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PubMed1991

Outcome of triplet and quadruplet pregnancies resulting from in vitro fertilization.

Analysis of the outcome of 26 sets of triplet and five sets of quadruplet pregnancies resulting from in vitro fertilization (IVF) shows an high incidence of antenatal complications including first trimester bleeding (53.3 and 80%), premature onset of labour (92.3 and 67%), pregnancy-induced hypertension (28.6 and 67%) and gestational diabetes mellitus (38.5 and 33%), respectively. Intra-uterine growth retardation occurred in 7.6 and 0%, while third trimester bleeding complicated 7.6 and 0% of triplet and quadruplet pregnancies, respectively. These patients were hospitalized for a mean of 22.9 +/- 19.4 and 56.0 +/- 30.5 days, respectively. The mean gestational age at delivery for triplet and quadruplet pregnancies was 31.8 +/- 2.7 and 30.3 +/- 0.6 weeks, while the mean birth weight was 1663 +/- 423 and 1232 +/- 181 g, respectively. These neonates stayed in the hospital for a mean of 28.1 +/- 16.2 and 69.6 +/- 15.5 days, respectively. The corrected perinatal mortality was 2.2% for triplets and 0% for quadruplets. These data can be used in counseling patients with triplet and quadruplet pregnancies especially those resulting from IVF.

Adult↗
PubMed2004

Maternal morbidity and obstetric complications in triplet pregnancies and quadruplet and higher-order multiple pregnancies.

OBJECTIVE: The purpose of this study was to assess the risk of maternal morbidity and obstetric complications in women with triplet pregnancies and quadruplet and higher-order multiple pregnancies. STUDY DESIGN: We compared the outcomes in women with triplet pregnancies (n=5491) and quadruplet and higher-order multiple pregnancies (n=423) with women with twin pregnancies (n=152,238), with the use of the 1995 to 1997 Multiple Birth File of the United States. RESULTS: After an adjustment was made for important confounding factors, the risks of pregnancy-associated hypertension and eclampsia, anemia, diabetes mellitus, abruptio placenta, premature rupture of membrane, and cesarean delivery were increased in women with triplet pregnancies and quadruplet and higher-order multiple gestations than in women with twin pregnancies. A dose-response relationship was observed for pregnancy-associated hypertension, diabetes mellitus, and placental abruption, with higher odds ratios in women with quadruplet and higher-order multiple gestations than in women with triplet pregnancies. CONCLUSION: The risks of maternal morbidity and obstetric complications are increased in triplet pregnancies and quadruplet and higher-order multiple pregnancies than in twin pregnancies; for certain outcomes, there is a dose-response relationship.

Abruptio Placentae↗
PubMed2004

Twins and triplets: the effect of plurality and growth on neonatal outcome compared with singleton infants.

OBJECTIVE: Information on outcome by gestational age from large numbers of twins and triplets is limited and is important for counseling and decision-making in obstetric practice. We reviewed one of the largest available neonatal databases to describe mortality and morbidity rates and growth in newborn infants from multiple gestations and compared these data with data for singletons. STUDY DESIGN: Data from a large prospectively recorded neonatal database that incorporated neonatal records from January 1997 to July 2002 were reviewed. We evaluated birth weight and neonatal mortality and morbidity rates that affected long-term outcome for each week of gestational age from 23 to 35 weeks of gestation for all nonanomolous inborn twins and triplets who were admitted to the neonatal intensive care unit and compared these data to all singletons who met similar criteria during the same time period. RESULTS: There were 12,302 twin and 2155 triplet births that met the entry criteria. The data for these newborn infants were compared with 36,931 singletons. Average birth weights at each gestational week were similar for all gestational ages until 29 weeks of gestation for triplets and 32 weeks of gestation for twins. After these gestational ages, the entire difference between twins and singletons was due to the weight of the smaller twin; the larger twins' mean weights were similar to singletons at all weeks that were studied. Birth order at each week also did not affect neonatal mortality rates, even when corrected for route of delivery and antenatal steroids. Neonatal morbidities associated with adverse long-term outcomes (intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis) were also not different between multiple infants and singletons. Intrauterine growth restriction (IUGR) was associated with increased mortality rates at all gestational ages, but in the absences of IUGR, discordance was not. CONCLUSION: Data on a large number of twins and triplets provide reassurance that neonatal outcome at all viable premature weeks of gestation are similar to singletons. Intrauterine growth restriction and prematurity are therefore the principal issues that drive neonatal mortality and morbidity rates in multiple gestations. These data are important for obstetric decision-making and patient counseling.

