Higher order multiple pregnancy outcomes in the Maltese islands 2000-2004

Abstract

Higher order multiple births have increased significantly in the last decades throughout the developed world. In spite of advances in obstetric care seen throughout the second half of the twentieth century, the perinatal outcomes associated with a multiple pregnancy remain associated with increased morbidity and mortality for the mother and the infants. This study attempts to assess the characteristics and outcomes of these maternities in the Maltese population. The National maternity data for 2000-2004 was analysed (19,935 maternities; 20,215 births) and various outcome parameters were statistically compared between higher order births to singleton births using the chi square test. While the twin maternity rate during the period stood at 1.26%, the triplet maternity rate stood at 0.06% and quadruplet maternities 0.01%. Artificial reproductive technology was used in 27.8% of triplets and 50.0% in quadruplets; in contrast to 0.7% in singleton maternities (p<0.001). High order multiple maternities were more likely to be terminated by Caesarean section (25.2% vs 100%; p<0.001) and be the result of a spontaneous or iatrogenic premature delivery (4.6% vs 84.0%; p<0.001). Infant outcome was more likely to be complicated by low birth weight under 2.5 kg (9.7% vs 97.6%; p<0.001), and the associated complications of respiratory distress (1.9% vs 22.0%; p<0.001), low Apgar score (1.4% vs 7.3%; p<0.001), and perinatal deaths (stillbirth: 0.4% vs 2.4%; p<0.001; neonatal deaths 0.4% vs 4.9%; p<0.001). There did not appear to be a greater risk of major malformations.