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PubMed2004

Antepartum management and neonatal outcome of triplet pregnancies.

MATERIALS AND METHODS: The maternal and neonatal outcome of 27 triplet and 1 quadruplet gestations was studied at the University Hospital of Verona. RESULTS: Mean maternal age was 31.7+/-3.7 years; 24 women (85.7%) were nulliparous. Six (21.4%) patients had conceived spontaneously. Common maternal complications were: preterm labor (78.6%), anemia (57.1%), preeclampsia (25.0%). Thirteen patients (46.4%) had cervical cerclage, 21(75%) received tocolysis, 20 (71.4%) corticosteroid prophylaxis, 4 (14.3%) unfractionated heparin. All patients underwent Caesarean section with mean gestational age of 32+/-2.5 weeks and mean postoperative stay was 9 days. Three patients were treated in ICU after delivery, 1 was hysterectomized and 6 received blood transfusions. The live newborns were 80, the stillborns 5. Mean birth weight was 1,520+/-516 g (range 650-2,665), 95.0% being LBW. The following neonatal complications were observed: RDS (28.7%), cerebral hemorrhage (26.2% of II degrees and 1.2% of III degrees ), anemia (20%), PDA (12.5%), ROP (6.5%), polyglobulia (3.75%), NEC (2.5%). Mean hospitalization time was 30.6 days (range 2-132). DISCUSSION: Iatrogenic multiple births are increasing as the use of assisted conception techniques expands. Gynecologists should be aware of maternal complications and neonatal outcome of triplet pregnancies and infertility management strategies should try to avoid iatrogenic multiple gestations.

Adult↗
PubMed2005

Welcomed triplets following gestation with retained intrauterine device.

Multiple gestations with concurrent intrauterine devices (IUDs) are rare events. We handled the case of a woman who discovered she was pregnant with triplets after the 12th week of gestation. Upon the mother's request the IUD was removed immediately and the pregnancy led a normal course until the planned caeserean delivery of three baby girls. This is the first report of triplet births after an early sharing occupancy of the narrow uterine cavity with an IUD. Such a gestation upon discovery should not automatically be presumed undesirable. Especially when faith issues are predominant such cases may end with satisfied parents as demonstrated in this case.

Adult↗
PubMed1981

Triplet pregnancy in Nigeria: socio-biologic aspects.

A retrospective analysis of 20 triplet pregnancies not stimulated by clomiphene or gonadotrophins revealed a perinatal mortality of 26.3%. There were greater losses recorded in the case of mothers who had received no antenatal care than for those who had been seen before the babies' births. Triplet pregnancy in this series was associated with anemia, hypertension, postpartum hemorrhage and hydramnios. In Nigeria, where there is a high incidence of such pregnancy, it should be suspected more often than elsewhere. The authors recommend amnioscopy, amniocentesis and early resort to cesarean section as part of the antenatal regimen, with careful management of the third stage of labor to prevent postpartum hemorrhage.

Adolescent↗
PubMed1989

Management and outcome of 21 triplet and quadruplet pregnancies.

The course of gestation and the outcome of fifteen triplet and six quadruplet pregnancies are reviewed. Twenty pregnancies followed induction of ovulation and only one was spontaneous. Bed rest, the use of beta-mimetics and betamethasone, and prolonged hospitalisation were part of the management. Elective cervical suture was not used. The most frequent antenatal complications were preterm labor, preterm rupture of membranes and pregnancy-induced hypertension. The median gestational age was 33.5 weeks in the triplets and 32 weeks in the quadruplets. The overall perinatal and neonatal mortality was 4.9%. The neonatal complications resulted from prematurity and sepsis.

Adult↗
PubMed1996

Prolongation of pregnancy and survival of remaining fetuses after operative evacuation of one triplet at 18 weeks' gestation.

BACKGROUND: Successful delay of aftercoming siblings is an infrequent event in obstetrics. No case of second-trimester operative vaginal evacuation of a fetus followed by delayed delivery of the remaining siblings has been described previously. CASE: A triplet pregnancy was complicated by preterm rupture of membranes at 17 weeks' gestation, followed by cord prolapse and subsequent fetal arm prolapse at 18 weeks' gestation. Operative evacuation of triplet A was performed under ultrasound guidance, with the placenta left undisturbed. Antibiotics and tocolytics were used perioperatively and the pregnancy was prolonged for another 16 weeks. Onset of active labor at 34 weeks' gestation resulted in the vaginal delivery of viable twin males weighing 2810 and 2680 g. CONCLUSION: In cases of multiple gestations with second-trimester rupture of the lower sac, selective fetal evacuation can be performed safely and may allow successful continuation of the remaining pregnancy.

