Triplet Pregnancy Research Articles

Validation of upsilon (Y) zone as pathognomonic ultrasound landmark for chorionicity and amnionicity in triplet pregnancy at any gestational age

Validation of upsilon (Y) zone as pathognomonic ultrasound landmark for chorionicity and amnionicity in triplet pregnancy at any gestational age

Maternal and fetal effects of COVID-19 virus on a complicated triplet pregnancy: a case report

BackgroundCoronavirus disease 2019 (COVID-19), the global pandemic that has spread throughout the world, is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Given the limited scientific evidence on the manifestations and potential impact of this virus on pregnancy, we decided to report this case.Case presentationThe patient was a 38 year-old Iranian woman with a triplet pregnancy and a history of primary infertility, as well as hypothyroidism and gestational diabetes. She was hospitalized at 29 weeks and 2 days gestational age due to elevated liver enzymes, and finally, based on a probable diagnosis of gestational cholestasis, she was treated with ursodeoxycholic acid. On the first day of hospitalization, sonography was performed, which showed that biophysical scores and amniotic fluid were normal in all three fetuses, with normal Doppler findings in two fetuses and increased umbilical artery resistance (pulsatility index [PI] > 95%) in one fetus. On day 4 of hospitalization, she developed fever, cough and myalgia, and her COVID-19 test was positive. Despite mild maternal symptoms, exacerbated placental insufficiency occurred in two of the fetuses leading to the rapid development of absent umbilical artery end-diastolic flow. Finally, 6 days later, the patient underwent cesarean section due to rapid exacerbation of placental insufficiency and declining biophysical score in two of the fetuses. Nasopharyngeal swab COVID-19 tests were negative for the first and third babies and positive for the second baby. The first and third babies died 3 and 13 days after birth, respectively, due to collapsed white lung and sepsis. The second baby was discharged in good general condition. The mother was discharged 3 days after cesarean section. She had no fever at the time of discharge and was also in good general condition.ConclusionsThis was a complicated triplet pregnancy, in which, after maternal infection with COVID-19, despite mild maternal symptoms, exacerbated placental insufficiency occurred in two of the fetuses, and the third fetus had a positive COVID-19 test after birth. Therefore, in cases of pregnancy with COVID-19 infection, in addition to managing the mother, it seems that physicians would be wise to also give special attention to the possibility of acute placental insufficiency and subsequent fetal hypoxia, and also the probability of vertical transmission.

359 Pregnancy outcomes in a contemporary cohort of thalassemia patients

Historically, women with transfusion dependent thalassemia (TDT) were considered very high risk for adverse pregnancy outcomes including death, primarily due to iron induced cardiomyopathy. However, recent advances in chelation therapy, better transfusion protocols and enhanced cardiac monitoring have resulted in markedly improved pregnancy outcomes in women with TDT. The purpose of this study is to evaluate risks of pregnancy in women with TDT in a contemporary cohort. A retrospective chart review was conducted of pregnancies in transfusion dependent women with different beta thalassemia genotypes treated at the Weill Cornell Thalassemia Center from 2005-2020. 15 women with TDT had a total of 25 pregnancies with 20 liveborns. 48% of pregnancies were achieved via ART with 4 multiple gestations but only one live set of twins (1 multifetal reduction, 1 2nd trimester loss of quadruplets, 1 2nd trimester loss of triplets due to maternal death). Pregnancy loss rate was 24% and women with TDT had high rates of hypertension in pregnancy (21%), gestational diabetes (52.4%) and post-partum hemorrhage (23.5%). Ongoing pregnancies had favorable fetal outcomes with mean GA of 38 weeks and mean birthweight of 3129g. Cesarean section rates were high (10/19 deliveries). 40% of women had diagnosis of cardiac disease before conception or during pregnancy (see Table 1). There was 1 major complication in the second pregnancy in a woman with a triplet pregnancy, known cardiomyopathy, and severe myocardial iron overload resulting in maternal death from cardiogenic shock at 18 weeks. Women with TDT who are considering pregnancy should have a thorough assessment preconception and select patients, without evidence of significant myocardial iron overload or cardiomyopathy, may safely pursue pregnancy. While many women with TDT will require ART for conception, multiple gestations should be discouraged due to poor outcomes. A multidisciplinary approach to care in pregnancy is paramount in this high-risk population with majority of patients achieving favorable pregnancy outcomes.

