Premature babies from multiple births can face breathing and feeding difficulties, writes Dr Muiris Houston.
THE BIRTH of octuplets is an exceedingly rare event. Most multiple births are either twins or triplets, although a set of nine babies – nonuplets – were born in Australia in 1971.
Pregnancies involving large numbers of babies are usually the result of prescribing fertility drugs aimed at stimulating the number of eggs a woman releases. It would be most unusual for in vitro fertilisation (IVF) to lead to eight babies.
Stimulating the ovaries is one of the first steps in assisted reproduction. Drugs such as clomiphene citrate induce ovulation, probably by tricking the brain into releasing a set of hormones that travel to the ovary where they induce the release of eggs. Clomiphene is the most commonly used drug for this purpose, although under IVF, a more controlled form of ovarian stimulation is used.
Multiple pregnancies occur when either a single egg is fertilised and then subsequently divides, or when multiple eggs are released and each is separately fertilised by sperm. In countries where abortion is legal, a woman with such a high number of foetuses may be advised to reduce the number in order to increase the survival chances of the remaining babies.
There are considerable risks to both mother and babies in large multiple births. The mother is at risk of pregnancy-induced high blood pressure, which is probably one of the reasons the Californian mother was admitted to hospital early in her pregnancy. Very high blood pressure, although treatable, can be life-threatening. The woman would also have been at high risk of developing pregnancy-related diabetes. And the chances of a serious haemorrhage, especially just after the birth, are much higher in multiple births.
From the babies’ point of view the risk of developing cerebral palsy, a neurological condition related to birth, is much greater, although the condition may take time to manifest itself. Babies born prematurely also have relatively immature lungs and may develop severe breathing problems. They also have feeding difficulties, not having developed to the point where being fed outside the womb is the norm.
However, initial reports on the octuplets’ condition are good. Just two are being ventilated, and while it would be remarkable if all eight babies lived, doctors are cautiously optimistic that most will do so.
The next 72 hours will be crucial.