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PubMed1992

Favourable outcome in 33 triplet pregnancies managed between 1985-1990.

In this paper, we describe the outcome of 33 triplet pregnancies referred to us between 1985 and 1990. They were managed as follows: management at home as soon as the diagnosis was made, then hospitalization at 28 weeks' gestation. Progesterone and beta-mimetics were administered daily, a cesarean section was always performed. One late abortion occurred at 21 weeks. The rate of prematurity was 90.6%, mean gestational age at delivery was 34.1 +/- 3 weeks, and 62.5% of deliveries occurred between 34 and 37 weeks. Ninety-four fetuses were delivered alive. Mean birth weight was 1880 +/- 410 g. Fetal growth retardation rate was 61.8%, including 28 infants under the third centile and 31 under the 10th centile. Perinatal death rate was 4.16% including 2 in utero deaths and 2 neonate deaths. All infants are healthy except for one child with severe mental retardation. These results show that triplet pregnancies can be safely managed, and that selective first-trimester reduction in triplet pregnancies does not appear to be necessary.

Adult↗

PubMed2004

Fetoscopic surgery in triplet pregnancies: a multicenter case series.

OBJECTIVE: The purpose of this study was to evaluate the feasibility of fetoscopic surgery in complicated monochorionic and dichorionic triplet pregnancies. STUDY DESIGN: This was a case series of fetoscopic surgery in 12 cases of monochorionic (n = 5) or dichorionic (n = 7) triamniotic triplets complicated by severe feto-fetal transfusion (n = 8), twin reversed arterial perfusion sequence (n = 3), or discordant for an anomaly (n = 1). Six underwent cord occlusion, and 6 had laser coagulation of the vascular anastomoses. RESULTS: All procedures were successfully completed, and the outcome was comparable to that reported for similar procedures in twins. Eighty-three percent of fetuses survived, and 13% had long-term problems. CONCLUSION: Fetoscopic surgery may be considered as a therapeutic option in complicated triplet pregnancies, with results similar to those found in twins.

Adult↗

PubMed2005

A unique case of conjoined triplets.

A unique case of conjoined triplets that was characterized as tricephalus, tetrabrachius, and tetrapus parapagothoracopagus is presented. Antenatal diagnosis of the conjoined triplet was made at 22 weeks of gestation with 2-dimensional ultrasonography and magnetic resonance imaging. Pregnancy was terminated by hysterotomy, and diagnosis of conjoined triplets was confirmed postnatally.

Adult↗

PubMed2007

Early prediction of preterm birth for singleton, twin, and triplet pregnancies.

OBJECTIVES: To create prediction models of early preterm birth for singletons, twin, and triplet pregnancies. STUDY DESIGN: We used a historical cohort study with the 1996 birth registration data for singletons and the 1995-1997 linked birth/infant death dataset for multiple births of the United States. Preterm birth was defined as gestational age <32 completed weeks. Eligible study subjects were randomly allocated to two groups: one group (80% subjects) for the creation of the prediction models, and the other group (20% subjects) for the validation of the established prediction models. Multivariate logistic regressions were used to establish the prediction models. We further assessed the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the established prediction models with different cut-off values in the validation group. RESULTS: The sensitivity, specificity, PPV, and NPV of the established model were 24.58, 93.54, 5.91, and 98.69%, respectively for singletons, 64.66, 57.04, 16.29, and 92.59%, respectively for twins, and 63.57, 53.58, 42.96, and 72.78%, respectively for triplets. CONCLUSION: The prediction models of early preterm birth for singleton, twin, and triplet pregnancies created by this study could be useful for obstetricians to identify women being at high risk of preterm birth at early gestation.

Adult↗

PubMed1996

The maternal and neonatal outcome of triplet gestations.

OBJECTIVE: Our purpose was to determine the contemporary maternal and neonatal outcome of triplet gestations. STUDY DESIGN: A retrospective review of 57 triplet deliveries between April 1, 1989, and July 31, 1994, was performed. RESULTS: The mean gestational age at delivery was 33.0 +/- 2.7 weeks, and the mean birth weight was 1820 +/- 513 gm. The most common maternal complications were preterm labor (86.0%), anemia (58.1%), preeclampsia (33.3%), preterm premature rupture of the membranes (17.5%), postpartum hemorrhage (12.3%), and HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome (10.5%). Neonatal complications included hyaline membrane disease (29.6%), transient tachypnea of the newborn (20.1%), intraventricular hemorrhage (7.7%), and major congenital anomalies (7.1%). The perinatal mortality was 41 per 1000. Birth order had no significant effect on the incidence of neonatal complications. CONCLUSION: Perinatal mortality rates have improved in recent years but remain higher than for singleton gestations. Despite increasing experience with triplets, the rate of maternal complications is high.

