Outcome Of Triplet Gestations Research Articles

The Relationship of Assisted Reproductive Technology on Perinatal Outcomes in Triplet Gestations.

To assess whether assisted reproductive technology (ART) is associated with increased risk of adverse perinatal outcomes in triplet gestations compared with spontaneous conception. Secondary analysis of a multicenter randomized trial for the prevention of preterm birth in multiple gestations. Triplets delivered at ≥ 24 weeks were studied. The primary outcome was the rate of composite neonatal morbidity (CNM) that included one or more of the following: bronchopulmonary dysplasia, respiratory distress syndrome, necrotizing enterocolitis, culture proven sepsis, pneumonia, retinopathy of prematurity, intraventricular hemorrhage, periventricular leukomalacia, or perinatal death. There were 381 triplets (127 women) of which 89 patients conceived via ART and 38 patients spontaneously. Women with ART were more likely to be older, Caucasian, married, nulliparous, have higher level of education, and develop pre-eclampsia. Spontaneously conceived triplets were more likely to delivery at an earlier gestation (31.2 ± 3.5 vs 32.8 ± 2.7 weeks) (p = 0.009) with a lower birth weight (p < 0.001). After adjusting for confounders, no differences were noted in culture proven sepsis, perinatal death, CNM, respiratory distress syndrome, or Apgar score < 7 at 5 minutes. All remaining perinatal outcomes were similar. Triplets conceived by ART had similar perinatal outcomes compared with spontaneously conceived triplets.

Maternal and neonatal outcomes in triplet gestations by trial of labor versus planned cesarean delivery

Objective To determine the rate of vaginal delivery after vaginal trial of labor (TOL) among women with triplet gestations. Study design This is a retrospective cohort study of all women delivering a viable triplet gestation between 2005 and 2016. The primary outcome was rate of vaginal delivery among all women attempting vaginal delivery. Secondary outcomes included factors associated with undergoing triplet TOL, and maternal and neonatal complications by planned delivery approach. Results Of the 83 eligible women, 21 (25.3%) underwent TOL. A majority of these (57.1, 95% confidence interval 36.5–75.5%) achieved a vaginal delivery of all three triplets. Women who underwent TOL were more likely to be multiparous or to have spontaneous preterm labor. There were no differences in adverse maternal or neonatal outcomes by planned delivery approach. Conclusions The rate of vaginal delivery among women with triplet gestations is higher in this institution than in reported literature, without increased morbidity.

Perinatal and Neonatal Outcomes of Triplet Gestations Based on Chorionicity [19K

INTRODUCTION: The purpose of this study was to compare perinatal and neonatal outcomes in triplet gestations based on placental chorionicity. We hypothesized that triplets containing a monochorionic twin pair (dichorionic-triamniotic) would have increased morbidity/mortality compared with triplets without a monochorionic twin pair (trichorionic). METHODS: This was a retrospective cohort study of triplet gestations delivered at greater than 20 weeks at our institution from 2009–2015. Data was abstracted through electronic medical records. The primary outcome was composite neonatal morbidity/mortality; respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, under 10th percentile birth weight, death. RESULTS: 42 sets of triplets were included; 26 trichorionic-triamniotic, 14 dichorionic-triamniotic, and 2 monochorionic-triamniotic. The dichorionic and monochorionic gestations were combined into one group (n=16) for the comparisons. Maternal baseline characteristics were comparable. There were no significant differences in pregnancy complications including the presence of a shortened cervix, cerclage placement, use of tocolytics, premature rupture of membranes, pregnancy-induced hypertension, gestational diabetes, or twin-twin transfusion syndrome. Increased risk of intrauterine growth restriction was noted in the dichorionic and monochorionic group compared to the trichorionic group (25% vs 3.8%), however, the difference was not statistically significant due to the small number of patients (P=.06). There was a significant difference in the composite morbidity/mortality between the groups. All dichorionic and monochorionic gestations suffered some morbidity. CONCLUSION: Dichorionic triplet gestations are at an increased risk of neonatal morbidity/mortality when compared to trichorionic triplet gestations. Further research is needed to elucidate the risk factors that increase the risk of monozygotic twinning.