Birth Weight↗
PubMed2005

Fetofetal transfusion syndrome in triplet pregnancies: outcome after endoscopic laser surgery.

OBJECTIVE: The purpose of this study was to determine the outcome of fetofetal transfusion syndrome in triplet pregnancies after treatment with endoscopic laser ablation of communicating placental vessels. STUDY DESIGN: Cases of severe fetofetal transfusion syndrome that occur in triplet pregnancies and that are treated with endoscopic laser ablation of placental anastomosis were identified from a prospectively collected fetal medicine database. Chorionicity was determined by sonography and classified as dichorionic or monochorionic. Perinatal outcome was obtained in all cases, and long-term follow-up was obtained in all pregnancies that resulted in at least 1 survivor. RESULTS: During a 6-year period, 10 cases of severe fetofetal transfusion syndrome that were treated with endoscopic laser ablation were identified, of which 7 cases were dichorionic and 3 cases were monochorionic. At least 1 fetus survived in all 7 dichorionic pregnancies and in 2 of the 3 monochorionic pregnancies. In the dichorionic pregnancies, 14 of 21 fetuses (66.7%) survived, but in the monochorionic pregnancies only 2 of 9 fetuses (22.2%) survived. CONCLUSION: Endoscopic laser ablation is feasible in triplet pregnancies that are complicated by severe fetofetal transfusion syndrome. The treatment appears to be associated with improved perinatal outcome in dichorionic, but not in monochorionic, triplets, probably because of the technical inability in achieving ablation of all the communicating vessels in monochorionic triplets.

Databases, Factual↗
PubMed2005

Comparative longitudinal study of cervical length and induced shortening changes among singleton, twin, and triplet pregnancies.

OBJECTIVE: To compare cervical length and induced shortening changes during gestation among singleton, twin, and triplet pregnancies. STUDY DESIGN: Thirty-two healthy gravidas (12 singleton, 13 twin, and 7 triplet pregnancies) between 17 and 20 weeks' gestation were prospectively enrolled in this longitudinal investigation of cervical length. Serial transperineal cervical length ultrasound assessments were made weekly until 34 weeks' gestation under 3 conditions: 1) supine, 2) supine with the Valsalva maneuver, and 3) standing. Cervical length, internal os diameter, and presence of cervical funneling were assessed under each condition. Multiple regression models were created using generalized estimating equations to predict these measures and accounting for confounding effects from covariates and adjusting for correlations from repeated measurements on each woman. RESULTS: A total of 1286 cervical sonographic measurements were made. In a multiple linear regression generalized estimating equations model, estimated cervical length was significantly different among singleton, twin, and triplet pregnancies. Overall, changing maternal position from supine to standing resulted in a nonsignificant change (-0.1 +/- 0.4 mm) in cervical length (P = .85). In contrast, measurement of cervical length during the Valsalva maneuver resulted in a significant reduction in cervical length when compared with the cervical length measured in supine (-1.0 +/- 0.3 mm) (P = .0009) and standing positions (-0.9 +/- 0.4) (P = .009). The observed induced shortening changes were similar across gestation, irrespective of singleton, twin, or triplet gestation. CONCLUSION: Longitudinal cervical length changes differ significantly throughout gestation among singleton, twin, and triplet pregnancies. Cervical length measurements made in a standing position are comparable with those measured while supine, whereas cervical lengths measured during the Valsalva maneuver are significantly shorter than those made in either the supine or standing position.

Cervix Uteri↗
PubMed2006

Comparative study of perinatal outcome of dichorionic and trichorionic iatrogenic triplets.

