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PubMed1998

Are there still obstetric and perinatal benefits for selective embryo reduction of triplet pregnancies?

We present in this study the results of a retrospective analysis comparing a group of ongoing triplet pregnancies and a group of triplet pregnancies reduced to twins. These two groups were managed in the same way between January 1993 and April 1996 in hospital. Mean gestational age at birth was comparable in both groups of patients. Prematurity rate was lower in the reduced pregnancies group (62.5 versus 95.6%, P < 0.05). Severe prematurity (<32 weeks) was not different in the two groups. The percentage of Caesarean section was lower in the reduced group (23.5 versus 70.8%, P < 0.01). No significant difference was observed for perinatal mortality. Newborns of ongoing triplet pregnancies had a higher percentage (67.7 versus 86.8%) of hospitalization in the intensive neonatal care unit and a tendency towards lower birthweight. The differences observed in this study do not seem to represent a decisive benefit for reducing triplet pregnancies. Due to the progress in the management of multiple pregnancies and neonatal intensive care, we think that embryo reduction should no longer be justified by obstetric benefits but rather as a possibility offered to couples who could be confronted with the potential severe psychological, social and economic problems of triple births.

Adult↗
PubMed2000

Multifetal reduction of triplets to twins: a prospective comparison of pregnancy outcome.

The aim of this study was to compare the outcome of triplets managed expectantly or by multifetal reduction to twins to assess the potential benefit of fetal reduction. The study design was prospective, comparative and monocentric and the study was conducted in a teaching hospital. Out of 148 women with triplets mostly obtained after infertility treatment, 83 were expectantly managed while 65 chose reduction to obtain twins. Main outcome measures were fetal loss before 24 weeks, premature deliveries before 28, 32 and 34 weeks, rate of low birthweight infants and neonatal and perinatal mortality rates. The fetal loss rate before 24 weeks did not differ between the ongoing group and the reduced group (6 versus 5.4%). Reducing triplets was associated with a significantly lower incidence of the following: prematurity before 28, 32 and 34 weeks (P < 0.001), low birthweight infants whose weights were under the third centile (P < 0.002) and infants whose weights were less than 1000, 1500 and 2000 g (P < 0.001). Neonatal (although apparently lower in the reduced group) and perinatal mortality did not significantly differ. Our results indicate that reduction of triplets to twins is effective to improve preterm birth and fetal growth.

Adult↗
PubMed2006

Risks of miscarriage and early preterm birth in trichorionic triplet pregnancies with embryo reduction versus expectant management: new data and systematic review.

BACKGROUND: Triplet pregnancies are associated with a high risk of miscarriage and early preterm birth. It is uncertain if the outcome is improved by embryo reduction (ER). METHODS: We examined trichorionic triplet pregnancies with three live fetuses at 10-14 weeks of gestation that were managed expectantly or by ER. The two groups were compared for the rates of miscarriage, defined as pregnancy loss before 24 weeks, and preterm delivery prior to 32 weeks. In addition, systematic searches were performed to identify studies comparing outcomes in expectant management versus ER in triplet pregnancies. RESULTS: We combined data from 365 pregnancies managed in our centre with those of five previous studies. In total there were 893 pregnancies. In the ER group (n=482) compared to the expectantly managed group (n=411), the rate of miscarriage was higher [8.1 versus 4.4%; relative risk (RR)=1.83, 95% confidence interval (CI)=1.08-3.16, P=0.036] and the rate of early preterm delivery was lower (10.4 versus 26.7%, RR=0.37, 95% CI=0.27-0.51, P<0.0001). It was calculated that seven (95% CI=5-9) reductions needed to be performed to prevent one early preterm delivery, while the number of reductions that would cause one miscarriage was 26 (95% CI=14-193). CONCLUSIONS: In trichorionic triplets, ER to twins is associated with an increase in the risk of subsequent miscarriage and decrease in risk of early preterm birth.

Abortion, Spontaneous↗
PubMed1992

Assessment at 1 year of the psychological consequences of having triplets.

