Perinatal risks in higher order multiple pregnancies: a modern view of the problem (literature review)

Background . Multiple pregnancies significantly increase the risk of a number of complications, including maternal (preeclampsia, gestational diabetes mellitus, anemia, postpartum bleeding) and fetal (fetal growth retardation, feto-fetal transfusion syndrome, congenital malformations). The maternal and perinatal mortality rate is significantly higher than that of single pregnancies. The fact that in most cases the outcome of multiple pregnancies is early preterm surgical delivery plays a significant role. There is currently a lack of aggregated data on higher order multiple pregnancies due to heterogeneity in the sampling and different design of studies. At the same time, there has been a significant increase in the incidence of such cases over the past 40 years, given the development of reproductive assistive technologies, which requires the identification of optimal pregnancy and delivery tactics, as well as the postpartum period in patients with multiple pregnancies of higher order. Objective . Systematization of modern scientific data about perinatal complications associated with multiple pregnancies of higher order.Material and methods. Analysis of current literature data presented in the databases MEDLINE, ELibrary, Scopus, Web of Science, Google Scholar, for the period from 2019 to 2025. Additional resources from the literature lists of submitted articles were used. Research results . Up to 66.7% of multiple pregnancies of higher order are complemented by a series of serious obstetric complications. On the mother’s side to such complications are attributed: great obstetrical syndrome (hypertensive disorders and preeclampsia — 46.3%, gestational diabetes mellitus — 28%, premature labor — 97.9%), anemia of pregnant women — 71.4%, operative abdominal delivery, postnatal bleeding — 33,3% and postpartum depression — 23%). The main complications of the side of the fetus are: selective growth retardation, congenital developmental defects, intrauterine death of the fetus, feto-fetal transfusion syndrome, twin reversed arterial perfusion sequence and twin anemia polycythemia sequence (in monochorea type of multiple pregnancy). In the neonatal period, there are complications such as: respiratory disorders (54.4%), extremely low birth weight (30.8%), intra-ventricular hemorrhage (38.5%), infection (25.5%), neonatal jaundice (11.4%) and transitory tachypnoea (5.2%). In the later period of development such children have a high risk of disability (50%), CDD (15-20%) and cognitive impairment. Conclusion . The problem of multiple pregnancies of higher order, associated with a high risk of maternal and perinatal morbidity and mortality, is now highly topical and requires optimization and personalization of approaches to obstetric care, the timing and delivery methods of such a pregnancy.