OBJECTIVE: The purpose of this study was to compare the perinatal outcome of dichorionic and trichorionic triplets who were conceived by assisted reproductive techniques. STUDY DESIGN: In this retrospective study, the maternal, neonatal, and chorionicity data were collected from 106 sets of trichorionic triamniotic and 34 sets of dichorionic triamniotic triplet pregnancies who were conceived by assisted reproductive techniques between January 1986 and December 2000. Perinatal and neonatal data were evaluated in relation to chorionicity and intertriplet birth weight discordance. RESULTS: The dichorionic triamniotic triplets have an 8-fold higher risk of perinatal death than trichorionic triamniotic gestations (odds ratio, 7.9; 95% CI, 4.4-14.0; P < .001). This is attributed to a higher risk of very low birth weight (P < .01), delivery at < 30 weeks of gestation (P < .001), and premature rupture of membrane (P < .001) in dichorionic triamniotic triplets compared with trichorionic triamniotic pregnancies. Twin-twin transfusion syndrome (odds ratio, 11.5; 95% CI, 4.8-27.7; P < .001), delivery at < 30 weeks of gestation (odds ratio, 40.5; 95% CI, 16.9-97; P < .01), premature rupture of membrane (odds ratio, 6.7; 95% CI, 3.8-11.9; P < .01), and nulliparity (odds ratio, 3.1; 95% CI, 1.6-6.1; P < .05) had independent effects on perinatal loss rate. CONCLUSION: The dichorionic triplets have an 8 times higher perinatal mortality rate than trichorionic triamniotic pregnancies.

Adult↗
PubMed2005

Pregnancy rates and gravid uterine parameters in single, twin and triplet pregnancies in naturally bred ewes and ewes after transfer of in vitro produced embryos.

The objectives of this study were to: (1) evaluate the pregnancy rates after transfer of embryos produced in the presence or absence of epidermal growth factor (EGF) during in vitro maturation, and (2) compare several variables of the gravid uterus on day 140 after fertilization in single, twin and triplet pregnancies in ewes (n = 12) bred naturally and in ewes (n = 18) after transfer of embryos produced in vitro. Oocytes collected from FSH-treated ewes (n = 18) were collected from all visible follicles and cultured in maturation medium with or without EGF. Oocytes were then fertilized in vitro by frozen-thawed semen. On day 5 after fertilization, embryos with > or = 16 cells were transferred to recipient ewes (n = 39). In addition 12 ewes were bred naturally. Pregnancy was verified by real-time ultrasonography on day 45 or later after embryo transfer (ET) or breeding. On day 140 of pregnancy, the reproductive tract was collected from all ewes and the following parameters were determined: the number, sex, weight and crown to rump length (CRL) of fetuses, weights of gravid uterus and fetal membranes, and weight and number of placentomes. Presence of EGF in maturation medium increased (P < 0.04) cleavage rates (78% versus 59%) and percentage of > or = 16 cell embryos on day 5 after fertilization (62% versus 40%). Pregnancy rates tended to be greater (P < 0.1) after transfer of embryos matured in the presence of EGF (52%) than in the absence of EGF (39%). EGF presence in maturation medium did not affect any variables of gravid uterus or fetal weight. For single pregnancies in naturally bred ewes and ewes after ET all uterine variables were similar. For twin pregnancies, weight of gravid uterus, weight of uterus plus fetal membranes, total weight of placentomes/ewe, mean weight of individual placentome, mean weight of fetus, total fetal weight/ewe and CRL were greater (P < 0.0001-0.04) for ewes after ET than for ewes bred naturally. The weights of gravid uterus, fluid, uterus plus fetal membranes, fetal membranes, total placentomes/ewe, mean weight of individual placentome and total fetal weight/ewe were greater (P < 0.0001-0.08) for triplet pregnancies in ewes after ET than single and twin pregnancies in ewes naturally bred or after ET. The number of placentomes/fetus was greatest (P < 0.0001-0.06) in single pregnancies in ewes bred naturally and after ET fewer in twin pregnancies in ewes bred naturally and after ET and fewest in triplet pregnancies in ewes after ET. The total number of placentomes/ewe was greatest (P < 0.0001-0.06) for twin pregnancies in ewes naturally bred, fewer in single pregnancies in ewes naturally bred and twin and triplet pregnancies after ET, and fewest in single pregnancies in ewes after ET. The mean weight of fetus was greater (P < 0.0001-0.07) in single pregnancies in ewes naturally bred or after ET than in twin or triplet pregnancies in ewes naturally bred or after ET. The CRL was the lowest (P < 0.01) in twin pregnancies in ewes bred naturally. For pregnancies after natural breeding and after ET, the number of fetuses/ewe was negatively correlated (P < 0.03-0.0001) with the weight of placentomes/fetus, the number of placentomes/fetus, the mean weight of the fetus and CRL, and was positively correlated (P < 0.0001-0.05) with weight of gravid uterus, the total number of placentomes/ewe and total fetal weight/ewe. These data demonstrate that the presence of EGF in maturation medium increases the rates of cleavage and early embryonic development, and has a tendency to enhance rates of pregnancy but does not affect variables of the gravid uteri in ewes after transfer of in vitro produced embryos. Transfer of embryos produced in vitro affected some uterine variables in twin but not single pregnancies to compare with pregnancies after natural breeding. In addition, culture conditions in the present experiment did not create large offspring syndrome. The low number of placentomes/fetus seen in triple pregnancies appears to be compensated for by the increase in the weight of each individual placentome.

