Triplet Pregnancy Research Articles

Triple trouble: uncovering the risks and benefits of early fetal reduction in trichorionic triplets in a large national Danish cohort study

Triplet pregnancies are high risk for both the mother and the infants. The risks for infants include premature birth, low birthweight, and neonatal complications. Therefore, the management of triplet pregnancies involves close monitoring and may include interventions, such as fetal reduction, to prolong the pregnancy and improve outcomes. However, the evidence of benefits and risks associated with fetal reduction is inconsistent. This study aimed to compare the outcomes of trichorionic triplet pregnancies with and without fetal reduction and with nonreduced dichorionic twin pregnancies and primary singleton pregnancies. All trichorionic triplet pregnancies in Denmark, including those with fetal reduction, were identified between 2008 and 2018. In Denmark, all couples expecting triplets are informed about and offered fetal reduction. Pregnancies with viable fetuses at the first-trimester ultrasound scan and pregnancies not terminated were included. Adverse pregnancy outcome was defined as a composite of miscarriage before 24 weeks of gestation, stillbirth at 24 weeks of gestation, or intrauterine fetal death of 1 or 2 fetuses. The study cohort was composed of 317 trichorionic triplet pregnancies, of which 70.0% of pregnancies underwent fetal reduction to a twin pregnancy, 2.2% of pregnancies were reduced to singleton pregnancies, and 27.8% of pregnancies were not reduced. Nonreduced triplet pregnancies had high risks of adverse pregnancy outcomes (28.4%), which was significantly lower in triplets reduced to twins (9.0%; difference, 19.4%, 95% confidence interval, 8.5%-30.3%). Severe preterm deliveries were significantly higher in nonreduced triplet pregnancies (27.9%) than triplet pregnancies reduced to twin pregnancies (13.1%; difference, 14.9%, 95% confidence interval, 7.9%-21.9%). However, triplet pregnancies reduced to twin pregnancies had an insignificantly higher risk of miscarriage (6.8%) than nonreduced twin pregnancies (1.1%; difference, 5.6%; 95% confidence interval, 0.9%-10.4%). Triplet pregnancies reduced to twin pregnancies had significantly lower risks of adverse pregnancy outcomes, severe preterm deliveries, and low birthweight than nonreduced triplet pregnancies. However, triplet pregnancies reduced to twin pregnancies were potentially associated with a 5.6% increased risk of miscarriage.

Pregnancy incidence and associated risk factors of dichorionic triamniotic triplet under assisted reproduction: A large sample of clinical data analysis.

Dichorionic triamniotic (DCTA) triplet pregnancies are rare in spontaneous pregnancy. The aim was to characterize the incidence and risk factors of DCTA triplet pregnancies after assisted reproductive technology (ART). A retrospective analysis of 10,289 patients, including 3,429 fresh embryo transfer (ET) cycle and 6,860 frozen ET cycle, was performed from January 2015 to June 2020. The effect of different ART parameters on the incidence of DCTA triplet pregnancies was evaluated by multivariate logistic regression analyses. Among all clinical pregnancies after ART, the incidence of DCTA was 1.24%. 1.22% occurred in the fresh ET cycle, while 1.25% occurred in the frozen ET cycle. The number of ET and cycle type has no effect on the occurrence of DCTA triplet pregnancies (p = 0.987; p = 0.056, respectively). There were significant differences in DCTA triplet pregnancies rate among receiving intracytoplasmic sperm injection (ICSI) and receiving in vitro fertilization (IVF) [1.92% vs. 1.02%, p < 0.001, OR = 0.461, 95% confidence interval (CI) 0.315-0.673], blastocyst transfer (BT) versus cleavage-ET (1.66% vs. 0.57%, P < 0.001, OR = 0.329, 95% CI 0.315-0.673), and maternal age ≥ 35 years versus maternal age < 35 years (1.00% vs. 1.30%, P = 0.040, OR = 1.773, 95% CI 1.025-3.066). Based on the regression analysis of cycle type, DCTA triplet pregnancies rate was higher in maternal age < 35 years than in maternal age ≥ 35 years (1.35% vs. 0.97%, P < 0.001, OR = 5.266, 95% CI 2.184-12.701), BT versus cleavage-ET (1.47% vs. 0.94%; P = 0.006, OR = 0.346, 95% CI 0.163-0.735), and receiving ICSI was higher than receiving IVF (3.82% vs. 0.78%, p < 0.001, OR = 0.085, 95% CI 0.039-0.189) in fresh ET cycle. However, DCTA triplet pregnancies rate did not show difference in maternal age, insemination methods, and number of ET, and only BT was found to be associated with a higher DCTA triplet pregnancies rate in the frozen ET cycle (1.73% vs. 0.30%, p < 0.001, OR = 0.179, 95% CI 0.083-0.389). The prevalence of DCTA triplet pregnancies has increased after ART. Maternal age < 35 years, BT, and receiving ICSI are risk factors for DCTA triplet pregnancies, also in fresh ET cycle. However, in frozen ET cycle, BT is an independent risk factor for increased DCTA triplet pregnancies rate.

