Consecutive Triplet Pregnancies Research Articles

Perinatal outcomes of fetoscopic laser surgery for twin-twin transfusion syndrome in triplet pregnancy: cohort study, systematic review and meta-analysis.

The aims of this study were to investigate the perinatal outcome of dichorionic triamniotic (DCTA) and monochorionic triamniotic (MCTA) triplet pregnancies complicated by twin-twin transfusion syndrome (TTTS) treated with fetoscopic laser photocoagulation (FLP) in two academic fetal centers, and to conduct a systematic review of previously published data to investigate perinatal survival in this targeted population. The first part of the study was a retrospective cohort study of prospectively collected data of consecutive triplet pregnancies with TTTS that underwent FLP at two fetal treatment centers between 2012 and 2020. Demographic, preoperative and operative variables and postoperative outcome were collected. Perinatal outcomes were investigated. The second part of the study was a systematic review and meta-analysis of studies evaluating the outcome of DCTA and/or MCTA triplet pregnancies, including our cohort study. PubMed, Web of Science and Scopus were searched from inception to September 2020. Primary outcomes were fetal survival (survival to birth), neonatal survival (survival to 28 days of age) and gestational age (GA) at birth. A total of 31 sets of triplets with TTTS managed with FLP were included in the cohort study. Of these, 24 were DCTA and seven were MCTA. There were no significant differences in preoperative and operative variables between the two groups. There were also no significant differences between groups in GA at delivery or perinatal survival rate, including fetal and neonatal survival of at least one triplet, at least two triplets and all three triplets. Nine studies, including our cohort study, were included in the systematic review (156 DCTA and 37 MCTA triplet pregnancies treated with FLP). The overall fetal and neonatal survival was 79% (95% CI, 75-83%) and 75% (95% CI, 71-79%), respectively, in DCTA cases and 74% (95% CI, 52-92%) and 71% (95% CI, 49-89%), respectively, in MCTA cases. The rate of preterm birth before 28 weeks and before 32 weeks' gestation was 14% (95% CI, 4-29%) and 61% (95% CI, 50-72%), respectively, in DCTA triplets and 21% (95% CI, 3-45%) and 82% (95% CI, 62-96%), respectively, in MCTA triplets. Triplet pregnancies with TTTS are at high risk of adverse perinatal outcome and preterm birth, regardless of chorionicity. The rate of survival after FLP in MCTA triplets was higher in our study than that reported in previous studies and is currently comparable with survival in DCTA triplets, which could be due to improved surgical skills. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Maternal and neonatal outcomes of 73 triplet pregnancies cared for in a dedicated multidisciplinary multiple pregnancy service at a tertiary referral unit

BackgroundMultiple pregnancies are high risk for both mother and fetus, and the risk increases as the number of fetuses increases.ObjectivesTo study the outcome of 73 consecutive triplet pregnancies cared for...

Ultrasound assessment of the prognosis in triplet pregnancies

To assess the diagnostic accuracy and show the prognostic influence of different ultrasonographic criteria in triplet pregnancies(TP). Retrospective study. Tertiary care center in France. Fifty-one consecutive TP in which at least one of the children, live- or stillborn, weighed 500 g or more, and with a gestation period of at least 22 weeks. Chorionicity, abnormal umbilical artery Doppler waveforms, intrauterine weight (IUW) <10th centile and prenatal diagnosis of fetal anomaly were studied simultaneously as prognostic criteria. Chorionicity was confirmed at birth by placental pathology. Diagnosis of chorionicity/amnionicity and IUW <10th centile. Neonatal intensive care unit admission, occurrence of respiratory distress syndrome and perinatal mortality. Prenatal misclassification of chorionicity/amnionicity after postnatal perinatal pathology review was 12%. The positive predictive value of IUW <10th centile diagnosis was 44% for the prediction of birthweight <10th centile. Prenatal diagnosis of mono- or dichorionic placentation was associated with increased neonatal morbidity in comparison with that of trichorionic triplets. Perinatal mortality was significantly increased where mono- or dichorionic placentation was diagnosed prenatally (OR: 4.2; CI: 1.04-17), IUW <10th centile (OR: 10; CI: 2.4-41), with raised odds for abnormal umbilical Doppler measurements (OR: 9.7; CI: 2-47) and fetal anomaly (OR: 6.4; CI: 1.4-28.9). Early prenatal diagnosis of chorionicity is of major importance in triplet pregnancy. Experienced sonographers must quickly evaluate any uncertain diagnosis. In cases of unknown chorionicity, other ultrasonographic criteria can highlight high-risk triplet pregnancy, but at a later stage.

