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The prevalence of high-order multiple (HOM) pregnancies has increased because of ovulation induction, assisted reproductive technologies, and spontaneous conceptions in older mothers. Pregnancies with 3 or more fetuses carry heightened morbidity and mortality risks for mothers and children. Although many families cope well, psychosocial complications include stress, marital and financial strain, social stigma, depression, grief, and neglect of multiples and their siblings. Adequate support reduces adverse consequences. Multiple births strain societal resources. With fertility treatment, the desires of patients, business pressures of clinics, and financial, legal, and religious considerations influence HOM conception rates. Maternal autonomy in fertility treatments must be balanced against obligations to prospective children and society. Selective termination of abnormal fetuses and multifetal pregnancy reduction are ethically justifiable, but may contradict parents' or clinicians' values. Decisions for moribund multiples are difficult. Media coverage is often inaccurate or intrusive, but benefits some families. Skilled care, accurate information, and practical resources optimize outcomes. |
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