294 Outcomes in twins versus singletons subsequent to preterm premature rupture of membranes

To compare maternal and neonatal outcomes subsequent to preterm premature rupture of membranes (PPROM) in people with twin versus singleton gestations. We conducted a secondary analysis of an obstetric cohort of 115,502 individuals and their neonates who were born in 25 hospitals nationwide (2008 to 2011). Those with PPROM between 23 0/7 and 33 6/7 weeks of gestation were included in this analysis, while those with triplet pregnancy, or major fetal anomalies were excluded. The co-primary outcomes were composite maternal morbidity (chorioamnionitis, blood transfusion, postpartum endometritis, wound infection, sepsis, venous thromboembolism, intensive care unit admission, or death) and composite major neonatal morbidity (persistent pulmonary hypertension, intraventricular hemorrhage grade III/IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II/III, bronchopulmonary dysplasia, or stillbirth subsequent to admission). For the twin cohort, one randomly selected twin from each gestation was used to identify the presence of morbidity for that gestation. Logistic regression was used to estimate unadjusted and adjusted odds ratios (aORs) with 95% CIs for twin vs. singleton gestations. 1531 (1.3%) individuals met eligibility criteria for this analysis, with 218 (14.2%) having twin gestations. The median gestational age at PPROM was similar between patients with twins and singletons (31.2 weeks [IQR 27.4-32.9] vs 30.6 weeks [IQR 26.9-32.7], p=0.23), however those with twin gestations had a shorter median latency period (2.0 days [IQR 1.0-5.0] vs 3.0 days [IQR 2.0-8.0], p<0.001). After adjustment for potential confounders, odds of experiencing composite maternal morbidity (17.9% vs 19.3%, aOR 0.97, 95% CI 0.66-1.42) or composite neonatal morbidity (17.9% vs 17.9%, aOR 1.01, 95% CI 0.69-1.48) did not differ between groups (Table). In a large, diverse cohort, the odds of composite maternal or neonatal morbidity per fetus following PPROM was similar between twin and singleton gestations.

Cardiovascular function during triplet pregnancy.

Pregnancy is recognized as a natural physiological stressor to the maternal cardiovascular system. Cardiovascular adaptation is markedly greater in twin pregnancy compared with singleton pregnancy; however, these changes are sparsely documented in triplet pregnancy. The aim of this case series was to compare maternal cardiac function, cardioautonomic regulation, and blood pressure reactivity in healthy singleton, twin, and triplet pregnancies. Resting cardiac structure and function (echocardiography), beat-by-beat blood pressure variability (BPV; photoplethysmography), and heart rate variability (HRV; electrocardiogram) were measured in two triplet, three twin, and three singleton pregnancies (matched for maternal age, prepregnancy body mass index, and gestational age). Hemodynamic responses to a 3-min cold pressor test were also recorded to assess blood pressure reactivity. Due to the small sample size of this case series, statistical comparisons were not made between groups. Compared with singleton and twin pregnancies, individuals pregnant with triplets had greater resting cardiac output but lower cardiac deformation (longitudinal strain, basal circumferential strain, and torsion), sympathetic dominance in cardioautonomic regulation (lower HRV and higher BPV), and elevated blood pressure reactivity in response to the cold pressor test. Taken together, these observations suggest that females with triplet pregnancies may have reduced cardiovascular function, which may contribute to the heightened risk of complications in multifetal pregnancies.NEW & NOTEWORTHY Individuals with healthy triplet pregnancies had greater resting cardiac output but lower left ventricular mechanics when compared with singleton and twin pregnancies matched for gestational age. In addition, triplet pregnancies had greater blood pressure variability and lower overall heart rate variability compared with singleton pregnancies, as well as greater blood pressure reactivity to the cold pressor test. Healthy triplet pregnancies may have reduced cardiovascular function as well as a greater sympathetic contribution to cardiac control.

The early second-trimester multifetal pregnancy reduction improves pregnancy outcome