Zygosity and Chorionicity in the Prognosis of Triplet Pregnancies: Contribution of Microsatellites

We assess the prognostic values of zygosity and chorionicity in triplet pregnancies (TP) with the assistance of microsatellites analysis. 53 consecutive TP whose prenatal care and delivery occurred in our maternity hospital were included in this prospective study. Zygosity of all sets of triplets (alive or stillbirth, after 22 weeks of gestation) was determined by PCR-amplified microsatellites markers analysis. Chorionicity was determined by placental analysis in our fetopathology referral department and validated by molecular analysis of zygosity. Placental conformations, obstetrical and neonatal outcomes of TP were studied according to their zygosity and chorionicity. Monozygotic and to a greater extent, dizygotic TP were associated with an increase in placental ischemic injuries, velamentous cord insertions, twin-twin transfusion syndromes, fetal anomalies, and perinatal mortality when compared with the trizygotic TP (p < 0.05). Monochorionic and more significantly, dichorionic TP presented with the same increases as trichorionic TP (p < 0.05). Thus chorionicity easily determined by ultrasound evaluation during the first trimester of the pregnancy must remain the main prognosis criterion in TP. Taking into account the rare indications of prenatal diagnosis of zygosity, it became apparent that chorionicity has a greater impact than zygosity when distinguishing high-risk groups of TP.

Maternal and neonatal outcome of 93 consecutive triplet pregnancies with 71% vaginal delivery.

The aim of this study was to investigate neonatal and maternal data in a large series of triplet pregnancies as a function of the decision regarding the route of delivery. A retrospective series of 93 triplet pregnancies managed and delivered between 1989 and 2001 in a single perinatal department was analyzed. Seventy-eight women with triplet gestations who underwent a trial of labor were compared with 15 women with triplet gestations who delivered their infants by elective cesarean delivery. Neonatal outcomes assessed included respiratory distress syndrome, retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage and Apgar scores. Maternal outcomes assessed included preeclampsia, blood transfusion, endometritis and urinary tract infection. Sixty-six of 78 women (84%) who underwent a trial of labor had a successful vaginal delivery of all three neonates. The other 12 delivered their infants by cesarean delivery. Perinatal mortality referred to 104 triplet pregnancies was 48/1000. Our experience suggests that offering vaginal delivery is an acceptable management plan for triplet gestation in a center with a sufficient number of triplet deliveries.

Maternal and neonatal outcome of 93 consecutive triplet pregnancies with 71% vaginal delivery

Maternal and neonatal outcome of 93 consecutive triplet pregnancies with 71% vaginal delivery

Impact of fetal reduction on the incidence of gestational diabetes

OBJECTIVE: To estimate the rate of gestational diabetes in triplet pregnancies and to assess the impact of fetal reduction on the incidence of this complication. METHODS: One hundred eighty-eight consecutive triplet pregnancies referred to the Sheba Medical Center between 1994 and 1998 were included. One hundred three of these pregnancies continued as triplets, whereas 85 women elected to undergo fetal reduction to twins. The incidence of gestational diabetes (based on the criteria of Carpenter and Coustan) and other outcome variables were compared between the two groups. Student t-tests and χ 2 analysis were used as appropriate. RESULTS: Mean (±SD) maternal age was 29.2 ± 4.8 in the triplet group and 29.3 ± 4.1 in the reduction group. The groups had similar median parity (1.6 ± 1.1 in the triplet group and 1.5 ± 0.7 in the reduction group). The rate of gestational diabetes was significantly higher in the triplet group than in the reduction group (22.3% vs 5.8%). A lower birth weight (1764 ± 448 g vs 2208 ± 526 g) and an earlier gestational age at delivery (33.4 ± 2.8 weeks vs 36.0 ± 2.8 weeks) were observed in the triplet group compared with the reduction group. CONCLUSION: The number of fetuses in multifetal pregnancies influences the incidence of gestational diabetes. These findings support the hypothesis that an increase in placental mass and, thus, an increase in diabetogenic hormones play a role in the etiology of gestational diabetes.

Maternal and neonatal outcome of 100 consecutive triplet pregnancies.

The objective of this study is to determine the maternal and neonatal outcome of a large group of triplet gestations. A retrospective review of 100 triplet gestations managed and delivered between January 1992 and September 1999 by a single perinatal group is examined. These pregnancies were managed on an outpatient basis. Prophylactic interventions were not utilized. Ninety-six percent of the pregnancies had at least one complication, with preterm labor the most common. The median gestational age at delivery was 33 weeks (range 20.4 to 37, SD 4.1 weeks) with 14% of pregnancies delivering prior to 28 weeks' gestation. The corrected perinatal mortality rate was 97/1000. Minimal long-term morbidity was seen with delivery after 27 weeks' gestation. Pregnancy outcome did not vary with birth order or mode of conception. Triplet pregnancy is associated with a high rate ofantenatal complications. Favorable neonatal outcome can be obtained without the use of prophylactic interventions.

