Background: Induced multiple fetal gestation has increased lately in our population with wide use of artificial reproduction techniques(ART). Aim: To study cases of higher-order multiple fetal gestation (HOMFG) patients and examine their related morbidity and mortality issues. Material & methods: Records of all HOMFG (both mothers and newborn infants) were reviewed at Dhahran Health Center between year's 1993- 1997 (total of 18,000 deliveries was involved). Fifteen sets of triplets, one quadruplet and one quintuplet were studied. Aside from one natural triplet set, all others were products of induced ovarian overstimulation due to either primary or secondary infertility reasons. Results: see table Fifteen mothers delivered by planned cesarean sections. A recent trend towards improved survival with lower birth weight and gestation was seen mainly after 30 wk of gestation. Discussion: Recent increase of induced HOMFG in our population imposed a demand on obstetric and neonatal services with hospital resources depletion. Increased morbidity and mortality among HOMFG mothers(hypertension, bleeding and fetal loss) and their newborns (prematurity, respiratory distress & low birth weight) were very obvious. Recommendations: A tighter regulation on ART utilization to allow specialized centers with both advanced obstetric and neonatal facilities to offer such services which must include selective fetal reduction. HOMFG parents education and support with their infants close follow up is highly advisable.

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