Female↗

PubMed1999

Ultrasonographic diagnosis of thoracopagus conjoined twins in a monoamniotic triplet gestation.

Ultrasonographic examination at 16 weeks 5 days' gestation diagnosed a monoamniotic triplet gestation complicated by thoracopagus conjoined twins. After pregnancy termination, the ultrasonographic diagnoses were confirmed by pathologic examination. In reporting the first ultrasonographically diagnosed monamniotic triplets with conjoined twins, we demonstrate that a systematic evaluation by twin-derived ultrasonographic techniques may permit correct diagnosis of unusual triplet pregnancies.

Adolescent↗

PubMed2001

Successful digoxin therapy of fetal supraventricular tachycardia in a triplet pregnancy.

BACKGROUND: Fetal supraventricular tachycardia is a rare complication of pregnancy associated with cardiac failure, hydrops, and fetal death. If no underlying cardiac defects are present, medical management with digoxin has been successful. CASE: A young woman with a triplet pregnancy presented at 23 17 weeks' gestation for routine Doppler auscultation which suggested fetal supraventricular tachycardia, confirmed by M-mode echocardiography. She was treated with oral digoxin for the remainder of her pregnancy with subsequent conversion of the tachycardic triplet to normal sinus rhythm with occasional premature atrial beats. After delivery, the triplet previously demonstrating supraventricular tachycardia had a normal sinus rhythm. CONCLUSION: Digoxin might be used safely and successfully to treat fetal supraventricular tachycardia in multifetal pregnancies.

Adult↗

PubMed2003

Successful outcome after serial amnioreductions in triplet fetofetal transfusion syndrome.

BACKGROUND: Triplet fetofetal transfusion is an extremely rare complication with high perinatal mortality. Its rarity does not allow any prospective randomized study on various interventional methods to be conducted. CASE: We report one case of triplet fetofetal transfusion syndrome with survival of all three fetuses. Two were donor fetuses, and one was the recipient fetus. Serial amnioreductions were performed at 22, 24, and 26 weeks' gestation to relieve symptomatic polyhydramnios. Premature rupture of membranes occurred at 27 weeks and cesarean delivery was performed. All three babies were discharged home by 4 months of age, and all had normal neurological development when assessed at 6 months of age. CONCLUSION: The option of serial amnioreduction, with the anticipation and preparation for delivery at around 28 weeks, should be seriously considered when triplet fetofetal transfusion syndrome is encountered.

Adult↗

PubMed2002

Perinatal care improves the outcome of triplets.

OBJECTIVE: To compare pregnancy complications and neonatal outcome of 85 triplet gestations cared for during the 15 years in a single perinatal unit. METHODS: Pregnancies were divided in two groups according to the differences in the management plan and their outcomes were compared. Group I (N = 44) consisted of pregnancies cared from 1986 to 1995, using standard model of care: preventive hospitalization from the early second trimester or home bed rest with routine hospitalization after 28-32 weeks of pregnancy, routine clinical and ultrasound examinations, biophysical profile and non-stress tests starting at 28 weeks, expert neonatal care without free access to surfactant or to parenteral nutrition. Group II (N = 41) consisted of pregnancies cared for from 1986 to 2000 using modified care: preventive hospitalization from early second trimester or home bed rest with routine hospitalization after 32 weeks of pregnancy, biophysical profile, non-stress tests and pulsed doppler analysis of fetal umbilical artery, fetal aorta and middle cerebral artery blood flow from as early as 26 weeks, and neonatal care improved by free access to surfactant and parenteral nutrition. RESULTS: The mean gestational age, mean birth weight, the proportion of growth-retarded infants, the incidence of various maternal complications and immediate neonatal conditions as judged by APGAR scores did not differ between the groups. The incidence of deliveries up to 28 weeks was lower in the group II in comparison to group I, but the proportion of term and near term deliveries was lower. The incidence of cesarean sections was high (91.8%), but significantly increased cesarean delivery rate because of fetal distress was observed in the group II (P = 0.014). Infants in the group II had less frequently uneventful early neonatal period, mainly due to significantly increased conatal infection (P = 0.007) and neonatal encephalopathy rate (P = 0.001). However, perinatal mortality was decreased from 235% in the group I to 142% in the group II for newborns that reached 24 weeks of gestation or more. The decrease of perinatal mortality was observed also in the newborns born after 28 weeks of gestation (123% in the group I and 99% in the group II). None of the children weighing <1000 g died in utero in the group II. Early neonatal death of infants weighing >1500 g was significantly reduced in the group II (P = 0.048). CONCLUSION: Advances in neonatal care, but also the delivery of infants in better overall condition must be the explanation for improved outcome of triplet gestations managed by modified care. A higher cesarean section rate because of imminent fetal jeopardy as judged by not only fetal heart rate tracings, but also umbilical, aortic and middle cerebral artery flow analysis, could be the explanation for lowered perinatal mortality and significantly improved outcome in very preterm infants from triplet gestations.

