Management Of Triplet Pregnancies Research Articles

General Principles for Counseling and Management of Triplet Pregnancies.

Compared with singleton pregnancies, triplet pregnancies are associated with a significantly increased risk of adverse pregnancy outcomes. Early ultrasound examination is the best way to diagnose triplets, establish dating, and determine the number of placentas to provide appropriate counseling and monitoring. Dichorionic placentation adds risks specifically associated with a shared placenta, and limits options for intervention. Multifetal reduction is an option that can significantly improve pregnancy outcomes compared with non-reduced triplet pregnancies. Integration of a Maternal-Fetal Medicine specialist in the prenatal care for a triplet pregnancy reduces the risk of preeclampsia, preterm birth, low birthweight infants, perinatal mortality, and major neonatal morbidity.

Prophylactic Trans-vaginal Cervical Cerclage versus Conservative Management in Triplet Pregnancies

Background: To compare the effect of prophylactic trans- vaginal cervical Cerclage versus the conservative treatment in management of triplet pregnancies and also the effect of parity on gestational age and birth weight in triplet pregnancies.Patients and Methods: 40 women with triplet pregnancies were divided into 2 groups. Group 1 (20) received prophylactic cerclage. Group 2 (20) with no Cerclage [conservative management]. Each group subdivided into two half ; half of the women were primi-para and the other half were multi-para (including unipara &multi-para), women with possibility of cervical insufficiency were excluded and pregnancy was followed in all women until delivery.Results: There was no significant difference between the both groups regarding the gestational age at time of delivery (31.45±4.68 in Cerclage group versus 32.65±4.01 in non Cerclage), the miscarriage rate (20% in Cerclage versus 15% in conservative management group) and time of delivery (35% delivered before 34 w, 35% between 34w and 36w, and 10% after 36w in cerclage group versus 35%, 40%, 10% in conservative management group respectively).There was no significant difference between both groups regarding the neonatal birth weight (1390±467.24 in cerclage group versus 1405±475.7 in conservation group) & NICU admission (90% in both groups). parity has effect on gestational age of delivery (75% of prime para delivered before 34 wks. 20 % between 34-36 weeks and 5% after 36weeks while in multi para (35%,40%, and 10%) respectively.Conclusion: Prophylactic trans- vaginal cervical cerclage in triplet pregnancies regarding pregnancy prolongation and neonatal outcomes is similar to conservation. Parity has effect on pregnancy prolongation & consequently the neo-natal outcomes.

Complications and Management of Triplet Pregnancy

Not uploaded.Key words: Pregnancy; Preterm; TripletDOI: 10.3126/jnhrc.v5i2.2473Journal of Nepal Health Research Council (JNHRC) Vol. 5, No.2, October 2007 62-65

Complications and Management of Triplet Pregnancy

Complications and Management of Triplet Pregnancy

Prophylactic cerclage in the management of triplet pregnancies

The purpose of this study was to determine if prophylactic cerclage improves pregnancy outcome in women with triplet pregnancies without a history of cervical insufficiency. Triplet pregnancies with > or = 1 day of outpatient surveillance beginning before 32 weeks' gestation were identified from a database of women in the US who received outpatient preterm labor surveillance services between January 1990 and May 2004. Triplet pregnancies managed with prophylactic cerclage were compared with triplet pregnancies in which cerclage was not placed. Patients with a diagnosis of cervical insufficiency in a previous or in the index pregnancy were excluded from analysis. The primary outcome was incidence of preterm birth before 32 weeks. Groups were compared using Fisher exact test, and Student t test with 2-sided P values < .05 considered statistically significant. Three thousand two hundred seventy-eight triplet pregnancies met criteria for inclusion, of which 248 women (7.6%) received prophylactic cerclage. No significant differences were seen in mean gestational age at delivery, incidence of preterm birth before 32 weeks, birth weight, or neonatal days in the hospital. This study had 80% power to detect a 30% reduction in the primary outcome. Prophylactic cerclage did not result in improved pregnancy or neonatal outcomes in triplet pregnancies without a history of cervical insufficiency.

