{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T14:56:17Z","timestamp":1778597777438,"version":"3.51.4"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,12,10]],"date-time":"2022-12-10T00:00:00Z","timestamp":1670630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aust NZ J Obst Gynaeco"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Higher\u2010order multiple (HOM) pregnancies are associated with significant maternal and neonatal morbidity, especially consequent to preterm birth. Multi\u2010fetal pregnancy reduction (MFPR) may be provided, though its benefits in prolonging gestation and improving neonatal outcomes must be weighed against its risks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>The aim was to compare outcomes of HOM pregnancies where expectant management was chosen (EM) with those where MFPR was provided.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The method involved a retrospective study of HOM pregnancies referred to a single quaternary hospital between 2007 and 2016. The primary outcome was gestational age. Secondary outcomes included miscarriage, nursery admission, hospital stay, Apgar scores, early fetal loss, stillbirth, neonatal death and composite fetal loss.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty\u2010seven pregnancies were eligible for inclusion. Median gestation at birth (weeks) was significantly higher for MFPR (35.3 vs 33.1, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01). Pregnancies after MFPR were less likely to lead to preterm birth (63.2 vs 100.0%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), half as likely to birth before 34\u2009weeks (31.6 vs 60.0%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.09) but similarly likely to extremely preterm birth (&lt;28\u2009weeks, 8.6 vs 10.5%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.58). Miscarriage was more likely after MFPR (13.6 vs 0%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.05). EM neonates were more likely to be admitted to the nursery (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01) and have longer hospital stay (29.6 vs 20.2\u2009days, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.05); however, they had similar Apgar scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our study demonstrates that MFPR is associated with an increase in gestational age, with a reduction by almost half of births before 34\u2009weeks, but no difference in extremely preterm births; the latter represents the highest risk group. This should be used to guide management counselling for HOM pregnancies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajo.13636","type":"journal-article","created":{"date-parts":[[2022,12,11]],"date-time":"2022-12-11T06:34:32Z","timestamp":1670740472000},"page":"365-371","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Outcomes of higher\u2010order multiple pregnancies in an Australian setting"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4323-8348","authenticated-orcid":false,"given":"Shian\u2010Li","family":"Wong","sequence":"first","affiliation":[{"name":"Department of Maternal\u2010Fetal Medicine The Royal Hospital for Women  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Emerson","sequence":"additional","affiliation":[{"name":"Department of Maternal\u2010Fetal Medicine The Royal Hospital for Women  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadiah","family":"Jamaludin","sequence":"additional","affiliation":[{"name":"Department of Maternal\u2010Fetal Medicine The Royal Hospital for Women  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa H.Y.","family":"Chang","sequence":"additional","affiliation":[{"name":"School of Women's and Children's Health The University of New South Wales Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alec","family":"Welsh","sequence":"additional","affiliation":[{"name":"Department of Maternal\u2010Fetal Medicine The Royal Hospital for Women  Sydney New South Wales Australia"},{"name":"School of Women's and Children's Health The University of New South Wales Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,12,10]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Australian Bureau of Statistics.Australian Demographic Statistics 3101.0 \u2013 June Quarter 2001 2001."},{"issue":"1","key":"e_1_2_8_3_1","first-page":"1","article-title":"Births: Final data for 2013","volume":"64","author":"Martin JA","year":"2015","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_8_4_1","unstructured":"Australian Bureau of Statistics.Australian Demographic Statistics 3301.0 \u2013 Births Australia 2018 2019."},{"key":"e_1_2_8_5_1","unstructured":"Health AIo Welfare.Australia's mothers and babies 2018\u2014in brief.Canberra:AIHW 2020."},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/des315"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c6945"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12478"},{"key":"e_1_2_8_9_1","unstructured":"NewmanJE FitzgeraldO PaulRC ChambersGM.Assisted reproductive technology in Australia and New Zealand 2017 National Perinatal Epidemiology and Statistics Unit the University of New South Wales Sydney 2019."},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12048"},{"key":"e_1_2_8_11_1","unstructured":"BryantJ SullivanE DeanJH.Assisted reproductive technology in Australia and New Zealand 2002. 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