Incidences of Feto-Fetal Transfusion Syndrome and Perinatal Outcomes in Triplet Gestations with Monochorionic Placentation

Introduction: This study aimed to determine the incidences of feto-fetal transfusion syndrome (FFTS) and perinatal outcomes in triplet gestations with monochorionic placentation. Materials and Methods: In this retrospective cohort study, we evaluated the incidences of FFTS and perinatal outcomes at 28 days of age in cases of triplet gestations with monochorionic placentation who visited our centers before 16 weeks of gestation and delivered over a period of 11 years. Results: In 41 triplet gestations (17 monochorionic triamniotic, 22 dichorionic triamniotic, 1 dichorionic diamniotic, and 1 monochorionic monoamniotic), the incidence of FFTS was 17.1%, and the median gestational age at FFTS diagnosis was 19 weeks. In 123 triplets, the incidences of fetal death and neonatal death at 28 days of age were 8.1 and 0.9%, respectively. None of the surviving infants had grade 3 or 4 intraventricular hemorrhage, while cystic periventricular leukomalacia occurred in 6 of 113 infants (5.3%). The incidence of poor outcomes (death or any major neurological complication at 28 days of age) was 13.8%. Discussion: Seventeen percent of triplet pregnancies with monochorionic placentation developed FFTS, and 14% had a poor outcome. Therefore, triplet gestations with monochorionic placentation should be followed carefully.

P15.02: Incidences of fetofetal transfusion syndrome and perinatal outcomes in triplet gestations with monochorionic placentation

P15.02: Incidences of fetofetal transfusion syndrome and perinatal outcomes in triplet gestations with monochorionic placentation

Triplet gestation: current scenario in a teaching hospital of Eastern India

Objective: The purpose of this study was to assess obstetrical and perinatal outcomes of triplet gestations, and to explore its clinical, social, psychological, and economic impact on the parents, and their families in the context of developing countries.Methods: The records of 7 triplet pregnancies delivered in S.S.K.M. Hospital, Kolkata between 1999 and 2006, were analyzed regarding method of diagnosis, antenatal complications, mode of delivery and perinatal outcomes. A qualitative observational study was also performed in 2 cases to explore possible social, financial and psychological impact of triplet pregnancies in a low-resource setting, and to assess the parents ability to cope with these challenges.Results: The incidence of triplet gestation was 1 in 1778 deliveries in this hospital. Anemia, gestational hypertension and preterm labour were common complications. Majority (70%) of these women were delivered by caesarean section. High perinatal mortality (222 per 1000 total births) was mainly due to combination of prematurity, low birth-weight and perinatal asphyxia. The qualitative study has revealed, profound psychological impact on the mothers, especially when all 3 children from a triplet gestation were girls.Conclusions: Early diagnosis with determination of chorionicity, antenatal counseling, psychological and financial support, and availability of advanced neonatal care are the cornerstones of favorable outcome in triplet gestation. Psycho-social preparation of the parents and their families is also vital to cope with the simultaneous needs of 3 low birth-weight neonates.

Study of a Population of Triplet Pregnancies: Maternal and Neonatal Outcomes

Objective: To describe maternal complications, perinatal mortality and neonatal morbidity in triplet pregnancies. Methods: Retrospective analysis of maternal and neonatal records of 21 triplet pregnancies delivered from January 2008 to June 2011 at San Pietro FBF Hospital of Rome, a tertiary medical center. Results: The incidence of triplet pregnancies was one in 690 births. Among the 21 triplet pregnancies, only one was conceived spontaneously and 20 were the result of assisted reproductive techniques. Mean maternal age was 34.4 ± 5 years. There was one case of a selective foeticide of a foetus with an encephalocele. Preterm delivery occurred in all the remaining 20 pregnancies. Other frequent complications were premature rupture of membranes (40%) and cervical incompetence (35%). There was no maternal mortality in any of the studied pregnancies. The mean length of maternal hospitalization was 15 ± 5.9 days. The mean gestational age was 31.8 weeks, with a mean birth weight of 1590 ± 590 grams. The neonatal mortality was 5%. The incidence of congenital anomalies was 16.7%. Respiratory distress syndrome occurred in 53% of cases and 75.6% of newborns required intensive care. Other common neonatal complications were jaundice (66.7%), anaemia (28.9%), patent ductus arteriosus (24.4%), apnea of prematurity (17.8%), sepsis (13.3%), neurological complications (11.1%) and bronchopulmonary dysplasia (11.1%). The mean length of newborns hospitalization was 33.6 ± 23.3 days. There was no significant difference in neonatal mortality and morbidity based on birth order. Conclusions: This series of triplet pregnancies demonstrated an excellent survival rate and a relatively low major morbidity, despite the 100% incidence of prematurity. Although perinatal outcomes in triplet gestations have improved in recent years, higher-order multiple pregnancies continued to be associated with great medical problems for both mothers and infants. All methods of assisted reproduction should aim for the prevention of multifetal pregnancies

123: Impact of maternal pre-pregnancy body mass index on pregnancy and infant outcomes in triplet gestations

ruption with a mean GA (31.4 4.3wk) compared to the 58 controls (35.1 5.7wk; p .01). Confirmed placental abruption (clinical and/or histological) occurred in 11.5% (7/61) in the study group and none in the controls. MSAFP decreased from 24-41 wk with a mean MSAFP significantly higher in the study group (221 139 g/l) compared with controls (128 67 g/l; p .01). Using an ROC curve the MSAFP cutoff values for the best prediction of placental abruption was calculated and compared with KB results (Table 1). CONCLUSION: MSAFP has predictive value for placental abruption in the 3rd trimester and can be available for use in clinical management. MSAFP can be performed as a simple, inexpensive, rapid test.