Gestational weight gain in triplet, trichorionic and triamniotic pregnancy: experience report with a case.

Introduction: inadequate weight gain during pregnancy is recognized as a risk factor for unfavorable maternal and perinatal outcomes, such as preeclampsia. Reports focusing on weight gain in triplet pregnancies are scarce in the literature.Aim: to achieve the evolution of gestational weight gain and the maternal and perinatal outcomes of a triple pregnancy case.Description of case: in the present experience report, the case of a triplet, trichorionic and triamniotic pregnancy was presented. The patient in the case, 36 years old, started prenatal care at 12 weeks of gestation and pre gestational nutritional diagnosis of grade I obesity. The total gestational weight gain was 21 kg, agreed according to the current recommendation. The case presented gestational diabetes mellitus and preeclampsia. However, surgical delivery took place at 32 weeks and 6 days and the newborns had adequate weight for gestational age, without serious clinical complications.Conclusions: the observed results reinforce the importance of nutritional monitoring and the need for more studies that address weight gain in triplet pregnancy.

Fetal Reduction of Triplet Pregnancies to Twins vs Singletons: A Meta-analysis of Survival and Pregnancy Outcome

ABSTRACT Fetal reduction (FR) for higher-order multiples accounted for 103.6 per 100,00 births across the United States in 2015, and the need for this service has expanded over the last 30 years. Despite improvements in neonatal care, triplet pregnancies are more likely to experience adverse outcomes, including infant mortality and morbidity, than twin or singleton pregnancies. In triplet pregnancies, prematurity is associated with an 11-fold increase and low birth weight with a 2.2-fold increase in infant deaths compared with singleton and twin prematurity pregnancies. This contributes to higher all-cause healthcare expenses for triplet pregnancies (US $407,000) versus singleton pregnancies (US $21,500). Fetal reduction has been shown to improve outcomes, including a lower risk of premature birth, in triplet pregnancies reduced to twins compared with triplet pregnancies with no FR. Another study found improved outcomes when triplet pregnancies were reduced to singleton or twin pregnancies versus expectant management. However, it remains unclear whether FR in triplet pregnancies to singleton pregnancy (RTS) improved outcomes compared with a reduction to twin pregnancies (RTT). The aim of this study was to compare perinatal outcomes and survival rates of RTS pregnancies versus RTT pregnancies, and FR in any triplet pregnancies versus expectant management. This was a systematic review and meta-analysis based on a literature search for studies with data comparing selective RTT and RTS pregnancies. Excluded were studies with multiple pregnancies &gt;3 fetuses, monochorionic triplets, and missing data. The primary outcome was the rate of fetal survival of RTT and RTS pregnancies, defined as a live birth &gt;24 weeks of gestation. Secondary outcomes included gestational age (GA) at birth, birth weight, incidence of preterm birth, early pregnancy loss at &lt;24 weeks, and neonatal death, up to 28 days after birth. A total of 10 studies directly comparing RTT pregnancies with RTS pregnancies and another 10 studies comparing FR with no FR were included in the analysis. The studies represented 1903 RTT pregnancies and 489 RTS pregnancies. There was a significantly lower survival rate among RTT pregnancies versus RTS pregnancies (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.40–0.92; 95% prediction interval [PI], 0.36–1.03; P = 0.02; I 2 = 0%). There was a comparable risk of early pregnancy loss (OR, 0.89; 95% CI, 0.58–1.38; 95% PI, 0.54–1.48; P = 0.61; I 2 = 0%) and neonatal death (OR, 0.56; 95% CI, 0.10–3.21; P = 0.55; I 2 = 28%). RTT pregnancies had significantly lower GA (mean difference, −2.20; 95% CI, −2.80 to −1.61; 95% PI, −4.27 to −0.14; P &lt; 0.001; I 2 = 79%) and lower birth rates (OR, 8.76; 95% CI, 5.56–13.80; 95% PI, 4.60–16.67; P &lt; 0.001; I 2 = 0%) than RTS pregnancies. RTT pregnancies also had a greater risk of preterm birth at &lt;34 weeks (OR, 3.04; 95% CI, 1.45–6.36; 95% PI, 0.54–17.18; P = 0.003; I 2 = 22%) and at &lt;32 weeks (OR, 2.14; 95% CI, 1.02–4.49; 95% PI, 0.64–7.13; P = 0.04; I 2 = 0%). No difference in live birth rate was observed between RTT pregnancies and expectant management. In conclusion, triplet pregnancies RTS pregnancies had better outcomes than RTT pregnancies, including higher fetal survival rate, higher GA at birth, lower risk of preterm birth, and higher birth weight. Understanding the potential risks and benefits of FR in triplet pregnancies is essential for obstetricians providing parental counseling.

