Ron-El R, Caspi E, Schreyer P, Weinraub Z, Arieli S, Goldberg M D
Obstet Gynecol. 1981 Apr;57(4):458-63.
The rate of multiple pregnancies with more than 2 fetuses has significantly increased since the introduction of ovulation induction agents. From 1970 through 1978, there were 19 triplets and 6 quadruplets in the authors' department, incidences of 1:696 and 1:5370, respectively. Eighteen (72%) of the 25 multiple pregnancies followed treatment with ovulation induction agents and 7 were spontaneous. The diagnosis of more than 2 fetuses was made earlier in the induced than in the uninduced pregnancies. Management, initiated upon diagnosis, included bed rest, high-protein diet, beta-mimetic agents, progestins, dexamethasone late in the second trimester, and selective cerclage. The mean gestational age was 34 weeks in the triplets and 35 weeks in the quadruplets. Forty-four percent of the deliveries were by cesarean section and the remainder were by vaginal delivery. The mean weight of the neonates was 1807 g in the triplets and 1950 g in the quadruplets. The mean overall Apgar score was 8.16, and the perinatal mortality was 185 per 1000, corrected (more than 28 weeks) to 137 per 1000. The main neonatal complications resulted from prematurity, and maternal complications noted were postpartum hemorrhage necessitating hysterectomy in 2 patients. The preferable mode of delivery cannot be stated dogmatically. Fetal outcome was similar in vaginal and cesarean deliveries among the various gestational age groups.
自引入促排卵药物以来，怀有超过2个胎儿的多胎妊娠率显著上升。从1970年至1978年，作者所在科室有19例三胞胎和6例四胞胎，发生率分别为1:696和1:5370。25例多胎妊娠中有18例（72%）在接受促排卵药物治疗后发生，7例为自然受孕。与未接受诱导的妊娠相比，在接受诱导的妊娠中，更早诊断出超过2个胎儿。诊断后开始的管理措施包括卧床休息、高蛋白饮食、β-拟交感神经药物、孕激素、孕中期晚期使用地塞米松以及选择性宫颈环扎术。三胞胎的平均孕周为34周，四胞胎为35周。44%的分娩通过剖宫产进行，其余通过阴道分娩。三胞胎新生儿的平均体重为1807克，四胞胎为1950克。新生儿总体平均阿氏评分8.16，围产期死亡率为每1000例185例，校正后（超过28周）为每1000例137例。主要的新生儿并发症源于早产，产妇并发症包括2例因产后出血而行子宫切除术。不能武断地确定更合适的分娩方式。在不同孕周组中，阴道分娩和剖宫产的胎儿结局相似。