The Association of Prepregnancy Body Mass Index with Pregnancy Outcomes in Triplet Gestations

The impact of obesity on triplet gestations is poorly understood. In this study, we investigate the association of obesity with birth outcomes in triplets. Triplet births in the state of Missouri from 1989 through 1997 were analyzed. Obesity was defined as maternal prepregnancy body mass index (BMI) >or=30 kg/m(2). We assessed the association between obesity and the following outcomes: stillbirth, preeclampsia, very preterm, small for gestational age (SGA), and a composite adverse birth outcome. We employed logistic regression with further correction for intracluster correlation to obtain adjusted estimates. A total of 667 triplet gestations were analyzed. As compared with normal-weight mothers, the likelihood of stillbirth and preeclampsia was higher among obese mothers (odds ratio[OR] = 3.70; 95% confidence interval [CI] = 1.37 to 9.97 and OR = 3.02; 95% CI = 1.69 to 5.40 respectively). Obese mothers were also about twice as likely to experience at least one of the adverse birth outcomes considered. Obese women with triplet gestations have about four- and threefold elevated risks for stillbirth and preeclampsia as compared with their counterparts with normal weight. This observation may be of utility in the preconceptional counseling of women considering the use of assisted reproductive technology.

Perinatal and Neonatal Outcomes of Triplet Gestations Based on Placental Chorionicity

The purpose of our study was to evaluate perinatal and neonatal outcomes in triplet gestations in relation to placental chorionicity. We hypothesized that triplets containing a monochorionic pair (dichorionic triamniotic) would have increased morbidity compared with triplets without a monochorionic pair (trichorionic triamniotic). We retrospectively analyzed all triplet sets > or =20 weeks delivering at our institutions from January 1995 through April 2007. Data were collected via perinatal and neonatal databases, chart review, and placental pathology. Individuals in dichorionic triamniotic triplet sets (N = 75), when compared with trichorionic triamniotic triplets (N = 309), were more likely to have a lower mean birth weight (P < 0.001) and lower gestational age at delivery (P < 0.001), spend more days in the neonatal intensive care unit (P = 0.045), have culture-proven sepsis (P = 0.02), and require intubation (P = 0.05). Multivariate analysis demonstrated that dichorionicity is not an independent cause of morbidity, but results in earlier delivery and lower birth weight. Dichorionic triamniotic triplets are at increased risk for earlier deliveries and lower birth weight at delivery compared with trichorionic triamniotic triplets.

328: The impact of pre-pregnancy body mass index on pregnancy outcomes in triplet gestations

328: The impact of pre-pregnancy body mass index on pregnancy outcomes in triplet gestations

268: Perinatal and neonatal outcomes of triplet gestations based on method of conception

METHOD OF CONCEPTION JEFFREY SPENCER, CHARLES INGARDIA, JAMES EGAN, CHRISTOPHER NOLD, KATE SMITH, WINSTON CAMPBELL, University of Connecticut Health Center, Farmington, Connecticut, Hartford Hospital, Hartford, Connecticut OBJECTIVE: To evaluate differences in perinatal and neonatal outcomes in triplet gestations based on method of conception: assisted reproductive technology (ART) vs. spontaneous (SPONT). STUDY DESIGN: We analyzed all triplet sets ( 20 weeks) delivering at our institutions from 1/95-4/07 (n 137). Data was obtained via perinatal and neonatal databases, chart review, and placental pathology. ART included in vitro fertilization, intrauterine insemination, and ovulation induction. We collected demographic data, gestational age of delivery (AOG), birthweight, APGARS, length of NICU stays, need for intubation (VENT), need for surfactant (SURF), rates of bronchopulmonary dysplasia (BPD), respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and culture proven sepsis (SEPSIS). We excluded cases of known fetal reduction and sets with incomplete data. Data was analyzed via t test and Chi square. RESULTS: We had 130 triplet sets available for analysis. 111/130 (85.4%) sets were conceived via ART. There was no significant difference in AOG (31.6 wks for ART, 33.1 wks for SPONT, p NS). Please see table for individual triplet results. CONCLUSION: At our institutions, there were no overall differences in outcomes of triplet gestations based on method of conception.