Birth Weight↗

PubMed2006

Delayed interval delivery in a triplet pregnancy.

Due to a surge in the availability of assisted reproductive techniques (ART), the incidence of multiple pregnancies is increasing. Preterm labor is a major complication in such pregnancies. Preterm delivery of the first fetus is often followed by delivery of the remaining fetuses. However, conservative management and delayed interval delivery in the remaining fetuses might allow for fetal lung maturity and would reduce perinatal morbidities. A 32-year-old female had a quadruplet pregnancy after receiving ART. Fetal reduction to triplet pregnancy was performed at 11 weeks of gestation. The remaining triplet pregnancy was stable until 29 weeks of gestation, when the first triplet was delivered after spontaneous rupture of membranes. Under intensive monitoring, the remaining 2 fetuses were delivered by cesarean section at 31 weeks of gestation. Only the first fetus had retinopathy after discharge. In conclusion, delayed interval delivery of the remaining fetuses should be attempted after preterm delivery of the first fetus.

Adult↗

PubMed1990

Triplets and higher order multiple births in Japan.

Multiple birth rates in entire Japan were analyzed using vital statistics for 1951 to 1988. The triplet rate was nearly constant from 1951 to 1974, where the rate per million births was 58, then increased with the year up to 1982 (104), and decreased up to 1984, and suddenly increased thereafter (109 in 1987). The average rate of quadruplets per million births from 1951 to 1968 was 0.93, then increased with the year up to 1975 (7.5), and decreased until 1984 and suddenly increased thereafter (10.6 in 1987). The rate of quintuplets was 0.77 per million births during the period from 1975 to 1987. The higher multiple birth rate since 1975 was attributed to the higher proportion of mothers treated with ovulation-inducing hormones in Japan. Since 1985, higher multiple birth rates might be partially attributed to in vitro fertilization. The stillbirth rates for male triplets gradually decreased from 1960 to 1978 and thereafter remained constant at a little higher level except in 1988, whereas the rates for females gradually decreased with the year. The overall stillbirth rates decreased to 1/4 for triplets and to 1/5 for quadruplets during the 37-year period from 1951. The overall stillbirth rate of quintuplets was 0.60 (51/85) during the period 1975-1987.

Adult↗

PubMed1990

Transfusion syndrome in a triplet pregnancy.

A case is reported of a transfusion syndrome in a triplet pregnancy with intrauterine death of two of the fetuses. This is an exceptional occurrence in a triplet pregnancy and raises the problem of the management of multiple pregnancies associated with the death of one or more of the fetuses. The problem of the method of delivery and the complications arising in triplet dizygotic pregnancies is discussed.

Adult↗

PubMed1991

Maternal reactions to the birth of triplets.

This study examines the reactions of 14 women to the birth of triplets. Home interviews and observations were conducted at 4 months and 1 year after the birth. The findings indicate that the triplet situation constitutes a real source of psychological stress for the women in this study. Reactions depend on two factors: individual makeup, in that some women become depressed whereas others develop defenses, and amount of support from family and friends. These variables, along with mothers' ability to overcome phantasms of abnormality generated by the exceptionality of a multiple maternity, serve to define a set of predictors of good/poor prognosis for the establishment of triplet-mother relationships.