Analysis of Pregnancy Outcomes After Fetal Reduction in Monochorionic, Dichorionic, and Trichorionic Triplet Pregnancies

To compare the pregnancy outcomes of pregnancy outcomes after selective fetal reduction treatment in monochorionic, dichorionic, and trichorionic triplet pregnancies. We conducted a retrospective analysis of the clinical data of 118 pregnant women carrying triplets. All subjects underwent regular prenatal check-ups and were admitted for delivery at West China Second University Hospital, Sichuan University between January 1, 2012 and January 31, 2021. According to the chorionicity, the subjects were divided into a monochorionic group ( n=13), a dichorionic group ( n=44), and a trichorionic group ( n=61). Within each group, the subjects were further divided into two subgroups, a reduction group and an expectant treatment group, according to whether they underwent fetal reduction or not. The clinical data and pregnancy outcomes were compared between the subgroups within each group. In the monichorionic group, the reduction subgroup had a lower preterm birth rate and higher neonatal birth body mass than those of the expectant management subgroup, but the differences were not statistically significant. In the dichorionic and trichorionic groups, the rates of preterm delivery, neonatal hospitalization, and serious complications of the reduction subgroups were lower than those of the expectant subgroups ( P<0.05), while the neonatal birth body mass was higher in the reduction subgroups than that in the expectant subgroups ( P<0.05). In the dichorionic group, the incidence of intrahepatic cholestasis during pregnancy was lower in the reduction subgroup than that in the expectant treatment subgroup. In all 3 groups, there was no statistically significant difference between the subgroups in the incidence of gestational diabetes, hypertensive disorders of pregnancy, premature rupture of membranes, and postpartum hemorrhage. The survival curve analysis showed that women receiving fetal reduction during the first trimester had a lower risk of pregnancy loss and more significant prolonged of gestational age than those undergoing the procedure during the second trimester. Fetal reduction of triplets can significantly prolong the gestational age and improve the perinatal prognosis. In addition, selective reduction in the first trimester may lead to greater benefits than selective reduction in the second trimester does.

Perioperative Anesthesia Management of a Patient with Triplet Pregnancy Who Developed Hemorrhage Due to Uterine Atony during Cesarean Section: A Case Report

The incidence of postpartum hemorrhage (PPH) is increased in multiple pregnancies and is an important cause of maternal death. Controlling bleeding and correct anesthesia management during this period are essential.&#x0D; In our 35-year-old patient with triple pregnancy, hemorrhage due to uterine atony developed during C/S surgery. We aimed to discuss the anesthesia management of PPH in our patient who underwent a total abdominal hysterectomy and bilateral salpingectomy (TAH BS) due to continued bleeding during and after C/S, with literature.&#x0D; We think that morbidity and mortality rates can be reduced in the perioperative period for PPHs with the help of multidisciplinary approach, rapid action, and close follow-up.

Niet-invasieve prenatale test bij meerlingzwangerschappen: een retrospectieve analyse van de distributie van de foetale fractie

Noninvasive prenatal testing in multiple pregnancies: retrospective analysis of the fetal fraction distribution This article describes the distribution of the fetal fraction (FF) in noninvasive prenatal testing (NIPT) in multiple pregnancies. A retrospective study of 514 NIPT experiments was performed in 484 women with an (originally) multiple pregnancy from January 1st, 2017 to December 31st, 2019 at the Center for medical genetics in Ghent (Belgium). The FF distribution in vanishing twin, twin and triplet pregnancies was significantly different with a mean of 14%, 18.1% and 23.7% respectively. Test failure due to a low FF was higher in dichorionic-diamniotic (DCDA) twins (9.5%) compared to monochorionic-diamniotic (MCDA) twins (0%). The mean ratio FF based on the Y-chromosome (FFY)/total fetal fraction in male-male pregnancies was 0.96, in male-female pregnancies 0.43 and in female-female pregnancies 0.0. In vanishing twin pregnancies, the duration of persistence of cell-free fetal DNA (cffDNA) from the demised cotwin was up to 7 weeks. Test failure due to a low FF seems to appear more frequently in DCDA twins compared to MCDA twins, which could be explained by the higher FF threshold in DCDA twins (8%) in comparison to MCDA twins (4%). In mixed pregnancies, on average each fetus seems to contribute equally to the FF, although this does not seem to apply to all mixed pregnancies, giving rise to the possibility of an unequal contribution and a higher risk of a false negative result.