269: Perinatal and neonatal outcomes of triplet gestations based on placental chorionicity

269: Perinatal and neonatal outcomes of triplet gestations based on placental chorionicity

Hospitalization vs. outpatient care in the management of triplet gestations

Objective: To compare the course and outcome of triplet gestations under a preventive care strategy that includes hospitalization, surveillance, bed rest, and daily specialized care from the beginning of the second trimester, with pregnancies managed according to the Croatian standard outpatient care protocol for multiplets. Methods: A retrospective study of 79 triplet pregnancies. Preventive hospitalization from the beginning of the second trimester, with complete bed rest and all necessary interventions, was chosen by 55 women (Group I). The remaining 24 women (Group II) elected the standard outpatient protocol for multiple pregnancies. Outpatient management with prophylactic bed rest was initiated at home as soon as the multiple pregnancy was diagnosed. After 28 weeks of gestation, all outpatients were hospitalized until delivery irrespective of symptoms. Results: There was no difference between the groups regarding maternal age, race, pre-pregnancy weight and height, weight gain during the first 24 weeks of pregnancy, or the proportion of pregnancies achieved with assisted reproductive technology. Four out of 55 women (7.2%) from Group I and 4 out of 24 women (12.5%) from Group II had monochorionic triplet pregnancies ( P=n.s.). Nulliparity was more frequent in Group I than in Group II ( P=0.006). Elective cesarean delivery was significantly more frequent in Group I (46 out of 55 gestations, 72.7%) than in Group II (9 out of 24 gestations, 37.5%), P=0.024. Gestational age at delivery and mean birth weight were significantly higher in Group I than in Group II ( P<0.001). Deliveries up to 28 weeks of pregnancy were infrequent in Group I ( P=0.02). Thirty-three gestations in Group I (60%) and 6 (25%) in Group II had a duration of 33–36 weeks ( P<0.001). Two out of 55 triplet gestations in Group I (3.6%) and 4 out of 24 in Group II (16.7%) ended in spontaneous abortion ( P=0.053). The survival of the three triplets was more frequent in Group I than in Group II ( P=0.048). For gestations reaching 24 weeks or more, the fetal and perinatal death rate was significantly lower in Group I ( P<0.001). In Group I the intrauterine death rate for fetuses weighing 1500 g or less was also significantly lower ( P=0.007), and the early neonatal death rate was almost half (15.8 vs. 28.9%, P=0.157). There were no differences in other pregnancy complications between the two groups except significantly more frequent preterm premature rupture of membranes and preterm labor requiring parenteral tocolysis in Group II ( P=0.042 and 0.036, respectively), and significantly more frequent fetal growth retardation in Group I ( P<0.001). Conclusion: Preventive hospitalization offers a better outcome for triplets even though prolonged hospitalization and all other procedures necessary to achieve optimal pregnancy outcome are also offered in the Croatian standard outpatient care protocol for multiplet pregnancies.

70 Comparison of clinical and financial outcomes of triplet gestations managed by maternal-fetal medicine versus community physicians

70 Comparison of clinical and financial outcomes of triplet gestations managed by maternal-fetal medicine versus community physicians

Neonatal outcomes in triplet gestations after a trial of labor

Objective: This study aimed to compare neonatal outcomes in a cohort of triplet gestations undergoing a trial of labor with those of a similar cohort delivered by elective cesarean delivery. Study Design: Thirty-three women with triplet gestations who underwent a trial of labor were compared with a matched cohort of 33 women with triplet gestations who were delivered of their infants by elective cesarean delivery. Neonatal outcomes assessed included respiratory distress syndrome, retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage, Apgar scores, and birth trauma. Results: Twenty-nine of 33 women (87.9%) who underwent a trial of labor had a successful vaginal delivery of all 3 neonates. One patient was delivered of her first triplet vaginally but then required a cesarean delivery for abruptio placentae; 3 other patients were delivered of their infants by cesarean section for active-phase arrest of labor. There were no differences in neonatal outcomes between the 2 groups, although triplet neonates delivered by elective cesarean section demonstrated a trend toward a greater incidence of respiratory distress syndrome (P = .09). Conclusion: Our experience suggests that offering vaginal delivery is an acceptable management plan for triplet gestations. (Am J Obstet Gynecol 1998;179:942-5.)

Management and outcome of triplet gestations: A retrospective review

Management and outcome of triplet gestations: A retrospective review