The purpose of this study was to assess the psychological difficulties encountered by mothers 1 year after the birth of triplets. Twelve mothers entered the study having delivered triplets in a public hospital in Paris. Nine pregnancies had been initiated after in-vitro fertilization (IVF) or gamete intra-Fallopian transfer (GIFT), two after ovarian stimulation and one was spontaneous. The method consisted of tape-recorded semi-structured interviews at the mothers' homes. At 1 year, a majority of mothers reported considerable fatigue and stress. In most cases, home help was no longer provided by social services or by relatives. A majority suffered from social isolation and had difficulties in going out because of a lack of help, and inquisitive looks and questions from other people. Most mothers said that having triplets placed a strain on the marital relationship. The relationship with the children was often disturbed. Mothers reported that it was difficult to give adequate attention to the three children at the same time. Most of them tended to become emotionally detached. Eight mothers expressed psychological difficulties and three of them were treated for depression. Families with triplets should be provided with increased help, special attention, counselling and support, either at home, in clubs or in special clinics.

Emotions↗
PubMed1984

Delayed interval delivery in triplet pregnancy: report of a single case and review of the literature.

A case report of delayed delivery of 99 days in a triplet pregnancy is presented. A triplet pregnancy in a single uterus resulted from Pergonal stimulation of ovulation. At 23.5 weeks' gestation, the first triplet delivered after spontaneous rupture of membranes. Ninety-nine days later, the remaining two fetuses were delivered, the second one stillborn after intrauterine death at 37 weeks of gestation, and the third fetus a normal viable female consistent with 37.5 weeks' gestation. This is the longest interval of delayed delivery discovered from a literature review, and the only such instance of triplet pregnancy in a single uterus.

Adult↗
PubMed2005

Perinatal mortality in the normal siblings of anomalous triplets.

OBJECTIVE: To estimate the risk of survival of unaffected cofetuses of anomalous triplets. METHODS: Retrospective cohort study of triplets delivered in the United States from 1995 through 1998. Four triplet clusters were identified: cluster A (all members anomaly-free); cluster B (1 anomalous member); cluster C (2 anomalous members), and cluster D (all 3 members anomalous). We compared the risk for stillbirth and infant mortality among nonanomalous fetuses in clusters A, B, and C after adjusting for intracluster correlations. RESULTS: A total of 7,560 triplet clusters (98.9%) were analyzed after excluding cluster D (1.1%). The total stillbirth rate was 20.9 (cluster A), 61.0 (cluster B), and 81.1 (cluster C) per 1,000 (P for trend < .001), and infant mortality rate was 56.4 (cluster A), 108.8 (cluster B), and 196.1 (cluster C) per 1,000 (P for trend < .001). Using cluster A as the referent category, the risk for stillbirth among anomaly-free clustermates climbed with increase in the number of siblings with anomalies in a dose-response pattern (adjusted odds ratio, 95% confidence interval 1.5, 0.7-3.1, for cluster B; and 5.2, 1.4-18.8, for cluster C; P for trend = .03). For infant mortality, the only rise in risk was in cluster C (3.3, 1.6-6.7), whereas cluster B showed comparable risk with the referent category (0.8, 0.5-1.4; P for trend > .05). CONCLUSION: The presence of anomalous fetuses compromises the survival of normal cotriplets. These findings could prove useful for counseling affected parents and highlight the need for follow-up of normal coinfants of anomalous fetuses.

Adult↗
PubMed1978

Down syndrome in two of three triplets.

This is the first report to our knowledge of trisomy 21 in two members of a set of triplets. The two with Down syndrome are monozygous; the other triplet is not identical. These triplets were born to a 22-year-old woman in whose family there have been six sets of twins (four like-sex) since 1775. Neither parent has any chromosomal abnormality. Zygosity estimates in the triplets are derived from studies of red blood cell antigens and HLA typing. Twinning has been reported in association with many different chromosome abnormalities. It has been suggested that the incidence of Down syndrome among twins is significantly higher than among singletons. It seems likely that some families have a heritable predisposition to both twinning and chromosome abnormalities.