Adult↗
PubMed2005

Live birth of healthy triplets after in vitro fertilization and embryo transfer in an acromegalic woman with elevated growth hormone.

OBJECTIVE: To report a case of successful triplet pregnancy in an acromegaly patient with IVF and embryo transfer. DESIGN: Case report. SETTING: Tertiary center for assisted reproductive technologies. PATIENT(S): A 33-year-old woman with acromegaly and primary infertility. INTERVENTION(S): Controlled ovulation hyperstimulation and IVF/embryo-transfer treatment using gonadotropins. MAIN OUTCOME MEASURE(S): Uncomplicated pregnancy course and successful take-home triplet infant girls. RESULT(S): Successful ovarian stimulation and IVF is possible in acromegalic patients. CONCLUSION(S): There may be an effect of elevated growth hormone resulting in increased ovarian response to gonadotropin, inducing hyperstimulation and high-order multiple pregnancies in these patients.

Acromegaly↗
PubMed2005

Pyloric stenosis in in vitro fertilized triplets--is it a coincidence?

Infantile hypertrophic pyloric stenosis was previously reported in multiple births, but there were only 3 triplets in the literature and all were naturally conceived. Assisted reproductive technologies, such as in vitro fertilization, are accused for increasing the risk for some anomalies in children. Triplets of in vitro fertilization, all of whom were operated on because of pyloric stenosis, are presented.

Female↗
PubMed2005

Feto-feto-fetal transfusion syndrome in monozygotic monochorionic triamniotic triplets: vascular evaluation by a cast model.

A unique cast model of the placenta in a rare case of feto-feto-fetal triplet transfusion syndrome (FFFTTS) allowed the demonstration of why the transfusion syndrome developed in one fetus and not in the other two in that single placenta. The vasculature anatomy of a monochorionic triamniotic triplet placenta with FFFTTS of three healthy infants (one donor, two recipients) born in the 35th week of gestation was cast by means of dental casting materials. After the cast hardened, the tissue was corroded, revealing the cast blood vessels. The diameters and lengths of the chorionic blood and intraplacental vessels of the cast placenta were measured with a digital caliper. The cast revealed two artery-artery (A-A) anastomoses on the chorionic plate between the two recipients and the donor. Seven artery-vein (A-V) deep anastomoses connected only the arteries of the donor and the veins of the two recipients. The blood vessel connections among the fetuses allowed the evaluation of a pathologic case with its own control in a single placenta. From the vascular appearance, we speculate that the A-A anastomoses between the two fetuses protected them from developing blood transfusions, but that the A-V anastomoses contributed to their development.

Adult↗
PubMed1995

A magnetic resonance imaging approach for the diagnosis of a triplet cornual pregnancy.

OBJECTIVES: To describe a rare case of triplet cornual pregnancy after IVF-ET and to assess the role of magnetic resonance imaging (MRI) for early diagnosis. DESIGN: Case report. SETTING: Infertility and IVF Unit, in an university medical center. PATIENT: A 31-year-old healthy patient with a 3-year history of primary male infertility. INTERVENTION: Standard IVF-ET treatment cycle, using a GnRH-agonist (long protocol) and hMG for ovarian stimulation. RESULTS: A cornual triplet pregnancy is described with the approach for the diagnosis. Magnetic resonance imaging was complementary to endovaginal sonography for early diagnosis and permitted a timed conservative management. CONCLUSIONS: When transvaginal ultrasound findings did not provide an accurate location of the pregnancy, MRI was indicated to confirm the diagnosis.

Adult↗
PubMed1998

Triplet pregnancy after intracytoplasmic sperm injection of cryopreserved oocytes: case report.

OBJECTIVE: To report a triplet pregnancy that occurred after intracytoplasmic injection of sperm into cryopreserved oocytes. DESIGN: Case report. SETTING: Instituto de Ginecología y Fertilidad (IFER), Buenos Aires, Argentina. PATIENT: A 36-year-old infertile patient with premature ovarian failure and a previous term pregnancy with fresh donated oocytes. INTERVENTION(S): We administered leuprolide acetate for pituitary down-regulation followed by E2 valerianate in incremental doses until an endometrial lining of >8 mm was observed by ultrasound. Thawing of frozen donated oocytes, intracytoplasmic sperm injection (ICSI), and translaparoscopic fallopian tube ET also were performed. Natural micronized progesterone was administered intravaginally (600 mg/d) before ET. MAIN OUTCOME MEASURE(S): Ultrasound at the 8th week of gestation revealed a triplet pregnancy with active fetal heartbeats. RESULT(S): A triple intrauterine gestation was achieved with the use of microinjection into cryopreserved oocytes. CONCLUSION(S): This case illustrates the feasibility of oocyte cryopreservation for clinical use in the era of ICSI.