Prophylactic cerclage in the management of triplet pregnancies

ObjectiveTo determine if prophylactic cerclage improves pregnancy outcome in women with triplet pregnancies.Study designTriplet pregnancies with ≥1 day of outpatient surveillance beginning at <32.0 weeks' gestation were identified from a database of women in the United States who received outpatient preterm labor surveillance services between 1/90 and 5/04. Triplet pregnancies managed with prophylactic cerclage were compared with triplet pregnancies in which cerclage was not placed. Patients with a diagnosis of cervical incompetence in a previous or in the index pregnancy were excluded from analysis. The primary outcome was incidence of preterm birth prior to 32 weeks. Demographic information, gestational age at delivery, and neonatal outcomes were also compared. Groups were compared using Fisher's Exact Test and Student's independent t test statistics. Two-sided P values < .05 were considered statistically significant.ResultsTabled 1TableNo CerclageCerclagen = 3,030n = 248P valueGA at delivery33.0 ± 2.533.1 ± 2.60.634<32 weeks27.5%27.4%1.000<28 weeks4.5%4.0%0.873Birth weight1819 ± 4761817 ± 4640.946Live weight99.3% (9,028)99.1% (737)0.617NICU admit81.1% (7, 376)79.8% (594)0.924Nursery days22.7 ± 20.621.1 ± 19.90.237 Open table in a new tab ConclusionIn triplet gestations wthout cervical incompetence in past or present pregnancy, prophylactic cerclage did not result in improved pregnancy and neonatal outcomes. ObjectiveTo determine if prophylactic cerclage improves pregnancy outcome in women with triplet pregnancies. To determine if prophylactic cerclage improves pregnancy outcome in women with triplet pregnancies. Study designTriplet pregnancies with ≥1 day of outpatient surveillance beginning at <32.0 weeks' gestation were identified from a database of women in the United States who received outpatient preterm labor surveillance services between 1/90 and 5/04. Triplet pregnancies managed with prophylactic cerclage were compared with triplet pregnancies in which cerclage was not placed. Patients with a diagnosis of cervical incompetence in a previous or in the index pregnancy were excluded from analysis. The primary outcome was incidence of preterm birth prior to 32 weeks. Demographic information, gestational age at delivery, and neonatal outcomes were also compared. Groups were compared using Fisher's Exact Test and Student's independent t test statistics. Two-sided P values < .05 were considered statistically significant. Triplet pregnancies with ≥1 day of outpatient surveillance beginning at <32.0 weeks' gestation were identified from a database of women in the United States who received outpatient preterm labor surveillance services between 1/90 and 5/04. Triplet pregnancies managed with prophylactic cerclage were compared with triplet pregnancies in which cerclage was not placed. Patients with a diagnosis of cervical incompetence in a previous or in the index pregnancy were excluded from analysis. The primary outcome was incidence of preterm birth prior to 32 weeks. Demographic information, gestational age at delivery, and neonatal outcomes were also compared. Groups were compared using Fisher's Exact Test and Student's independent t test statistics. Two-sided P values < .05 were considered statistically significant. ResultsTabled 1TableNo CerclageCerclagen = 3,030n = 248P valueGA at delivery33.0 ± 2.533.1 ± 2.60.634<32 weeks27.5%27.4%1.000<28 weeks4.5%4.0%0.873Birth weight1819 ± 4761817 ± 4640.946Live weight99.3% (9,028)99.1% (737)0.617NICU admit81.1% (7, 376)79.8% (594)0.924Nursery days22.7 ± 20.621.1 ± 19.90.237 Open table in a new tab ConclusionIn triplet gestations wthout cervical incompetence in past or present pregnancy, prophylactic cerclage did not result in improved pregnancy and neonatal outcomes. In triplet gestations wthout cervical incompetence in past or present pregnancy, prophylactic cerclage did not result in improved pregnancy and neonatal outcomes.

Management of triplet pregnancies with prophylactic cerclage

Management of triplet pregnancies with prophylactic cerclage

Conservative management of triplet pregnancy after delivery of one foetus

Conservative management of triplet pregnancy after delivery of one foetus

Ultrasonographic assessment of cervical length in triplet pregnancies

Objective: Our goal was to evaluate the utility of ultrasonographic assessment of cervical length in the management of triplet pregnancies and to compare these measurements with previously reported data for singleton pregnancies. Study Design: The maternal records for all triplet pregnancies managed at the Mayo Medical Center from January 1993–January 1998 were reviewed. Cervical length assessment was undertaken at regular intervals during each pregnancy according to an established real-time transperineal ultrasonographic technique. Presence or absence of cervical funneling was noted at the time of the examination. Obstetric management and outcome data were assessed. Results: Thirty-two triplet pregnancies were managed at our institution between January 1993 and January 1998. Average duration of pregnancy (±SD) was 32.4 ± 2.3 weeks. Progressive cervical shortening was noted with advancing gestational age; average cervical lengths (±SD) were 42.0 ± 5.0 mm at 10 weeks, 37.0 ± 8.0 mm at 20 weeks, 26.0 ± 10.0 mm at 25 weeks, and 21.0 ± 7.0 mm at 30 weeks. Comparison of triplet cervical length measurements with reported data from singleton pregnancies revealed a significant difference between the singleton and triplet data, respectively, at both 24 weeks (35.2 ± 8.3 mm vs 25.0 ± 8.0 mm, P < .001) and 28 weeks (33.7 ± 8.5 mm vs 28.0 ± 11.0 mm, P < .005). Cervical funneling was noted in 3 women with an average of 27 days from onset to delivery. Conclusions: Ultrasonographic assessment of cervical length is a useful adjuvant in the management of the triplet gestation. Triplet cervical length measurements are significantly different from those reported for gestational age–matched singleton pregnancies. Premature cervical shortening and the presence of cervical funneling are harbingers of premature delivery and should necessitate obstetric intervention. (Am J Obstet Gynecol 1999;180:1442-5.)

Cost savings and perinatal outcome associated with outpatient management of triplet pregnancy

Cost savings and perinatal outcome associated with outpatient management of triplet pregnancy

Management of Triplet Pregnancies in the 1980s-Are We Doing Better?

The incidence of triplet pregnancies has increased with the introduction of ovulation induction agents and is expected to further increase with the implementation of multiple embryo transfer in the in vitro fertilization programs. We review our experience with 29 triplet pregnancies in the last 10 years. Despite early sonographic diagnosis, close follow-up, increased use of tocolytics, and prophylactic cervical suture, we could not document prolongation of pregnancy, increased infants' weight, or a significantly decreased perinatal mortality, which still remains about 14%. Furthermore, the use of cesarean section as the delivery method of choice did not change the well-documented unfavorable relationship between birth order and fetal outcome. There is an urgent need for prospective assessment of the value of different treatment modalities, which nowadays becomes possible with the increasing incidence of triplet pregnancies. The prevention of triplet pregnancies or treatment by selective fetal reduction deserves a second thought.

Management of triplet pregnancy.

Based on the outcome of 21 triplet pregnancies from Antoine Béclère Hospital, early diagnosis in the major requirement for improving rates of fetal survival in multiple pregnancies. The outcome was better in mothers with spontaneous ovulation than in those with induced ovulations. Elective cesarean section is proposed.