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Neonatal outcomes and risk/benefit ratio of induced multiple pregnancies
  1. A A Zuppa1,
  2. D de Luca2
  1. 1Department of Neonatology, Institute of Pediatrics, University Hospital A Gemelli, L GO A Gemelli 8, 00168, Rome Italy; zuppaaa{at}
  2. 2V Tiberio Imperatore 43, 00145, Rome, Italy

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    During recent years we have seen and assisted at a significantly increased number of twin births. The main reason for this increase in the frequency of twin births is the increasing number of so called “induced pregnancies”, whether through hormonal stimulation or artificial insemination techniques.

    It is well known1 that twins have high mortality and morbidity rates during the perinatal and the following period. The characteristics of conception and pregnancy can determine the development of several pathologies, including prematurity and intrauterine growth retardation, twin to twin transfusion, cardiorespiratory depression, and respiratory distress syndrome, all of which are very common.

    Twin pregnancy represents therefore a biological risk factor and needs a very high level of obstetrical and neonatological management, achievable only in highly specialised and well equipped centres; a very high level of investment in terms of human and economic resources is also required.

    A recent study carried out2 by the Department of Neonatology at the A Gemelli hospital of the Catholic University of Rome shows a significantly higher incidence of prematurity, low birth weight, severe cardiorespiratory depression at birth, (Apgar 0–3) and respiratory pathology, among twins born from “induced pregnancies” than from those born from spontaneous pregnancies.

    Such a high incidence of respiratory pathology and cardiorespiratory depression at birth does not seem to be related to prematurity. In fact mean gestational age and mean birth weight of the neonates with severe depression at birth and respiratory diseases are similar in induced and spontaneous pregnancy.

    In multiple pregnancies such results are in agreement with the higher incidence of prematurity and low birthweight, already observed by other authors,3–6 in single newborns from “induced pregnancies”, in comparison to those from spontaneous pregnancies.

    Quite apart from any clinical implications this situation leads us to consider the ethics of this situation.

    Wider and multicentre studies will be necessary if we are to understand whether the induction of pregnancy is a strategy with an acceptable risk/benefit ratio, or whether the possible above mentioned complications can reduce the benefits for a couple of having children.

    Also, it will probably be necessary to examine socioeconomic problems related to clinical and treatment needs for pregnancy or for newborn babies. In fact preterm babies often make large demands on the therapies in the neonatal intensive care unit, require long times of stay in hospital, and social support and rehabilitation after they leave the hospital.

    This implies a remarkable use of technological, human, and economic resources in order to guarantee their survival and optimum quality of life.


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