Animals↗
PubMed1996

Selective reduction of multifetal pregnancies to twins improves outcome over nonreduced triplet gestations.

OBJECTIVE: Our purpose was to evaluate effects of multifetal pregnancy reduction on pregnancy complications and birth weights of remaining twin fetuses compared with expectantly managed triplets and nonreduced twins. STUDY DESIGN: Medical records of 54 triplet pregnancies, 59 twin pregnancies resulting from multifetal pregnancy reduction, and 88 sets of twins conceived with assisted reproductive techniques and delivered at New York Hospital after 24 weeks were retrospectively reviewed. Birth weights were corrected for gestational age at delivery by use of a formula derived from composite standardized growth curves. Statistical analysis was performed with chi(2) analysis and Student t test. RESULTS: Twins remaining after reduction and nonreduced twins were less likely to have preeclampsia than were triplets (14% and 23% vs 30%) and to be delivered before 36 weeks (39% and 27% vs 72%). They had birth weights that were > 100 gm larger than those of triplets even when corrected for gestational age. Reduced twins were similar to nonreduced twins in all parameters studied. CONCLUSIONS: Multifetal pregnancy reduction results in pregnancy complications, gestational age, and birth weights closer to those of nonreduced twins than to expectantly managed triplets.

Adult↗
PubMed1993

Effects of selective reduction in triplet gestation: a comparative study of 80 cases managed with or without this procedure.

OBJECTIVE: To evaluate the effect of selective termination in triplet pregnancies. DESIGN: Comparative, prospective, nonrandomized study. SETTING: All 80 pregnancies were managed in a single tertiary center by the same obstetrical team. PATIENTS: Eighty women with triplet pregnancies were divided into two groups: group I consisted of 48 women who wished to continue their pregnancies without reduction; in group II were 32 women who choose reduction generally to obtain twins. INTERVENTIONS: Selective terminations were performed after an average term of 9.6 weeks of gestation by transcervical or transabdominal approaches. MAIN OUTCOME MEASUREMENTS: The rate of miscarriage and prematurity, fetal growth, perinatal morbidity and mortality, and maternal complications in the two groups. RESULTS: Prematurity was lower in reduced pregnancies (95.5% in triplets versus 53.5%), especially between 24 to 32 weeks' gestation where prematurity was reduced by half. Birth weight was > 450 g higher in the reduced group. The perinatal mortality rate was lower for reduced pregnancies, but this difference was not statistically significant. Five life-threatening maternal complications occurred in triplets, with none in the reduced group. CONCLUSIONS: Selective terminations are effective in decreasing the rate of prematurity, improving fetal growth, and avoiding maternal complications. The procedure thus could be used in triplet gestations. The ultimate decision should be taken by the couple who must be well informed of the risks of the procedure before deciding.

Abortion, Induced↗
PubMed1993

Embryo reduction in triplet pregnancies after assisted procreation: a comparative study.

OBJECTIVES: To evaluate pregnancy outcome after selective embryo reduction by transcervical aspiration or transvaginal puncture and intrathoracal injection with potassium chloride (KCl) in triplet pregnancies occurring after assisted procreation and to compare this outcome with that for triplets not undergoing embryo reduction. DESIGN: Retrospective case series. SETTING: In vitro fertilization program of the Centre for Reproductive Medicine of the Dutch-speaking Brussels Free University, Belgium, which is a tertiary referral institution. PATIENTS: Seventy-two patients presenting a triplet pregnancy after assisted procreation. INTERVENTION: Transcervical aspiration embryo reduction at 8 to 9 weeks of pregnancy or transvaginal puncture and intrathoracal injection of KCl at 9 to 10 weeks of pregnancy. MAIN OUTCOME MEASURES: Rate of spontaneous embryo reduction, complications relating to the procedure, pregnancy, and neonatal outcome. RESULTS: The rate of spontaneous reduction was 18%. Among the 14 patients undergoing transcervical aspiration, 3 aborted and 4 lost an additional fetus. The transvaginal puncture technique had a lower complication rate (2/19). Neonatal outcome was improved in pregnancies after selective embryo reduction. After transvaginal puncture, the outcome was comparable with that for twin pregnancies after assisted procreation. CONCLUSIONS: Triplet pregnancies after assisted procreation had a poor neonatal outcome. The outcome was improved after spontaneous reduction. Transcervical aspiration should not be used because of its high rate of early and late complications. Transvaginal puncture had less early complications, but the technique might be associated with prematurity and third trimester fetal death. In triplet pregnancies, embryo reduction decreases the number of babies going home per patient, but the quality of life of the remaining babies is improved.