Prenatal determination of chorionicity in triplet pregnancy by ultrasonographic examination of the ipsilon zone

To determine chorionicity in triplet pregnancies by ultrasonographic assessment of the ipsilon zone, the junction of the three interfetal membranes. The thickness of the component membranes in the ipsilon zone was studied to determine chorionicity in 28 triplet pregnancies, by retrospective examination of the ultrasonographic images taken at 9-24 weeks' gestation, and in 20 consecutive triplet pregnancies followed prospectively by targeted ultrasonography at 8-21 weeks' gestation. Prenatal ultrasonographic findings were compared with those obtained from the records of the infertility centers or referring hospitals (the number of gestational sacs and live embryos in each sac seen by transvaginal scanning at 6-7 weeks' gestation). Of the 28 triplet pregnancies with appropriate images demonstrating the ipsilon zone, 22 were classified as trichorionic, five dichorionic, and one monochorionic. This classification was correct in all but one trichorionic pregnancy, which was misclassified as dichorionic. In the prospective subset (n = 20) there were 16 trichorionic and four dichorionic triplet pregnancies. The ipsilon zone was not present in one case in which the interfetal membrane did not intersect. In the remaining 19 pregnancies, there was a complete correlation between the findings at the ipsilon zone and transvaginal ultrasonography at 6-7 weeks. Ultrasonographic assessment of the ipsilon zone is useful for predicting chorionicity in triplet pregnancies.

Delivery of uncomplicated triplet pregnancies: Is the vaginal route safer?: A case-control study

OBJECTIVE: Our purpose was to evaluate the safety of vaginal delivery of triplets. STUDY DESIGN: A retrospective case-control study on 69 consecutive triplet pregnancies delivered in the same institution between 1981 and 1992. Vaginal delivery was attempted in 23 otherwise uncomplicated triplet pregnancies, which form the study groupo. They were compared with 23 controls undergoing routine cesarean section and matched for gestational age at birth. Maternal hospital stay, neonatal mortality, hospitalization in the neonatal intensive care unit, and 5-minute Apgar scores were compared by means of paired tests. RESULTS: In the vaginal delivery group there was one neonatal death related to prematurity (32 weeks) after intrapartum cesarean section for failure to progress. However, neonatal mortality was not significantly increased in comparison with controls (1 of 69 vs 0). In the study group Apgar scores were significantly higher (9.5 vs 8.4) and hospitalization in the neonatal care intensive unit was significantly shorter (6 vs 18 days) than in the cesarean section group ( p ≤ 0.002). CONCLUSION: In carefully selected cases vaginal delivery of triplets may be safe.

The effect of fertility drugs and in vitro methods on the outcome of 106 triplet pregnancies

To compare the effect of fertility drugs and IVF on the outcome of triplet pregnancies. Prospective clinical study. A single university medical center. One hundred six consecutive triplet pregnancies treated from 1984 through 1992. The frequency of pregnancy loss, livebirths, and antenatal and neonatal complications was compared in spontaneous, clomiphene citrate (CC), menotropins, and IVF triplet pregnancies. Eighty-one of the 106 (76.4%) triplet pregnancies progressed beyond 25 weeks, comprising 6 of 7 (85.7%) spontaneous pregnancies, 13 of 16 (81.2%) CC induced, 44 of 56 (78.6%) menotropin induced, and 18 of 27 (66.6%) IVF gestations. There were no significant differences in the stillbirth and neonatal mortality rates according to the mode of conception. The mean gestational ages and the mean birth weights were similar in the four groups. The frequency of premature contractions, premature rupture of membranes, cesarean section, and neonatal complications were similar in the ovulation induction and IVF pregnancies. Triplet pregnancies after ovulation induction and IVF have a similar outcome.

Consecutive triplet pregnancies following in-vitro fertilization and embryo transfer. Two case reports

The number of multiple pregnancies has been increasing as a result of the relatively widespread use of drugs for induction of ovulation and assisted conception techniques. This paper details the first reported cases of triplet pregnancies occurring in consecutive IVF cycles in two patients.

Triplet pregnancy: a review of 27 cases.

Analysis of 27 consecutive triplet pregnancies seen at the University Teaching Hospital in Enugu, Nigeria, from 1972 to 1979 revealed an incidence of one in 1014 live births; three of these mothers had had a previous twin pregnancy. Overall fetal mortality was 30.9%, with babies of older women faring better than those of the younger. The fetal death rate was 1.8 times greater in the absence of antenatal supervision. Although the male infant was generally heavier at birth, sex did not influence survival and neither predominated. Surprisingly, vertex delivery, independent of birth order, was associated with the worst prognosis. All babies of sets having a combined birth weight of 2800 gm and under died; all those 5440 gm and above survived. Maturity, rather than birth weight, determined fetal survival, which was also unaffected by time interval between deliveries of a set. The first triplet did have the least birth hazard.