Chromosome Banding↗
PubMed1995

Planned abdominal compared with planned vaginal birth in triplet pregnancies.

OBJECTIVE: To compare a policy of planned abdominal delivery with a policy of planned vaginal delivery in triplet pregnancies. DESIGN: Retrospective study. SETTING: Two Dutch university hospitals, each having a different approach to the planned mode of delivery in triplet gestations. SUBJECTS: Thirty women giving birth to triplets in the hospital in Leiden, who favoured planned abdominal delivery, compared with 39 from the Medical Centre in Amsterdam who favoured vaginal delivery. MAIN OUTCOME MEASURES: Perinatal mortality and early neonatal complications. RESULTS: Both centres were equally successful in achieving their planned policies: in Leiden 80% of women were delivered by caesarean section but in Amsterdam 87% of women were delivered vaginally. Compared with vaginal delivery, planned abdominal delivery was associated with a significantly higher perinatal mortality rate (P = 0.02), primarily due to respiratory distress syndrome, and a higher recorded neonatal complication rate (P = 0.03), especially sepsis, respiratory distress syndrome, and necrotising enterocolitis. CONCLUSIONS: A policy of planned abdominal delivery in triplets is not superior to a policy of planned vaginal delivery in terms of fetal and early neonatal outcome.

Adult↗
PubMed1993

Twins, triplets, and cerebral palsy in births in Western Australia in the 1980s.

OBJECTIVES: To examine the rate of cerebral palsy in twins and triplets in births from 1980 to 1989 in Western Australia and to identify factors associated with increase in risk. DESIGN: Pluralities for all births in Western Australia were identified through the standardised midwives' notification system, and cases of cerebral palsy were identified from the Western Australian cerebral palsy register. MAIN OUTCOME MEASURES: Multiple births, cerebral palsy, excluding postneonatal cause. RESULTS: The prevalence of cerebral palsy in triplets, of 28 per 1000 survivors to 1 year (95% confidence interval 11 to 63) exceeded that in twins (7.3; 5.2 to 10) and singletons (1.6; 1.4 to 1.8). Although twins and triples were more likely than singletons to be low in birth weight, their risks of cerebral palsy if low in birth weight were similar. In contrast, in normal birthweight categories twins had a higher rate of cerebral palsy (4.2; 2.2 to 7.7) than singletons (1.1; 1.0 to 1.3). The prevalence of cerebral palsy was similar in twins of unlike sex pairs, all of whom are dizygotic, and in like sex pairs. A twin pair in which one member died in utero was at higher risk of cerebral palsy: 96 per 1000 twin pairs (36 to 218) compared with 12 (8.2 to 17) for twin pregnancies in which both survived. There was a similar but non-significant trend for death of one triplet to be associated with increased risk of cerebral palsy in the survivors of the set. CONCLUSION: Triplet pregnancies produced a child with cerebral palsy 47 times more often than singleton pregnancies did and twin pregnancies eight times more often. Eighty six per cent of cerebral palsy in multiple births was in twins. As multiple births are increasing mainly because of personal and medical decisions the increased risk of cerebral palsy in multiple births is of concern.

Birth Order↗
PubMed1982

Sex ratio of triplet births in Japan.

The effects of paternal and maternal ages, gestational age and the socioeconomic factor of occupation on the sex ratio of triplet individuals were analysed using data on 4,290 triplet individuals which occurred in Japan during the period from 1955 to 1967 and in 1974. The sex ratios among live births and fetal deaths slightly decreased with time. The decline of the sex ratio was related to the decline of age-specific fertility in older mothers. The mean sex ratio was 0.479 during the period. The sex ratio is not high but similar to those of Europe and the USA. The sex ratio was lower in triplets than in twins or the general population. It seems that predominant male triplets may be selectively aborted in early gestational age compared with that of twins or the general population.

Adult↗
PubMed2003

Ophthalmologic follow-up of premature twins and triplets.

