Perinatal outcome of quadruplet pregnancies in relation to chorionicity.

OBJECTIVE

To compare the perinatal outcome of quadruplets in relation to chorionicity.

PATIENTS AND METHODS

In this retrospective study, the maternal, neonatal and chorionicity data were collected from 24 sets of quadruplet pregnancies delivered between January 1985 and December 2001. Perinatal and neonatal data were evaluated in relation to chorionicity.

RESULTS

Sixteen pregnancies were quadra-chorionic quadramniotic (QC) and eight had at least one monochorionic pair (TC). The median gestational age at delivery was 31 weeks (23 to 34 weeks) with overall perinatal mortality rate of 177 per 1000 total birth. Delivery before 30 weeks (OR 89; 95% CI 9 to 607; P<0.01) and discordant birth weight of >25% (OR 7.6; 95% CI 2 to 29; P<0.01) had independent effects on perinatal loss rate. The perinatal loss was five fold higher in TC quadruplets than those of QC (OR 5.1; 95% CI 1.7 to 15.4; P<0.001). This was attributed to higher risk of very low birth weight (69 vs 13%; P<0.01), delivery before 30 weeks (63 vs 13%; P<0.001) in TC quadruplets compared to QC gestation.

CONCLUSIONS

The quadruplets with MC pair have 5 times higher perinatal mortality than quadra-chorionic quadruplet pregnancies owing to preterm delivery and discordant birth weight.