Abortion, Induced↗
PubMed1993

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

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

Adult↗
PubMed1997

Psychological consequences of having triplets: a 4-year follow-up study.

OBJECTIVE: To assess the mental health of mothers of triplets and the quality of relationship with the children 4 years after delivery. DESIGN: Prospective follow-up study from delivery, to 4 years. Assessments at home by a psychologist, using semistructured tape-recorded interviews. SETTING: One maternity hospital in Paris, France. PATIENT(S): Eleven consecutive mothers having delivered triplets between October 1988 and February 1990. All except one had conceived after infertility treatment. MAIN OUTCOME MEASURE(S): Evaluation of the mothers' emotional well-being and level of depression measured by the CES-D Scale (Center for Epidemiologic Studies-Depression Scale). Opinion of the mothers about the quality of the relationship with the children. RESULT(S): All mothers reported emotional distress at 4 years, mainly fatigue and stress. Four mothers had a high score of depression and used psychotropic medication. The relationship with the children and difficulties in coping with their aggressive behavior and conflicts were the main reason for psychological distress. Difficulties had not decreased since the previous assessment at 2 years. Four mothers spontaneously expressed regrets about having triplets. CONCLUSION(S): Patients undergoing infertility treatments should receive adequate information about the long-term psychological "cost" of a triplet birth. Infertility treatments should be adapted in order to decrease the risk of triplet pregnancies.

Adaptation, Psychological↗
PubMed2003

The clustering of neonatal deaths in triplet pregnancies: application of response conditional multivariate logistic regression models.

BACKGROUND/OBJECTIVES: A population-based retrospective cohort study of triplet pregnancies was conducted to estimate individual probabilities of neonatal mortality (death within 28 days of birth) conditional on the number of neonatal deaths experienced by other infants in the triplet set. METHODS: Data on 4,697 triplet sets (14,091 births) were derived from the U.S. 1995-1997 matched multiple birth file assembled by the National Center for Health Statistics. Response conditional multivariate logistic regression was used to model the association of neonatal mortality among cotriplets. To account for the correlation of the outcomes among cotriplets, regression parameters were estimated by the methodology of generalized estimating equations with robust variance estimates. RESULTS: Compared with a triplet where both cotriplets survived the neonatal period, the adjusted odds ratio and 95% confidence interval (CI) for a neonatal death associated with one and two cotriplet neonatal deaths were 1.80 (95% CI 1.06, 3.04), and 13.41 (95% CI 2.31, 77.7), respectively, after adjusting for birthweight and gestational age. CONCLUSIONS: These results show strong evidence of clustering of neonatal deaths in triplet pregnancies.

Humans↗
PubMed2000

[Mothers of triplets and their children: course from 4 to 7 years after birth].

OBJECTIVES: To study the psychological health of the mothers and their difficulties seven years after the birth of triplets and to compare these results with those obtained at four years. DATA AND METHODS: Eleven mothers of triplets were followed up from birth to seven. At four and seven years the psychological status of the mothers and their relationships with the triplets were evaluated using a semi-structured interview and the level of depression was measured using a standardized scale (CES-D). At seven years the scores were compared to those of mothers having a singleton child of the same age. RESULTS: At seven years three mothers of triplets out of 11 still suffered of depressive symptoms. These symptoms were more frequent than among control mothers but non significantly. One mother of triplets out of two (6/11), twice more than at four years, appreciated the increase of her educative tasks and the decrease of practical problems. In the other half of the sample problems still persisted between adults and children. CONCLUSION: Although the situation seemed to improve at seven years, the mother's psychological distress and quality of relationship with the children remained preoccupying in one family out of two.

Depression↗
PubMed1998

A comparative study of twinning and triplet rates in 17 countries, 1972-1996.