Purpose: To evaluate pregnancy outcome of selective second-trimester multifetal pregnancy reduction (MFPR) compared with that of first-trimester MFPR, and control group which consists of women with ongoing primary twin pregnancies. Materials and Methods: This retrospective cohort study included all women with triplet pregnancies who underwent fetal reductions to twin pregnancies from January 2010 to December 2019 in Shandong Provincial Hospital. 154 MFPR were performed by intracardially injection of potassium chloride, 8 MFPR were performed by intracranially injection of potassium chloride. Reductions to monochorionic twins and reductions to one embryo were excluded. All procedures were performed at 12-24+6 wks gestation. The outcome of pregnancy in women with reduced triplets was compared with that of the control group. Results: We identified 162 women with reduced triplet pregnancies who underwent fetal reductions to twin pregnancies, and 160 women with ongoing primary twin pregnancies as the control group. There was a significant difference in the abortion rate between MFPR and control group. The abortion rate of the early second trimester MFPR group (at gestation 14-15+6 wks) (13.3%, 5/35) was not significantly different compared with that of the first trimester MFPR group (at gestation 12-13+6 wks) (8.3%, 8/96) or that of the control group (6.9%, 11/160). There were no significant differences in average gestation time at delivery, delivery rate in 28-34 wks, neonatal birth weight, gestational diabetes mellitus, or hypertensive disorder complicating pregnancy among the first trimester MFPR group , the early second trimester MFPR group, and the control group. Conclusion: In women with triplet pregnancy, fetal reduction in the early second trimester is an effective way to avoid delivery of abnormal fetuses, reduce complications during delivery, and improve neonatal quality.

Genetic consulting and obstetrics managment of congenital malformation diagnostics in triplet pregnancy

Genetic consulting and obstetrics managment of congenital malformation diagnostics in triplet pregnancy

Hypervolemia and physiology changes in triplet pregnancy in a mother with permanent pacemakers due to bradicardia resulting from sinus node dysfunction due to AV block with secondary infertility for 19 years

The well-known hypervolemia associated with normal pregnancy averages 40 to 45 percent above blood volume in non-pregnant women after 32 to 34 weeks. The case was on Mrs. FN, 40 years old, a patient reffered due to sinus bradycardia before the insertion of permanent pacemaker. After 6 month-use of the permanent pacemaker, she became pregnant with triplet pregnancy. This case report evaluated the patient's condition from her hypervolemic condition to her cardiac function.

Does late second-trimester cervical length predict unscheduled preterm birth in asymptomatic triplet pregnancies?

Objective Multiple gestation increases the risk of unscheduled preterm birth (PTB), both spontaneous and indicated, leading to increased neonatal morbidity and additional healthcare costs. The purpose of this study was to determine whether cervical length (CL) assessment by 28 weeks could predict unscheduled PTB <34 weeks in triplet pregnancies. Secondary outcomes included prediction of PTB <30 weeks, prediction of PTB based on degree of cervical change and effect of ART-use on PTB. Methods This was a retrospective cohort of women with triplet pregnancies. The exposure variable of interest was short cervix < 25 and <20 millimeters (mm) by 28 weeks. Maternal characteristics were described. The distribution of CLs was analyzed by the primary outcome of unscheduled PTB < 34 weeks, and by PTB <30 weeks (secondary outcome). Gestational age at delivery was compared between women with and without a short cervix. Changes in CL were compared between the groups with unscheduled PTB and those delivering ≥34 and ≥30 weeks. Statistical analyses were performed using appropriate tests. Results Of 92 triplet pregnancies, 51 met the criteria, with 1233 total (411 shortest) CL measurements from 16 to 34 weeks’ gestation. The overall rate of PTB <34 weeks was 31.4% and <30 weeks was 9.8%. The median gestational age at delivery was 32.7 (IQR 2.3) weeks. There were no statistically significant differences in rates of unscheduled PTB in women who had a short cervix and those that did not: PTB <34 weeks with CL <25 mm (p = .53) and CL <20 mm (p = .70); PTB <30 weeks with CL <25 mm (p = .38) and CL <20 mm (p = .26). The degree of cervical change from 18 to 28 weeks was not statistically significant for predicting unscheduled PTB <34 and <30 weeks. Of 70.6% of triplet pregnancies conceived by ARTs, 13.9% had unscheduled PTB <30 weeks, whereas no spontaneously-conceived pregnancies delivered <30 weeks (p = .14). Conclusion Short cervix did not predict unscheduled spontaneous PTB <34 weeks nor <30 weeks in our triplet cohort, nor did the degree of cervical change by 28 weeks predict PTB. Triplets conceived by ARTs may have an increased risk of unscheduled PTB.

