Most couples facing a multifetal pregnancy are
quite anxious, and rightly so. Sustaining a triplet pregnancy
is probably the hardest thing that mother will do, sometimes only
exceeded by the following parenthood. The initial consultation
visit in which we discuss the risks, uncertainties and commitment
necessary is frightening and makes some want to avoid seeing us
ever again.
Nevertheless, facing the issues squarely
is inevitable and best done early. Most will have a satisfactory
outcome with their triplet, and even quadruplet or quintuplet,
pregnancy; some will not. A frank discussion of the personal commitment
necessary to sustain such a pregnancy must be undertaken early,
with the couple discussing and reaffirming their commitment to
follow the prescribed management before they continue further
in the pregnancy.
MAJOR RISKS
Although there is much that could adversely affect a multifetal
pregnancy and the mother who carries it, the most likely problem
is preterm delivery. Both preterm labor and cervical incompetence
are factors likely to lead to preterm delivery. Both of these
factors are best handled by prevention rather than treatment,
if possible. However, even the best preventive efforts
will not always avoid delivery prematurely.
Babies born before 24 weeks cannot be expected
to survive with any reasonable frequency. Survival rates improve
between 24 and 28 weeks, but there is significant risk of long-term
damage, the most distressing of which may be neurologic deficits.
With modern newborn intensive care, those born at 28 weeks have
a good likelihood of survival, but still have substantial need
of
care, and may suffer long-term damage. Delivery at and after 32
weeks is likely to be followed by intact survival, but NICU care
is necessary at least until 34 weeks or so. Even if delivery is
precipitated by natural events at 34-36 weeks, some babies will
require NICU care, including mechanical ventilation. Lest we minimize
the risks and discomforts afforded a baby on mechanical ventilation,
we should picture ourselves in that situation.
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