PURPOSE: To assess the influence of multiple gestation on the visual apparatus and on the general state of health of premature infants and to investigate the condition of the twin or triplet with the lowest birth weight compared to multiple gestation siblings. METHODS: Seventy-seven premature twins or triplets (8 to 54 months of age) were monitored at the Verona University Ophthalmology Department from November 1995 to November 1999. In another 12 subjects (younger than 8 months), only the neonatal disease records were examined; these subjects were excluded from the ophthalmologic follow-up because they were too young to be tested reliably. The study sample was compared with 120 premature singletons monitored from January 1996 to March 1998. Visual acuity, ocular motility, strabismus, refraction defects, dioptric media, and fundus oculi were assessed. RESULTS: The incidence of retinopathy of prematurity, refraction defects, or strabismus was not significantly different between premature twins or triplets and premature singletons. The twin or triplet with the lowest birth weight was more frequently affected by eye morbidity and the diseases typical of prematurity. This difference, however, was not statistically significant. CONCLUSIONS: Premature infants are at a disadvantage compared to those born at term, irrespective of multiple birth status; multiple gestation adds no risk beyond that due to prematurity.

Birth Weight↗
PubMed1996

Japanese triplets with cerebrotendinous xanthomatosis are homozygous for a mutant gene coding for the sterol 27-hydroxylase (Arg441Trp).

We present the first case of triplets with cerebrotendinous xanthomatosis (CTX). A C-to-T base change identified in the genomic DNA and cDNA encoding the sterol 27-hydroxylase led to replacement of arginine by tryptophan at position 441 (Arg441Trp) in the triplets. The triplets were homozygous and their mother was heterozygous for this mutant gene. The triplets exhibited an identical phenotypic expression, which was different from that of a sporadic CTX case with the same mutation.

Adult↗
PubMed2004

Microstructural observations of villous and membrane histology in monochorionic triplet placenta after in vitro fertilization.

The frequency of triplet gestation is low in humans, estimated at 1:6400 deliveries. Monochorionic gestations represent a subpopulation of approximately 10% of these triplet pregnancies. Hypertensive complications are known to occur with greater frequency in the context of multiple gestation. In this report we describe microscopic placental changes associated with pre-eclampsia and proteinuria in the setting of an uncommon monochorionic-triamniotic triplet pregnancy achieved via in vitro fertilization. Histologic features observed in this case include placental stromal fibrosis and increased syncytial nodularity (Tenney-Parker change). In this triplet delivery resulting from two consecutive fissions of a single embryo, chorion and amnion configuration are also characterized with a review of the literature discussing the potential relationship between in vitro culture conditions and monozygotic multiple gestation.

Adult↗
PubMed1992

Triplet, quadruplet and quintuplet pregnancies. Management and outcome.

The management and outcome of 46 pregnancies, 37 triplets, 7 quadruplets and 2 quintuplets, were analysed. Management of pregnancies, initiated upon diagnosis of multiple pregnancy, included bed rest, beta-mimetic agents, dexamethasone late in the second trimester and selective cerclage. The mean gestational age at labor was 235 days in triplet pregnancies, 241 for quadruplets and 220 days for quintuplets. Fifty-four percent of the deliveries were by cesarean section and the remainder per vaginam. The mean weight of the neonates was 1809 g for the triplets, 1837 g for quadruplets and 1284 g for the quintuplets. The mean overall Apgar score was 8.13, total perinatal mortality 14.8% and 9.4% in cases more than 28 weeks. There was no statistically significant difference in the outcome for triplets born vaginally or by cesarean section. In recent years there has been a pronounced reduction in neonatal mortality, dropping from 17.3% during 1970-78 to 5.9% from 1979 to 1983 (p less than 0.05), probably due to the improved neonatal treatment.

Adult↗
PubMed1991

Menotropins as a possible risk factor for premature deliveries in triplet pregnancies.