Perinatal outcomes of dichorionic triamniotic triplet pregnancy

Objective: To analyze the perinatal outcomes in different methods of multifetal pregnancy reduction in dichorionic triamniotic (DCTA) triplet pregnancy. Methods: A retrospective analysis was performed on 57 cases of DCTA triplets in Peking University Third Hospital from January 1, 2010 to January 1, 2020, including 27 cases in expectant pregnancy group and 30 cases in selective fetal reduction (FR) group. The selective FR group was further divided into 3 subgroups according to different FR methods:retaining monochorionic dichorionic (MCDA) group, retaining dichorionic dichorionic (DCDA) group, and retaining singleton group. The perinatal outcomes of expectant pregnancy group and 3 subgroups of selective FR group were compared. Results: The gestational weeks in selective FR group was (34.5±5.7) weeks, and full-term delivery rate was 53% (16/30), respectively higher than those of the expectant pregnancy group (29.9±6.0) weeks and 7% (2/27). The miscarriage rate of the selective FR group was 10% (3/30), lower than that of the expectant pregnancy group (33%, 9/27). The differences between the two groups were statistically significant (all P<0.05). The ratios of pregnancy complications and newborn admission to neonatal ICU (NICU) in the selective FR group were lower than those of the expectant pregnancy group (all P<0.05). In the selective FR group, the gestational weeks in retaining MCDA group (6 cases), retaining DCDA group (13 cases), and retaining singleton group (11 cases) were (32.2±4.3), (33.0±6.3), and (37.4±4.7) weeks; the miscarriage rates were 1/6, 1/13, and 1/11; the premature delivery rates were 4/6, 7/13, and 0/11; the full-term delivery rates were 1/6, 5/13, and 10/11; pregnancies with at least 1 survivor rates were 5/6, 12/13, and 10/11; NICU occupancy rates were 6/8, 9/18 and 0/10, respectively. The retaining singleton group had the highest rate of full-term delivery and the lowest rate of NICU occupancy. Compared with other groups, the differences were statistically significant (all P<0.05). The full-term delivery rate was significantly higher in the retaining DCDA group than that of the expectant pregnancy group (P<0.05). Conclusions: The risk of DCTA triplet pregnancy is high. Reduction of the MCDA pair to singleton has the highest rate of full-term delivery and the lowest rate of NICU occupancy. For pregnant women who wish to retain twin pregnancy, the risk should be fully informed, and consider reduction of one fetus of the MCDA and retaining DCDA twins to continue pregnancy.

VP03.08: Down's syndrome screening in triplet pregnancy: a large single centre cohort study

VP03.08: Down's syndrome screening in triplet pregnancy: a large single centre cohort study

VP22.19: Clinical implication of weight discordance in triplet pregnancy beyond the first trimester

VP22.19: Clinical implication of weight discordance in triplet pregnancy beyond the first trimester

VP42.09: Validation of upsilon sign (Yu) as a pathognomonic ultrasound landmark for chorioamnionicity in triplet pregnancies at any gestational age

VP42.09: Validation of upsilon sign (Yu) as a pathognomonic ultrasound landmark for chorioamnionicity in triplet pregnancies at any gestational age

VP52.24: Prediction of spontaneous preterm birth in low‐risk triplet pregnancies using second trimester cervical length

VP52.24: Prediction of spontaneous preterm birth in low‐risk triplet pregnancies using second trimester cervical length

VP22.20: Comparison of perinatal outcomes in triplet pregnancies: spontaneous versus elective preterm birth

VP22.20: Comparison of perinatal outcomes in triplet pregnancies: spontaneous versus elective preterm birth

VP22.13: Triplet pregnancies reduced to twins and singletons: comparison of outcomes

VP22.13: Triplet pregnancies reduced to twins and singletons: comparison of outcomes

Triplet pregnancy with severe preeclampsia: appropriate management

Introduction: The case of preeclampsia and triplet pregnancy is likely to cause hypertension in uncontrolled pregnant women if they are not managed properly, which may harm both the mother and the fetus. References for the treatment of similar cases are still uncommon. Therefore, this case study provides an overview of midwifery care management on cases of triplet pregnancy and severe preeclampsia.Case presentation: A case of exacerbated triplet pregnancy with severe preeclampsia is described in a 36-year-old woman who was recently detected at the third-trimester visit at 31 weeks four days' pregnancy.Conclusion: Management of patients with triplet pregnancies and severe preeclampsia is to perform standard antenatal care, ultrasound examinations in each trimester, hospital care, as well as psychological assistance.