Maternal and fetal benefits of fetal reduction in triplet pregnancies

IntroductionTriplet pregnancy is a type of high-risk pregnancy that often results in premature delivery. Although fetal reduction is recommended, a number of factors can lead to triplet pregnancies without reduction. As there is no consensus on reduction, it is necessary to carry out a specific evaluation of the benefits of reduction in triplet pregnancy. This study was performed to evaluate and discuss the prognosis of triplet pregnancy with or without fetal reduction.Material and methodsClinical data from 24 women with triplet pregnancies were retrospectively collected and analyzed. Twelve women underwent fetal reduction (fetal reduction group) and 12 women continued triplet pregnancy (non-fetal reduction group). In the fetal reduction group, four dichorionic triamniotic triplets were reduced to dichorionic diamniotic twins (with a reduction of one of the monochorionic diamniotic fetuses); six trichorionic triamniotic triplets were reduced to dichorionic diamniotic twins (with a reduction of one monochorionic monoamniotic fetus).ResultsThere were significant differences in the incidence of premature rupture of membranes and neonatal hypoglycemia between the reduction and non-reduction groups. The average birth weight was significantly different between the reduction group and non-reduction group. The Apgar score was significantly different between the monochorionic monoamniotic reduction group and monochorionic diamniotic reduction group.ConclusionsTriplet pregnancy should be closely monitored throughout pregnancy and the perinatal period, regardless of fetal reduction. The chorionicity should be considered with fetal reduction. Compared with the mother, the remaining fetuses may benefit more from fetal reduction, especially in terms of neonatal weight.

Indiscriminate slaughter of pregnant goats for meat in Enugu, Nigeria: Causes, prevalence, implications and ways-out.

The indiscriminate slaughter of pregnant goats (SPGs) undermines meat production and food security especially in developing countries. It also connotes animal cruelty, depletion of goat population and may enhance the spread of zoonotic pathogens inhabiting the female reproductive tract during carcass processing. Consequently, this study determined the causes and prevalence of slaughtering pregnant goats for meat in Enugu, Nigeria. The study also estimated the economic losses associated with SPGs, discussed the negative public health consequences and suggested the ways-out. Structured, validated and pilot-tested questionnaire was used to ascertain the reasons for SPGs for meat among 78 willing and randomly selected respondents. The questionnaire survey was conducted in the form of interview. Pregnancy statuses of the goats slaughtered were ascertained by visual inspection and palpation of the eviscerated and longitudinally incised uteri and the horns for macroscopic evidence of pregnancy. Ages of the dams were estimated by dentition method. Estimation of the gestational age was performed by crown-rump length method. The study lasted for six months, comprised of three months (December to March) during the dry/hot season and another three months (May to August) during the wet/rainy season. Economic loss estimation was based on the current monetary values of a matured (30 kilogram) goat and one kilogram of chevon in Enugu, Nigeria; which was determined through market survey. Pearson's Chi-square test was used to determine whether there were significant (P<0.05) statistical associations between SPGs and age and season. Major reasons adduced for SPGs were: economic hardship (41%), ignorance of the goat's pregnancy status (21%), increased demand for chevon (13%) and feed scarcity during drought (11%). Of the 1,658 does examined during the six months study, 589 (35.5%) were pregnant. The majority (876/1658, 52.8%) of the female goats slaughtered were in their active reproductive age of ≤ 4 years, while 782 (47.2%) were aged > 4 years. Similarly, majority (1007/1658, 60.7%) of the does/nannies were slaughtered during the dry/hot season. A total of 907 foetuses at first (n = 332, 36.6%), second (n = 486, 53.6%) and third (n = 89, 9.8%) trimesters of gestation were recovered from the 589 PGs. Singleton, twin and triplet pregnancies were observed in 312 (53%), 236 (40%) and 41 (7%) PGs, respectively. About ₦34.44 million ($83,390) would have been earned if the foetuses were born alive and raised to maturity. Additionally, 19,136 kg of chevon, valued at ₦47,841, 000 ($115,838), which would have accrued from the wasted foetuses was also lost. Considering the economic, zoonotic and livestock production implications of this work, frantic efforts to reduce SPGs in Enugu, Nigeria is imperative. This could be achieved through advocacy, goat farmers' enlightenment, ante-mortem pregnancy diagnosis, provision of subsidized feed materials during the dry season and strict enforcement of the Nigerian Meat Edict law, which proscribes unapproved slaughter of gravid animals. These measures may improve food safety and security, improve goat reproduction and production, reduce protein malnutrition, limit dissemination of zoonotic pathogens during carcass processing and hence protect public health in Nigeria.