Secular changes in twinning and triplet rates were analyzed using vital statistics in Austria, the Czech Republic, the Slovak Republic, England and Wales, Germany, the Netherlands, Switzerland, Denmark, Finland, Norway, Sweden, Canada, Australia, Hong Kong, Israel, Japan, and Singapore during the period from 1972 to 1996. Among those 17 countries, the twinning and triplet rates in the Czech Republic and in the Slovak Republic remained constant from 1972 to 1994, whereas these rates increased significantly year by year in the other 15 countries during the examined period in each country. Twinning rates increased from 1.2-fold in Austria to 2-fold in Denmark from 1972 to 1996. As for triplets, the rate increased from 3-fold in Denmark to 9-fold in Norway during that period. With one exception, that being the Slovak Republic, the triplet rate was highest in the Scandinavian countries, followed by the other European and Asian countries. The rising twinning and triplet rates have been attributed to the higher proportion of mothers treated with ovulation-inducing hormones and partially attributed to IVF.

Asia↗
PubMed1995

Prenatal weight gain and the birthweight of triplets.

The objective of this study was to evaluate the association between maternal factors, including rates of gestational weight gain before and after 24 weeks' gestation, and adequacy of intrauterine growth for gestational age at birth of triplets, as a mean Z-score of the triplet set. The study design was a retrospective, anonymous, pilot telephone survey of mothers of triplets and an historical cohort analysis of their prenatal weight gain records. The statistical analyses performed included multiple regression analysis to formulate a model for mean triplet Z-score (a measure of birthweight-for-gestational age) and analysis of variance to confirm and simplify the components of this model. Factors significant in the final model and their beta coefficients included weeks' gestation (-0.124, p < 0.0001), rate of gain before 24 weeks' gestation (0.606, p = 0.005), and induced conception (-0.404, p = 0.01). Rate of gain > or = 1.5 lbs/week before 24 weeks was significant in the analysis of variance (p = 0.009). Better intrauterine growth for gestational age is achieved in triplet gestations with maternal weight gains of > or = 1.5 lbs/week before 24 weeks' gestation.

Adult↗
PubMed1989

Triplet pregnancy: a 10-year review of 105 cases at Harare Maternity Hospital, Zimbabwe.

During the 10-year period, 1975-1984, 105 triplet pregnancies were delivered at Harare Maternity Hospital, Zimbabwe, among 286,338 pregnancies in the Greater Harare Unit, giving an incidence of triplets of 1:2,727. The mean gestational age at delivery was 32.5 wk with 81 women (77.1%) delivering before 37 wk. Primigravidas delivered at a significantly earlier mean gestational age (P less than 0.05) and had a higher perinatal mortality (P less than 0.001) compared with grand multigravidas. Of the 315 babies, 277 (87.9%) weighed less than 2500 g. The overall perinatal mortality rate was 327%, with a perinatal mortality rate of 146% for infants weighing greater than or equal to 1000 g. Women hospitalised for bed rest during the antenatal period had fewer perinatal deaths compared with those diagnosed during the antenatal period, but not hospitalised for bed rest (P less than 0.02). No difference was found in the mean gestational age at delivery or the mean birth weights between these two groups. Among infants greater than or equal to 28 wk gestation there were fewer perinatal deaths in triplets delivered by cesarean section compared with triplets delivered vaginally (P less than 0.0004). This suggests that cesarean section may offer the optimal mode of delivery in triplet pregnancy.

Adult↗
PubMed1988

The Northwestern University Triplet Study. III: Neonatal outcome.

Limited data suggest that cesarean section (CS) may be the preferred method of delivery for triplets. Despite this, it is also felt that the third triplet is at great risk at delivery. We reviewed our experience of 14 triplet pregnancies at Northwestern University between 1981 and 1985. All deliveries were attended by neonatal teams in sufficient number to resuscitate each infant. Of the 14 pregnancies, two ended in previable loss. Thirty-six infants were born from 12 pregnancies of a mean gestational age of 33 weeks (28-38 weeks). The overall survival was 97.3%. Two women delivered vaginally. While the first was successful, the second resulted in vaginal delivery of the first two triplets followed by emergency CS for the third. That infant had a cord blood pH of 6.96 (BE-19), was resuscitated and survived. All 10 CS were successful. The mean cord blood gas tensions and pH were normal. In addition, Apgar scores, the requirement for mechanical ventilation or supplemental oxygen, and mortality did not differ between the first and third-born triplet. These observations suggest that CS was beneficial. Our very low mortality rate supports the concept that CS delivery and aggressive neonatal resuscitation and therapy greatly enhances survival.

Birth Order↗