Delayed interval delivery of preterm multiples: experience from a large specialized twin center

Objective Preterm delivery is a recognized complication of twins and higher order multiple pregnancies. Delayed interval delivery is a rarely used management option for pre- or peri-viable preterm labor in these pregnancies. We describe the management and outcomes of 7 delayed interval deliveries over an 8-year period in a large specialized twin center. Study design A retrospective cohort study of all delayed interval deliveries of preterm multiples from 2009 to 2016, defined as >24 h between deliveries of twins 1 and 2. Results During the study period there were 68,845 deliveries with 1377 multiple pregnancies comprising 1331 sets of twins and 46 sets of higher-order multiples. 7 of these were identified as being delayed interval deliveries – 6 twin pregnancies and 1 triplet pregnancy. The mean gestation of delivery of the first infant was 23 + 4 weeks (range 22 + 3 to 30 + 0 weeks) with a mean interval of 10 days (range 1.5–39 days). Outcomes for the first infant delivered were poor, with 5 out of 7 (71%) dying from extreme prematurity. However, out of the remaining twins or triplets, 5/8 (62%) survived. The mean gestation of delivery of the remaining infant (or infants in the triplets) was 25 + 0 weeks (range 23 + 0 to 30 + 2 weeks). Only one mother (16%) developed clinical chorioamnionitis requiring iatrogenic delivery of the remaining infant with subsequent neonatal death due to extreme prematurity. There were no cases of severe maternal morbidity – however, there was one maternal death in the cohort due to an amniotic fluid embolism. The neonatal follow up of the surviving infants to date is mostly normal. Conclusion Delayed interval deliveries can offer hope for survival for the remaining infant(s) with an acceptable risk profile to the mother. Close clinical and laboratory monitoring is essential to reduce the risk of severe maternal morbidity.

Maternal and Perinatal Outcome of Multiple Pregnancy in a Tertiary Care Hospital of Bangladesh

Background: Multiple pregnancies are prone to be associated with adverse maternal and perinatal outcome. The incidence of multiple pregnancies has shown a significant increase over the last decades. This study aimed to determine the maternal and perinatal outcome in a tertiary teaching hospital.&#x0D; Materials and methods: This prospective observational study was conducted in Chattogram-Maa-O-Shishu-Hospital Medical College, from July 2014 to June 2016. A total of 173 multiple pregnant women having 28 weeks completed gestation admitted for delivery were consecutively included in the study. Maternal and perinatal outcome were investigated.&#x0D; Results: The results show that the number of multiple pregnancies delivered during study periods was 173 with the incidence of 1.7% among total deliveries. There were 5 triplets pregnancies among these cases. The women with multiple pregnany were relatively older. There were no maternal mortality. Pregnancy complications were remarkabely higher. The main maternal adverse outcome were preterm delivery (84.97%), anaemia (39.88%), pregnancy induced hypertension (28.97%), premature rupture rupture of membrane (28.32%), postpartum haemorrhage (16.76%), antepartum haemorrhage (11.9%). The mean gestational age at delivery was 35.39 weeks for twins and 33.3 weeks for triplets. The commonest mode of delivery was by ceasarean section. The most common neonatal complications was low birth weight and most common cause of neonatal death was prematurity and neonatal sepsis.&#x0D; Conclusion: Majority of the multiple pregnancy is high risk one. So, all multiple pregnancies need early diagnosis, adequate antenatal, intra-natal and postpartum care to improve the outcome and should have mandatory hospital delivery.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 54-58

Association of the daily diet with childhood stunting in Burundi

Background: Stunting is a major public health problem in Africa, where more than one-third of below 5 years children are stunted. The aim of this paper is to find relation of daily dietary intake of &lt;5 years old children with their height for age status in Burundi.&#x0D; Method: A literature review was done using CINAHL, PubMed, Medline. A grey literature search was done using Google scholar and Bing. The most recent Demographic and Health Survey (DHS) data from the target country was used for the data analysis. The analysis contains the data pertaining to children &lt;5 years of age.&#x0D; Results: information of a total of 6096 children were included in the study among them 55% of children were stunted. Female children are more susceptible to stunting than the male. Children living in rural areas have a higher possibility of having below normal height for age. Children who did not consume milk and sugar in the previous day (1.809 times higher risk and 1.542 times higher risk respectively) are at higher risk of being stunted relative to the normal child. Children who are born in a twin (AOR OR = 3.4, 95% CI = 1.875-6.104) or triplet (AOR = 6.9, 95% CI = 3.204-14.736) pregnancy have high risk of being stunted. The relative risk of stunting increases in people who are in a low socio-economic class.&#x0D; Conclusion: Findings from this national-level data clearly show that there is a need for interventions addressing macro-nutrient deficiency along with special attention to micro-nutrients supplements can solve the problem of stunting in Burundi.&#x0D; Birdem Med J 2020; 10(2): 108-114