Accuracy of radiographic fetal count in ewes

Accurate fetal count is important for farm animal species as the number of fetuses can affect management decisions in both research and production settings. Documented methods of pregnancy diagnosis include radiography, progesterone assays, transrectal palpation, and transrectal and transabdominal ultrasonography; however, there is variability in fetal count accuracy with each of these methods. Abdominal radiography evaluation in 13 pregnant ewes among observers of various skill levels was compared retrospectively with the known number of fetuses determined using computed tomography. Overall accuracy using abdominal radiography across skill levels for determining fetal counts correctly was 79%. Accuracy decreased as the number of fetuses increased, with accuracies for singleton, twin, and triplet pregnancies being 92, 72, and 50%, respectively. Additionally, observer experience was inversely related to radiographic fetal count accuracy.

JS-NG-9: PRIMARY HYPERALDOSTERONISM IN A TRIPLET PREGNANCY: CONSIDERATIONS FOR INTRA-PARTUM DIAGNOSIS AND MANAGEMENT

Primary aldosteronism (PA) is an uncommon etiology of hypertension. We report the first known case of PA in a triplet pregnancy to describe the intra-partum considerations in diagnosis, investigation and management of PA. A 33-year-old female G3P0A2 at 10 weeks gestation with triplet pregnancy was admitted for hyperemesis gravidarum and hypertension. Her comorbidities include chronic hypertension, uterine fibroids, and two previous pregnancy losses. Home medications are labetalol 100 mg BID. On presentation, the patient complained of nausea, vomiting and epigastric pain and headache. On examination, her blood pressure was 161/90 and heart rate of 75. The rest of the cardiopulmonary exam was normal. Laboratory values were notable for potassium:2.9 mmol/L (n 3.5–5mmol/L) and bicarbonate 26 mmol/L (n 24–31mmol/L). The platelets, liver function tests and renal function tests were normal. Despite continuous high dose oral and parenteral high dose potassium supplementations, she had hypokalemic episodes (nadir 2.7mmol/L). She remained hypertensive at 140/90 on labetalol 200 mg QID and nifedipine XL 30 mg q12 hours. PA was suspected and testing revealed aldosterone 1280 (n 166–2885), renin 0.49 (n 0.10–1.10), aldosterone-renin ratio (ARR) 2615 (n &lt; 1500), which is indeterminate. Abdominal MRI demonstrated right adrenal mass, measuring 2.7 x 5.2 x 2.9 cm. Repeat testing revealed aldosterone 11,000, renin 0.34, ARR &gt; 30,000, which is highly suggestive of PA. The uterus was too bulky with the triplet pregnancy and uterine fibroids to safely proceed with adrenalectomy. The patient consented to receive eplerenone 25 mg BID for medical management of PA in addition to nefidipine XL 60 mg BID and oral potassium supplementation. She re-presented to hospital at 31 weeks with spontaneous rupture of membranes. She had an emergency caesarian section and delivery three healthy male infants. At one month postpartum, she was switched to spironolactone 25 mg BID from eplerenone, in addition to nefidipine and potassium supplementation, and maintained blood pressure of 130–140/80–90. At five months postpartum, she had testing on doxazosin 4 mg daily, hydralazine 10 mg TID and potassium supplementations, which revealed aldosterone 2360 pmol/L, renin &lt; 2, ARR &gt; 1200. Adrenal vein sampling demonstrated marked lateralization of aldosterone production to the right adrenal gland. A right laparoscopic adrenalectomy was completed and she achieved normotension on post-operative day 2. She was discharged on no antihypertensive medication or potassium supplementation. At 8 months post-adrenalectomy, her blood pressure is 120/96 potassium is 4mmol/L and her aldosterone levels remain low at 252 on no medications. In this case of triplet pregnancy, the diagnosis of PA was difficult to establish given the impact of pregnancy on the renin-angiotensin-aldosterone-system. Treatment with eplerenone resulted in improvement of hypertension and good pregnancy outcome. Postpartum, adrenalectomy resulted in rapid and sustained improvement in hypertension and reversal of hypokalemia.

