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Mode of conception of triplets and high order multiple pregnancy in Dublin – a 10-year review
  1. I Basit1,2,
  2. S Johnson3,
  3. E Mocanu1,
  4. M Geary1,
  5. M Wingfield2,
  6. S Daly3
  1. 1Rotunda Hospital, Dublin, Ireland
  2. 2The National Maternity Hospital, Dublin, Ireland
  3. 3The Coombe Women and Infants' University Hospital, Dublin, Ireland

Abstract

The aim of this study was to know the mode of conception of triplet and high order multiple (HOM) pregnancies with a view to determining means of reducing their incidence.

An audit was performed of all triplet and HOM pregnancies delivered in Dublin's three teaching hospitals over a 10 year period (1999 to 2008). The mode of conception for each pregnancy was studied.

92 triplet, 9 quadruplet and 1 quintuplet pregnancies occurred, representing respectively 0.04%, 0.003% and 0.0004% of total births (226 792) at the 3 hospitals. Information regarding the mode of conception was available for 83 (81%) pregnancies and is shown in the table. Of those treated with IVF/ICSI/FET, 2 embryos were transferred in 8 cases (28%), 3 in 12 cases (41%) and the number was not recorded for 15 cases (31%). The quintuplets, 2 (22%) quads and 12 (13%) triplets resulted from clomiphene treatment.

Conclusion Triplet and HOM pregnancies are a major cause of maternal, fetal and neonatal morbidity. Many are iatrogenic, arising from fertility treatments. A worrying number occur following treatment with clomiphene citrate. Reducing the numbers of embryos transferred will address IVF/ICSI-related multiple pregnancy rates and this is currently happening in Ireland. However, the prescription of agents such as clomiphene citrate or FSH/HMG, is less well regulated and audited. These drugs should only be prescribed when appropriate resources are available to monitor patients adequately.

Mode of conceptionTriplet pregnanciesQuadruplet pregnancies
Spontaneous262
Clomiphene122
IUI32
IVF/ICSI330
Unknown16

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