Background and Aims Higher order multiple (HOM) pregnancies are associated with higher risk of complications for both mother and babies with resultant increase in financial and psychological strain on the families. Data on outcome is essential for adequate counseling of families and positive interventions.

Aim To determine the prevalence and outcome of HOM pregnancies in a tertiary hospital in Lagos, Nigeria.

Methodology Data on the mode of delivery, gestational age, pregnancy and neonatal outcome of babies delivered from HOM pregnancies obtained from the labor ward and theatre registers and neonatal unit records over a 3year period (April 2009–March 2012) were reviewed retrospectively.

Results Seventy-four babies (45, 24 and 5 triplets, quadruplets and quintuplets respectively) were delivered from 22 HOM pregnancies out of 6521 deliveries giving a prevalence of 3.37/1000 total births. All deliveries were preterm and all the babies except 2 sets of triplets, 1 set and the 1^st 2 of another set of quadruplets were delivered by caesarean section. The perinatal mortality rate was 243/1000 total births. Mortality was significantly increased with no antenatal booking (21/29 versus 5/45 for unbooked and booked pregnancies respectively, p=0.000), gestational age <30weeks (21/25 versus 5/49 for gestational age <30 weeks and >30weeks respectively, p=0.000) and birth weight < 1000g for live births (8/56 versus 10/10 for birth weight >1000gm and <1000gm respectively, p=0.000).

Conclusion Proper antenatal care and close feto-maternal monitoring of HOM pregnancies will significantly reduce early preterm births and the resultant immediate poor outcomes for these pregnancies.