Mode of delivery in triplet pregnancies, a retrospective cohort study over 20 years

Mode of delivery in triplet pregnancies, a retrospective cohort study over 20 years

Long-term morbidity of triplets according to their birth order; A population- based cohort study

The association between birth order and adverse perinatal outcome has been studies vastly in twin pregnancies. However, little is known regarding differences in long-term morbidity within triplets according to birth order. Hence, we opted to assess differences in long-term morbidities of triplets by their birth order. In a population-based retrospective cohort study, the incidence of long-term morbidity was compared between the triplet's siblings according to their birth order. Deliveries occurred between the years 1991 and 2021 in a tertiary medical center. The study groups were followed until 18 years of age for cardiovascular, respiratory, neurological and infectious- related morbidities. Kaplan-Meier survival curves were used to compare cumulative morbidity and Cox proportional hazards models were performed to control for confounders. The study included 117 triplet deliveries. No significant differences in cardiovascular, respiratory, neurological and infectious, morbidities were noted between the first, second and third sibling (Table). Likewise, no significant differences in cumulative incidence of long-term pediatric morbidities were noted between the siblings, using Kaplan-Meier survival analyses (Figure). In Cox proportional hazards models, controlling for weight and gender, birth order in triplet pregnancy did not exhibit an association with long-term morbidities of the offspring. Despite the known association between birth order in twins and adverse perinatal outcome, birth order in triplets does not seem to have an impact on the long-term morbidity of the offspring.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Incidence, risk factors, and outcomes of multifetal gestation: A prospective, single center study from Central India

Introduction: Multifetal pregnancies (MFPs) are high risk pregnancies and are associated with higher complications and adverse outcomes. Aims and Objectives: To assess the incidence, risk factors, comorbidities, and outcomes of MFPs. Materials and Method: This prospective, observational study was performed over a period of 12 months (December 2018 to November 2019) and involved 212 women with MFP admitted in antenatal ward and labor room of a tertiary care center located in Central India. Maternal characteristics including age, parity, gestational age, mode of delivery, and maternal comorbidities and complications were recorded. Finally, neonatal morbidity and mortality was studied. Results: The incidence of MFP was 1.25%, with that of twin and triplet pregnancy being 1.22% and 0.03%, respectively. Majority of the women belonged to the age group of 25-30 years (43.3%), were multigravida (53.3%), and had a gestational age of 34-36 weeks (41.03%). Women most commonly underwent vaginal delivery (58.01%). The predominantly comorbidity and complications were hypertensive disorders (36.8) and preterm labor (58.49%), respectively. Majority of the neonates had low birth weight (LBW, 80.3%). There was no significant difference between the first and second twin in terms of LBW (P-value &gt;0.05). Perinatal mortality was statistically associated with both prematurity and LBW (both P-values &lt;0.0001). Conclusion: Overall, MFP was associated with high maternal and perinatal morbidity and mortality. Increased parity, low SES, rural area of residence, and advancing maternal age were the major determinants of MFPs. Perinatal mortality was significantly associated with LBW and prematurity.

Comparison of clinical features in antepartum and postpartum HELLP syndrome

Objective: To analyze the clinical features and pregnancy outcomes in antepartum and postpartum hemolysis, elevated live enzymes, and low platelet count syndrome(HELLP syndrome). Methods: A retrospective study was conducted to collect maternal and neonatal information of pre-eclampsia complicated with HELLP syndrome in Peking University First Hospital during the ten years from April 2009 to March 2019. A total of 83 pregnant women were included according to the Tennessee Classification System. They were then allocated into two groups based on the onset time of HELLP syndrome: antepartum HELLP syndrome group (n=70) and postpartum HELLP syndrome group (n=13). The clinical features, symptoms, laboratory biomarkers, and pregnancy outcomes were compared between the two groups. Results: Among the 83 pregnant women with HELLP syndrome, 70 occurred prenatally (84%, 70/83) and 13 occurred postpartum (16%, 13/83). The twin or triplet pregnancy rate in the postpartum HELLP syndrome group was significantly higher than that in the antepartum HELLP syndrome group [6/13 vs 6% (4/70), P=0.001]. The gestational weeks for HELLP onset and delivery in the postpartum HELLP syndrome group were significantly later than those in the antepartum HELLP syndrome group [(35.8±3.0) vs (31.5±5.2) weeks, P=0.025; (36.7±2.3) vs (32.2±5.0) weeks, P=0.002]. The incidence of early-onset pre-eclampsia in the antepartum HELLP syndrome group was significant higher than that in the postpartum HELLP syndrome group [64% (45/70) vs 2/13, P=0.002]. The quantitative of 24-hour proteinuria was significant higher in the antepartum HELLP syndrome group than that in the postpartum HELLP syndrome group [(4.8±5.1) vs (1.8±1.6) g, P=0.002]. But there were no statistical significances in the comparison of other laboratory test indexes (all P>0.05). There were no significant differences between the two groups in clinical symptoms, severe maternal complications, transfusion or adverse maternal outcomes (all P>0.05). Conclusions: Antepartum and postpartum HELLP syndrome have similar clinical symptoms and laboratory characteristics. Both antepartum and postpartum HELLP syndrome could lead to severe maternal complications, which should be paid special attention in clinical practice, especially to the postpartum HELLP syndrome.