Adult↗
PubMed1984

Vesicoureteral reflux in triplets.

During an investigation for urinary tract infections in 3-month-old triplets similar patterns of vesicoureteral reflux were noted. To our knowledge, this is the first report of vesicoureteral reflux in triplets. The patterns of inheritance in vesicoureteral reflux and the need for sibling evaluation are discussed.

Female↗
PubMed2001

Management of a triplet pregnancy with two anencephalic fetuses and polyhydramnios.

The occurrence of a triplet pregnancy discordant for anencephaly is rare and its management presents a clinical dilemma. We report what appears to be the first case of a triplet pregnancy with two anencephalic fetuses complicated by premature contractions and severe polyhydramnios. Its management, which results a healthy newborn weighing 1385 g is discussed.

Adult↗
PubMed2000

Acardiac fetus in a triplet pregnancy: ultrasound pitfalls. A case report.

This communication aims at illustrating ultrasound diagnostic difficulties in early pregnancy with acardiac fetus. Our case concerns a spontaneously conceived triplet pregnancy. It was diagnosed as a twin pregnancy at 11 weeks of amenorrhea. One and a half months later the patient was referred to our center for spontaneous premature rupture of membranes with the diagnosis of a fetal demise in a triplet pregnancy. The definite diagnosis of acardia was assessed sonographically by the presence of a reverse blood flow through the umbilical cord, reflex movements, limbs anomalies and discordance between femoral and crown-rump length. Two days after admission, the patient developed chorioamnionitis and the three fetuses were expelled.

Adult↗
PubMed2003

Reducing the incidence of twins and triplets.

Multiple pregnancy rates remain high after assisted conception because of a misconceived assumption that transferring three or more embryos will maximize pregnancy rates. Maternal morbidity is sevenfold greater in multiple pregnancies than in singletons, perinatal mortality rates are fourfold higher for twins and sixfold higher for triplets, while cerebral palsy rates are 1-1.5% in twin and 7-8% in triplet pregnancies. Therefore, multiple pregnancies must be considered a serious adverse outcome of assisted reproductive techniques. Primary prevention of multiple pregnancies is the solution. The overwhelming evidence presented in this chapter demonstrates that limiting the embryo transfer in in vitro fertilization to two embryos would significantly reduce adverse maternal and perinatal outcomes by reducing the incidence of high order multiple pregnancies without reducing take-home-baby rates. Secondary prevention by multifetal pregnancy reduction is effective, but not acceptable to all patients. New developments in blastocyst culture, single embryo transfer, embryo cryopreservation and pre-implantation aneuploidy exclusion, should allow improvements in pregnancy rates without increasing multiple pregnancies.

Embryo Transfer↗
PubMed1998

Type 1 diabetes and prediabetic state in a monozygotic triplet.

Type 1 diabetes mellitus (IDDM) results from a chronic process of autoimmune destruction of beta cells of the Langerhans islets. The presence of autoantibodies (ICA, GADA, anti-IA2, IAA) in serum precedes the clinical onset of the disease. Genetic predisposition for IDDM is connected with HLA, CTLA-4 and insulin gene region. The aim of the study was the genetic and immunological analysis of a triplet. One of them developed Type 1 diabetes mellitus. We analysed HLA class II, CTLA-4 and insulin gene polymorphisms in the whole family. Besides, we investigated immunological status of three brothers. All patients present identical genotype for VNTR loci: D1S80, D17S5 and Apo B, as well as for HLA-DRB1, -DQA1, -DQB1, CTLA-4 gene and all studied insulin gene polymorphisms. That proves their monozigosity. The triplet presents strong genetic predisposition for IDDM. The two patients without overt diabetes have increased levels of ICA, GADA, IA2 and IAA.

Abatacept↗
PubMed1992

Acardius in a triplet pregnancy: cytogenetic and morphological profile.

We describe a rare case of acardius in a triplet pregnancy terminated by Caesarean Section at 32 weeks gestation. Morphological and chromosomal abnormalities of the fetus as well as structural abnormalities of the placenta are presented. Cytogenetic analysis and examination of the single disc triplet placenta provide evidence for the two major theories of pathogenesis of acardius, the twin reversed arterial perfusion (TRAP) sequence and the genetic theory, which we believe are not necessarily mutually exclusive.

Abnormalities, Multiple↗
PubMed1988

The Northwestern University Triplet Study. I: Overview of the international literature.

The international literature on triplet births is surveyed. No definitive work on triplet gestations exists. The relatively few articles on this subject are divided into three categories: 1) national data; 2) local, regional or hospital series; 3) case reports. Clinical concerns, such as prematurity, low birth weight, bed rest, and tocolysis, are discussed with specific reference to literature citations.

Bed Rest↗