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PubMed1988

Mode of delivery in multiple birth of higher order.

A retrospective review of triplets delivered at a Boston perinatal center from 1977 to 1986 was performed. Comparison was made between this group (study group) and previously published data on triplets in our institution (control group). Since 1977 there was a more liberal use of abdominal delivery. Cesarean sections (CS) of all triplets with malpresentation was our protocol. Of the 15 sets of triplet pregnancies in the study group, 11 were delivered by CS and 4 by vaginal delivery, vs only 1 CS in the control group which consisted also of 15 triplets. The corrected mortality rate in the study group was lower than in the control group (2.6% vs 7.1%) but did not reach statistical significance. Apgar scores at 1 and 5 minutes were significantly higher in the study group (P less than 0.002). Apgar scores for the third triplet were also higher in the study group (P less than 0.05). In comparing the combined mortality and morbidity between the study group and the control group, no difference was found in the first triplet, but those of the second and third triplets were significantly lower in the study group. Of interest is the finding that the combined mortality and morbidity was not different statistically among the first, second, and third triplets in the study group, while in the control group an increase from the first to the third triplet was noted (21%, 31%, and 43%, respectively). A more liberal approach toward abdominal delivery of pregnancies of higher fetal number is advocated.

Apgar Score↗
PubMed1984

Multiple birth rates in Japan: further analysis.

The rates of MZ and DZ twin births and of triplet births slightly decreased in Japan in 1955-1967 and 1974, whereas that of trizygotic triplets tripled. The rates of triplet and quadruplet births were comparable to those of Caucasians. Although the sample size is small, Japan seems to be characterized by higher rates of triplets and quadruplets of polyembryonal origin and lower rates of those of polyovulational origin as compared to Caucasian populations. Stillbirth rates in both MZ and DZ twins gradually decreased in 1960-1967 and 1974. The rate was higher in MZ than DZ twins, and higher in males than females. The secular trends of stillbirth rates in like-sexed triplets was similar to that in twins, whereas the rate in unlike-sexed triplets remained almost constant for the entire period. The rate was higher in like-sexed than unlike-sexed triplets.

Adult↗
PubMed2001

Use of multivitamins and folic acid in early pregnancy and multiple births in Sweden.

Folic acid is recommended to reduce the risk of neural tube defects and other congenital malformations. Data from the Swedish Medical Birth Registry were used to study frequency of twinning in women who in early pregnancy reported the use of folic acid. Women (n = 2,569) who in early pregnancy reported the use of folic acid had an increased rate of twin deliveries after consideration of maternal age and of length of involuntary childlessness, both variables being significant confounders. The effect of folic acid was seen also in women who did not report involuntary childlessness. A similar but not statistically significant trend was seen after use of multivitamins without simultaneous use of folic acid tablets (n = 1,979). The increased risk seems to be limited to dizygotic twinning (relative risk = 2.13, 95% CI 1.64-2.74). If this association is causal, wide-spread supplementation with folic acid may represent a hazard larger than the postulated beneficial effect on neural tube defects, at least in low-risk areas.

Adult↗