Fetoscopic laser surgery for twin-to-twin transfusion syndrome in DCTA triplets compared to MCDA twins: collaborative study and literature review

Objective To compare the outcomes of dichorionic triamniotic (DCTA) triplets with that of monochorionic diamniotic (MCDA) twin gestations undergoing fetoscopic laser surgery (FLS) for treatment of twin-to-twin transfusion syndrome (TTTS). Methods Retrospective cohort study of prospectively collected data of consecutive DCTA triplet and MCDA twin pregnancies with TTTS that underwent FLS at two fetal treatment centers between 2012 and 2020. Preoperative, operative and, postoperative variables were collected. Perinatal outcomes were investigated. Primary outcome was survival to birth and to neonatal period. Secondary outcomes were gestational age (GA) at birth and procedure-to-delivery interval. Literature review was conducted in which PubMed, Web of Science, and Scopus were searched from inception to September, 2020. Results Twenty four sets of DCTA triplets were compared to MCDA twins during the study period. There were no significant differences in survival (no survivor, single, or double survivors) to birth and to the neonatal period of the MC twin pairs of the DCTA triplets vs MCDA twins. Median GA at delivery was approximately three weeks earlier in DCTA triplets compared to MCDA twins (28.4 weeks vs 31.4 weeks, p = .035, respectively). Rates of preterm birth (PTB) less than 32 and less than 28 weeks were significantly higher in DCTA triplets compared to twins (<32 weeks: 70.8% vs 51.1%, p = .037, respectively, and <28 weeks: 37.5% vs 20.8%, p = .033, respectively). Conclusion Perinatal survival including fetal and neonatal are comparable between DCTA triplets and MCDA twins. However, this might have resulted from the small sample size of the DCTA triplets. GA at delivery is earlier in triplets, which could be due to the nature of triplet gestation rather than to the laser procedure itself.

Co-Occurrence of a Pathogenic HSD3B2 Variant and a Duplication on 10q22.3-q23.2 Detected in Newborn Twins with Salt-Wasting Congenital Adrenal Hyperplasia

Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders caused by enzyme deficiencies required for cortisol biosynthesis in the adrenal cortex. The majority of CAH are due to the deficiency of the 21-hydroxylase enzyme, while 3β-hydroxysteroid dehydrogenase type 2 deficiency accounts for less than five percent of all CAH cases. We report two Moroccan twins from a spontaneous triplet pregnancy. The 46,XY newborn exhibited a disorder of sexual differentiation (DSD) with hypo virilization, while the 46,XX newborn had normal female external genitalia. In the first week of life, they showed hyponatremia and primary adrenal insufficiency with a slight 17OHP elevation and increased DHEAS and renin levels. The aCGH-SNP analysis disclosed a 8.36 Mb long contiguous stretch of homozygosity (LCSH) on chromosome 1p13.2-p11.2 including the candidate HSD3B2 gene, a LCSH of 7.3 Mb on 14q31.1-q32.11, and a 7 Mb duplication on 10q22.3-q23.2. Clinical exome sequencing revealed the biallelic c.969T > G (p.Asn323Lys) HSD3B2, likely pathogenic, variant in both of the affected twins. This case emphasizes the importance of a prompt molecular diagnosis performed through the combination of aCGH and clinical exome, both for establishment of correct therapy and for follow-up, as the newborns also carry a genomic rearrangement with possible clinical implications.

Frequency of Multiple Gestations in Kohat

Objectives: To determine the frequency of multiple gestations in Kohat City.&#x0D; Study Design: Retrospective longitudinal study.&#x0D; Place and Duration of Study: Labour Room and Neonatal Intensive Care Unit (NICU), Combined Military Hospital, Kohat Pakistan, from Jan 2019 to Dec 2020.&#x0D; Methodology: We included 5285 women delivered at Combined Military Hospital, Kohat Pakistan, during our study period.Basic data were collected from medical record files, and further information was gathered through telephonic interviews with the patients. The frequency of multiple gestations was calculated and compared with local and international statistics.Results: Out of 5285 deliveries during the study period, there were significant twin pregnancies 156(2.95%) and triplet pregnancies 11(0.21%). 167(3.16%) multiple deliveries were managed at our centre. Further probing showed that 109(65.3%) women used induction medication from registered medical practitioners or quakes/ spiritual healers to get pregnant.&#x0D; Conclusions: Multiple gestations and the use of induction therapy are much higher in Kohat compared to other parts of the country.

