554 Successful planned vaginal delivery of triplets: a systematic review and meta-analysis

Abstract

To evaluate the success of vaginal delivery (VD) of all three triplets when vaginal birth was attempted. A systematic review of peer-reviewed English language articles concerning women who planned for VD of triplets was conducted using PubMed, Scopus, and Cochrane libraries. All studies that reported actual mode of delivery for all three triplets were included. The primary outcome was the incidence of successful VD for all triplets in women who planned a vaginal birth. Secondary outcomes were maternal and neonatal outcomes based on the intended and actual mode of delivery. 19 studies (n= 694 triplet gestations) met inclusion criteria. The studies were heterogenous (I2=91.1%, CI 87.6%-93.6%). The incidence of VD for all three triplets among those attempting vaginal birth was 79.8% (95% CI 68.2%-89.2%). Women who attempted VD were younger than those who had planned cesarean (31.3 vs 32.6 years, MD -0.26, 95% CI -0.41, -0.11). Multiparous women were more likely to attempt VD (OR 1.84, 95% CI 1.32-2.58). Maternal outcomes were not reported for women who had a successful VD versus women who were unsuccessful or had a scheduled cesarean. There was increased incidence of necrotizing enterocolitis among infants born to women who attempted VD compared to those who had a scheduled cesarean (OR 2.36, 95% CI 1.02-5.48). The mean gestational age (GA) was lower among triplets who attempted VD compared to those who had a scheduled cesarean (32.6 vs 33.6 weeks, MD -0.92, 95% CI -1.87-0.04). There was increased neonatal mortality among those with a successful VD compared to the cesarean group (OR 5.55, 95% CI 2.0-15.3); however, this analysis included a study from 1989 in a low-resource setting, which may not reflect current practices. When this paper was excluded, there was no difference in neonatal mortality between groups (OR 2.57, 95% CI 0.39-17.1). The optimal mode of delivery for triplets remains unclear. This study may assist in counseling patients regarding success rate and outcomes if a vaginal birth is desired.View Large Image Figure ViewerDownload Hi-res image Download (PPT)