This study was undertaken in order to evaluate pregnancy outcome in three groups of triplet conceptions. Of 36 delivered triplet gestations, seven were spontaneous, 12 achieved using clomiphene citrate and 17 induced by menotropins. The mean gestational age (weeks) at delivery was 36.5 +/- 1.0 SD, for spontaneous and clomiphene citrate pregnancies it was 35.9 +/- 1.9 SD which differed significantly from that in pregnancies induced by menotropins which was 32.9 +/- 3.7 SD. Similarly, triplets born following menotropin treatment had a significantly lower gestational weight (g) of 1656 +/- 516 SD vs. 2015 +/- 198 SD and 2176 +/- 315 SD for spontaneous and clomiphene citrate gestations, respectively. It is concluded that triplets following menotropins are at an increased risk for premature delivery and low birth weight.

Adult↗
PubMed2000

Birthweight percentiles by gestational age in multiple births. A population-based study of Norwegian twins and triplets.

OBJECTIVE: To assess secular trends for birthweight by gestational age in twins in Norway and to develop current national birthweight standards by gestational age for twin and triplet births using population-based data. MATERIAL AND METHODS: The analysis of secular trends for birthweight and gestational age in twins was based on 32,379 twin livebirths (1967-95). Taking into account the observed secular trends in birthweight for 35-40 weeks of gestation, data on twins born during 1987-95 only were included in the calculation of birthweight percentiles for 35-40 weeks, while for lower and upper weeks, data on twins born during 1967-95 were used. The construction of birthweight-for-gestation curves for triplets was based on the data on 690 triplets. RESULTS: Whereas the overall mean birthweight and gestational age decreased in 1987-95 compared with the previous years, the mean birthweights by gestational age for the 35-40 weeks of gestation was significantly higher in 1987-95. Male twins weighed more than female twins throughout the gestation with consistent and significant differences from 27 to 42 weeks of gestation. Smoothed curves for birthweight-by-gestational-age percentiles of male and female twins are plotted. The birthweight-by-gestational-age curves of triplets were almost identical with twin curves before 30 weeks of gestation, starting to diverge from them progressively thereafter. The intrauterine growth of twin births also starts to differ markedly from singletons at approximately 30 weeks of gestation. CONCLUSION: This study shows that plurality-specific birthweight-by-gestation standards should be used for assessment of fetal growth in multiple births rather than singleton standards.

Birth Weight↗
PubMed2000

[Triplet gestation--analysis of pregnancy course, delivery and neonatal outcome, based on personal material].

UNLABELLED: Triplet gestation appears in 0.1-0.3% of all pregnancies and it is high risk pregnancy for mother and foetus. It appears more frequently in Afroamerican women, rarely in Japan women. In multifetal pregnancy early prenatal diagnosis and management are very important. AIM: Analysing course of pregnancy, way of delivery, condition of newborns, influence of environmental factors, and concomitant diseases in triplets gestation. MATERIAL: 30 women treated between 1989-1998, in Division of Perinatology, University of Medical Sciences in Poznań, Poland. RESULTS: 21 pregnancies were ended by caesarean section, 9 by vaginal delivery. Apgar score for II and III foetus decreases significantly. pH value of umbilical artery was without significant differences. CONCLUSIONS: Almost all triplets have ended preterm. Route of delivery of triplets have to be considered individually. Environment factors could play an important role in multifetal pregnancy.

Adult↗
PubMedDate not supplied

[Occurrence of triplet births].

The authors studied all cases of triplets who were born at the Department of Gynaecology and Obstetrics of University Clinical Centre in Belgrade, over a twenty-year period (1970-1989). Thirty sets of triplets were born in this period. This means that one set of triplets was born per 5845 births. Preterm deliveries occurred in 19 cases. Liveborn children had lower Apgar score. Common birthweight was slightly below 1800 grams. In more than one half of the foetuses malpresentation was found. More than one fourth of sets were delivered by Cesarean section. Total foetal loss reached 23.33% and purified perinatal mortality rate reached 11.11%. The triplet diagnosis on time is important because of the necessary prevention measures and appropriate therapy.

Birth Weight↗