higher multiple pregnancies delivered after 22 weeks gestation. Detailed questionnaire sent to those giving a positive response. Setting British Paediatric Surveillance Unit organized mailings to all members of the British Paediatric Association working in the British Isles. Subjects 156 pregnancies resulting in 482 babies (143 triplets, 12 quadruplets and 1 quintuplet set). These data were compared to nationally collected OPCS data. Main outcome measures Method of conception, obstetric performance, neonatal outcome. Results Of the 156 pregnancies, 47 (31%) were conceived naturally, 52 (34%) had ovarian stimulation (usually with clomiphene or gonadotrophins) 37 (24%) had IVF and 17 (11%) GIFT. All quadruplet and quintuplet pregnancies were established after assisted reproduction. Mothers who had had IVF were significantly older than those who had ovulation induction alone. The median gestation at birth was 33 weeks. Overall 181 (40%) of the babies required intensive care for a median duration of 5 days. The perinatal mortality of the triplets alone and quads and quins together was 70 and 104 per 1000 respectively. Conclusions Assisted reproduction is the major cause of triplets and higher multiple births and ovarian stimulation is the single most important technique currently in use. These babies are very likely to be born pre term and make considerable demands on neonatal intensive care facilities.