Dr.sathya balasubramanyam

MD DNB MRCOG (UK) FNB(Reprod med)

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The number of multiple pregnancies has seen a significant rise in the last two decades. Higher-order multiple pregnancies, consisting of three or more foetuses, have seen a fivefold increase in the recent times. This rise is mostly attributed to various procedures followed infertility treatments.

Being pregnant with a single foetus itself brings about a lot of physical and emotional changes in a woman. So the apprehension towards multiple pregnancies can be comprehended easily. Multiple pregnancies of higher order as in triplet, quadruplets or more can be risky for both the mother as well as the foetuses.

higher order multiple pregnancy

Multiple pregnancies, mainly those of higher order are found to be closely linked with infertility treatments. Ovulation induction with the help of drugs is known to result in multiple pregnancies in some cases. These are done in the case of women suffering from subfertility issues due to abnormalities in their ovulation cycle.

Ovulation can be induced by the administration of drugs such as clomiphene citrate, FSH (Follicle Stimulating Hormone) and so on. Various stimulation protocols are also used in inducing ovulation. These procedures are used in various ART (Artificial Reproduction Techniques) for oocyte extraction.

Artificial Reproduction Techniques such as IVF and GIFT are major contributors to higher order multiple pregnancies. This is because, in these procedures, more than one embryo is transferred into the uterine cavity to increase the probability for successful implantation. However transferring more than three embryos to ensure at least one successful implantation cannot be justified.

Although the perinatal mortality rate (PMR) of higher order multiple pregnancies have reduced, the potential risk and complications associated with it still stand. Multiple pregnancies have a higher risk of preterm labour and delivery of underweight babies. The mothers are at risk too.

Multiple pregnancies demand increased iron reserve from the mother. Hence they are at a higher risk of deficiencies such as anaemia. Delivery complications such as Premature Rupture of Membrane are another commonly occurring complication witnessed in women with multiple pregnancies of a higher order.

Intrauterine Growth Restriction is another issue seen in multiple pregnancies. This restricts the foetal growth resulting in low weight or underdeveloped babies. Preeclampsia, neonatal morbidity and postpartum haemorrhage are some other complications that are witnessed in these pregnancies.


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