Adaptation, Psychological↗

PubMed1995

Amelogenesis imperfecta in triplets: a unique family record.

A unique family is recorded in which triplets were observed with the hypomaturation type of amelogenesis imperfecta. A simple technique of DNA analysis showed that two of the more severely affected triplets were monozygotic and the third less severely affected triplet dizygotic.

Alleles↗

PubMed2006

Severe hypodontia in a set of triplets.

Hypodontia is the developmental absence of one or more teeth from the dentition and constitutes one of the most common developmental anomalies in humans with a reported prevalence of 1.6 to 9.6% in the permanent dentition. Hypodontia may occur in association with other genetic diseases, or as an isolated familial or sporadic form. This article describes the rare phenomenon of severe hypodontia in a set of triplets. The triplets presented with congenital absence of the second molars, second premolars in all quadrants and lower central incisors. An additional five teeth (upper canines, upper lateral incisors and upper left first premolar) were missing in one of the triplets. The treatment plan and the possible genetic mode of inheritance are discussed.

Anodontia↗

PubMedDate not supplied

Clinical dilemma in triplet pregnancy: when is it appropriate to intervene for a jeopardized fetus?

OBJECTIVE: To determine gestational age-specific risks of intervening to "rescue" a compromised fetus in triplet pregnancies. STUDY DESIGN: We analyzed retrospectively triplet pregnancies managed at New England Medical Center (July 1992-May 2000; n=97 pregnancies). For each week in gestation, we compared the chance of at least one of three infants developing complications of prematurity in Scenario A (delivery at that gestation to rescue the jeopardized fetus) with the chance of at least one of two infants from Scenario B (allowing the jeopardized fetus to die in utero to prolong pregnancy) developing that complication later in gestation. RESULTS: We observed a decreased risk of at least one infant developing a specific complication in Scenario B than in Scenario A for all complications studied. CONCLUSIONS: Comparison of triplet outcomes with the two surviving older newborns identifies important changes in risk between 25 and 32 weeks. These data enable physicians and parents to weigh acceptable risks with benefits.

Adult↗

PubMed2001

Generalized dystrophic epidermolysis bullosa: identification of a novel, homozygous glycine substitution, G2031S, in exon 73 of COL7A1 in monozygous triplets.

We report monozygous triplets affected with dystrophic epidermolysis bullosa (DEB). The female triplets were delivered by Caesarean section and skin fragility of each child, which was partly induced by trauma, was apparent from the third to fourth day of life. Clinically, the triplets were equally affected. Mutation analysis in this family revealed a novel recessively expressed glycine substitution, G2031S, in exon 73 of the collagen VII gene COL7A1. Most glycine substitutions in this gene region encoding for the triple helical domain of collagen VII are associated with milder, dominantly inherited phenotypes. By contrast, the novel point mutation of this study is clinically silent in the heterozygous state and leads to a severe DEB subtype when homozygous.

Collagen↗

PubMed2000

Cervical length at 23 weeks in triplets: prediction of spontaneous preterm delivery.

OBJECTIVES: To establish the distribution of cervical length at 23 weeks of gestation in triplet pregnancies and to examine the relation to preterm delivery before 33 weeks. METHODS: Cervical length was measured by transvaginal sonography at 23 (range 22-24) weeks of gestation in 43 triplet pregnancies. The distribution of cervical length was determined and the relationship between cervical length and the rate of spontaneous preterm delivery before 33 weeks was calculated. RESULTS: The cervical length distribution was skewed to the left with a median of 34 mm. The rate of spontaneous labor and delivery before 33 weeks increased exponentially with decreasing cervical length at 23 weeks from 8% at 36-48 mm, to 11% at 26-35 mm, 33% at 16-25 mm and 67% at 15 mm or less. Cervical length was < or = 30 mm, < or = 25 mm and < or = 15 mm in 37%, 16% and 8% of cases, respectively, and the corresponding sensitivities in the prediction of spontaneous delivery before 33 weeks were 67%, 50% and 33%. CONCLUSIONS: In triplet pregnancies, measurement of cervical length provides a useful prediction of risk for spontaneous early preterm delivery.

Cervix Uteri↗