Prediction of perinatal mortality in triplet pregnancies.

Abstract

To investigate predictors of perinatal mortality in triplet pregnancies. Retrospective cohort managed in a tertiary teaching hospital (1998-2012) including all pregnancies with tree live fetuses at the first ultrasound examination, performed after 11weeks of gestation. Primary end-point was defined as the number of children alive at hospital discharge. Ordinal stepwise regression analysis examined the association with maternal age, parity, pregnancy chorionicity, gestational age at our first ultrasound evaluation, presence of maternal clinical, obstetrical and fetal complications and gestational age at delivery. Sixty-seven triplet pregnancies were first seen at 18.5±6.8weeks, 33 (49.3%) were trichorionic, obstetric complications occurred in 34 (50.7%) and fetal complications were diagnosed in 17 (25.4%). Perinatal mortality rate was 249‰ (95% CI 189-317) and 138 (73%) children were discharged alive from hospital (11 pregnancies with no survivors; single and double survival in ten cases each; all children alive in 36). Regression analysis showed that presence of fetal complications (OR 0.10, 95% CI 0.03-0.36) and gestational age at delivery (OR 1.55, 95% CI 1.31-1.85) are significant predictors of outcome (p<0.001). Perinatal mortality in non-selected triplet pregnancies is high and is related to the presence of fetal complications and gestational age at delivery.