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Prevalence and outcome of higher order multiple pregnancies in Lagos, Nigeria

Abstract Objective: To determine the prevalence and outcome of higher order multiple (HOM) pregnancies in Lagos, Nigeria. Methods: The mode of delivery, gestational age, pregnancy and neonatal outcome of babies delivered from HOM pregnancies were reviewed retrospectively from the labor ward and theater registers, neonatal unit admission records and medical notes in a tertiary referral centre from April 2009 to March 2012. Results: Twenty-two (15, 6 and 1 set of triplets, quadruplets and quintuplet, respectively) of 6521 pregnancies delivered during the period were HOM pregnancies giving a prevalence of 3.37/1000. All the 74 babies except 12 were delivered by cesarean section. There were 18 perinatal deaths giving a perinatal mortality rate of 243 per 1000. Overall mortality was significantly associated with no antenatal booking (21 versus 5, OR: 21.0, 95% CI: 2.1–72.3, p = 0.000), gestational age ≤30 weeks (21 versus 5, OR: 46.2, 95% CI: 11.2–189.9, p = 0.000) and birth weight <1000 g for live births (p = 0.000). Mode of delivery and number of fetuses >3 were however not significantly associated with mortality. Conclusion: Reduction of early preterm births by proper antenatal care and close feto-maternal monitoring of HOM pregnancies will significantly reduce the resultant immediate poor outcomes for these pregnancies and their newborns.