7675 Tri-Topic Pregnancy: A Case of Spontaneous Triplets in Three Distinct Locations

<h3>Study Objective</h3> To present a case of spontaneous triplet pregnancy consisting of a single intra-uterine pregnancy and two distinct ectopic pregnancies and review the literature regarding interstitial pregnancy management. <h3>Design</h3> Case report. <h3>Setting</h3> Tertiary care hospital. <h3>Patients or Participants</h3> One patient. <h3>Interventions</h3> 29-y/o G3P2002 at approximately seven weeks gestational age by LMP with history significant for two prior full-term cesarean sections presented to the emergency department with severe, sudden onset abdominal pain. Beta-HCG was greater than 200,000. Bedside transabdominal ultrasound was limited by degree of pain; however, it revealed a fetal pole measuring eight weeks with cardiac activity surrounded by a sizable layer of myometrium, as well as an additional fetal pole with cardiac activity laterally with a thin surrounding layer of myometrium. Given severe pain in early pregnancy, ruptured ectopic pregnancy was presumed and the patient was consented for a diagnostic laparoscopy and removal of ectopic pregnancy. Intraoperatively, approximately 500cc of hemoperitoneum and both an interstitial pregnancy and an ampullary pregnancy were appreciated. Laparoscopic unilateral salpingectomy and cornuectomy were performed. Ultrasound postoperatively surprisingly demonstrated a third remaining viable intrauterine pregnancy. The patient denied any history of ART. <h3>Measurements and Main Results</h3> Pathology confirmed ectopic pregnancies in both specimens. Laparoscopic excision of two ectopic pregnancies was safely performed in this patient with maintenance of a viable, intrauterine pregnancy. Excision of the interstitial pregnancy posed greatest risk to both the patient and concurrent intrauterine pregnancy. Care was taken during cornuectomy to minimize entry depth into surrounding myometrium and blood loss. <h3>Conclusion</h3> The incidence of heterotopic pregnancy without ART is approximately 1 in 30,000. Furthermore, interstitial pregnancies make up only 1-4% of ectopic pregnancies. Laparoscopic management of interstitial pregnancies has been repeatedly demonstrated as a safe approach. We present a rare case of a ruptured triplet heterotopic pregnancy with minimal risk factors managed successfully with laparoscopic removal technique and maintenance of intrauterine pregnancy.

Perinatal and neurodevelopmental outcome in complicated monochorionic pregnancy after selective fetal reduction: radiofrequency ablation vs microwave ablation.

To summarize our experience in the application of radiofrequency ablation (RFA) and microwave ablation (MWA) for selective fetal reduction in complicated monochorionic pregnancies and compare the perinatal outcome of the two techniques. This was a retrospective study of data from a consecutive cohort of all monochorionic twin pregnancies that underwent selective fetal reduction with RFA or MWA at Peking University Third Hospital, Beijing, China from January 2012 to December 2018. All surviving cotwins were followed up to assess their neurodevelopment using the Age &amp; Stage Questionnaire, Chinese version. Perinatal and neurodevelopmental outcomes were compared between the RFA and MWA groups. We also fitted multivariable models to test the association between procedure-related factors and the main perinatal outcomes, including preterm birth (PTB) &lt; 37 weeks' gestation, intrauterine fetal death (IUFD) of the cotwin, adverse outcome (defined as occurrence of IUFD of the cotwin, termination of pregnancy or PTB &lt; 28 weeks) and overall survival. In total, 45 cases (42 twin and three triplet pregnancies) underwent RFA and 126 cases (105 twin and 21 triplet pregnancies) underwent MWA. The overall survival rates in monochorionic diamniotic twin pregnancies were similar between the RFA and MWA groups (61.0% vs 67.0%; P = 0.494). However, pregnancies whose indication for fetal reduction was selective intrauterine growth restriction or twin reversed arterial perfusion had higher overall survival rates (75.5% and 82.6%, respectively) compared with those in other indication groups. A total of 104 children were followed up (20 in the RFA group and 84 in the MWA group); four (20.0%) and eight (9.5%) children were assessed as having overall developmental delay in the RFA and MWA groups, respectively, with no significant difference between the two groups. Multivariable analyses showed that procedure indication, number of ablation cycles and gestational age at procedure were associated significantly with the main perinatal outcomes. RFA and MWA for selective fetal reduction in complicated monochorionic pregnancies can achieve similar overall survival rate and neurodevelopmental outcome, but MWA is associated with a lower risk of preterm birth. Moreover, procedure-related factors are associated significantly with perinatal outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.