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Published in: Archives of Gynecology and Obstetrics 3/2016

01-09-2016 | Maternal-Fetal Medicine

Prediction of perinatal mortality in triplet pregnancies

Authors: Carolina B. Maia, Adolfo W. Liao, Maria L. Brizot, Rossana P. V. Francisco, Marcelo Zugaib

Published in: Archives of Gynecology and Obstetrics | Issue 3/2016

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Abstract

Purpose

To investigate predictors of perinatal mortality in triplet pregnancies.

Methods

Retrospective cohort managed in a tertiary teaching hospital (1998–2012) including all pregnancies with tree live fetuses at the first ultrasound examination, performed after 11 weeks of gestation. Primary end-point was defined as the number of children alive at hospital discharge. Ordinal stepwise regression analysis examined the association with maternal age, parity, pregnancy chorionicity, gestational age at our first ultrasound evaluation, presence of maternal clinical, obstetrical and fetal complications and gestational age at delivery.

Results

Sixty-seven triplet pregnancies were first seen at 18.5 ± 6.8 weeks, 33 (49.3 %) were trichorionic, obstetric complications occurred in 34 (50.7 %) and fetal complications were diagnosed in 17 (25.4 %). Perinatal mortality rate was 249 ‰ (95 % CI 189–317) and 138 (73 %) children were discharged alive from hospital (11 pregnancies with no survivors; single and double survival in ten cases each; all children alive in 36). Regression analysis showed that presence of fetal complications (OR 0.10, 95 % CI 0.03–0.36) and gestational age at delivery (OR 1.55, 95 % CI 1.31–1.85) are significant predictors of outcome (p < 0.001).

Conclusions

Perinatal mortality in non-selected triplet pregnancies is high and is related to the presence of fetal complications and gestational age at delivery.
Literature
1.
go back to reference Adegbite AL, Ward SB, Bajoria R (2005) Perinatal outcome of spontaneously conceived triplet pregnancies in relation to chorionicity. Am J Obstet Gynecol 193(4):1463–1471CrossRefPubMed Adegbite AL, Ward SB, Bajoria R (2005) Perinatal outcome of spontaneously conceived triplet pregnancies in relation to chorionicity. Am J Obstet Gynecol 193(4):1463–1471CrossRefPubMed
2.
go back to reference Alexander GR, Kogan M, Martin J, Papiernik E (1998) What are the fetal growth patterns of singletons, twins, and triplets in the United States? Clin Obstet Gynecol 41(1):114–125CrossRefPubMed Alexander GR, Kogan M, Martin J, Papiernik E (1998) What are the fetal growth patterns of singletons, twins, and triplets in the United States? Clin Obstet Gynecol 41(1):114–125CrossRefPubMed
3.
go back to reference Bajoria R, Ward SB, Adegbite AL (2006) Comparative study of perinatal outcome of dichorionic and trichorionic iatrogenic triplets. Am J Obstet Gynecol 194(2):415–424CrossRefPubMed Bajoria R, Ward SB, Adegbite AL (2006) Comparative study of perinatal outcome of dichorionic and trichorionic iatrogenic triplets. Am J Obstet Gynecol 194(2):415–424CrossRefPubMed
4.
go back to reference Blickstein I, Jacques DL, Keith LG (2003) Effect of maternal height on gestational age and birth weight in nulliparous mothers of triplets with a normal pregravid body mass index. J Reprod Med 48(5):335–338PubMed Blickstein I, Jacques DL, Keith LG (2003) Effect of maternal height on gestational age and birth weight in nulliparous mothers of triplets with a normal pregravid body mass index. J Reprod Med 48(5):335–338PubMed
5.
go back to reference Blondel B, Kaminski M (2002) The increase in multiple births and its consequences on perinatal health. J Gynecol Obstet Biol Reprod (Paris) 31(8):725–740 Blondel B, Kaminski M (2002) The increase in multiple births and its consequences on perinatal health. J Gynecol Obstet Biol Reprod (Paris) 31(8):725–740
6.
go back to reference Blumenfeld Z, Lowenstein L, Brook O, Gonen R, Ophir E, Samueloff A (2006) Does maternal height affect triplets’ birth weight? Med Sci Monit 12(1):CR40–CR43PubMed Blumenfeld Z, Lowenstein L, Brook O, Gonen R, Ophir E, Samueloff A (2006) Does maternal height affect triplets’ birth weight? Med Sci Monit 12(1):CR40–CR43PubMed
7.
go back to reference Devine PC, Malone FD, Athanassiou A, Harvey-Wilkes K, D’Alton ME (2001) Maternal and neonatal outcome of 100 consecutive triplet pregnancies. Am J Perinatol 18(4):225–235CrossRefPubMed Devine PC, Malone FD, Athanassiou A, Harvey-Wilkes K, D’Alton ME (2001) Maternal and neonatal outcome of 100 consecutive triplet pregnancies. Am J Perinatol 18(4):225–235CrossRefPubMed
9.
go back to reference Geipel A, Berg C, Katalinic A, Plath H, Hansmann M, Germer U et al (2005) Prenatal diagnosis and obstetric outcomes in triplet pregnancies in relation to chorionicity. BJOG 112(5):554–558CrossRefPubMed Geipel A, Berg C, Katalinic A, Plath H, Hansmann M, Germer U et al (2005) Prenatal diagnosis and obstetric outcomes in triplet pregnancies in relation to chorionicity. BJOG 112(5):554–558CrossRefPubMed
10.
go back to reference Guilherme R, Le Ray C, Vuillard E, Garel C, Delezoide AL, Oury JF et al (2009) Ultrasound assessment of the prognosis in triplet pregnancies. Acta Obstet Gynecol Scand 88(4):386–390CrossRefPubMed Guilherme R, Le Ray C, Vuillard E, Garel C, Delezoide AL, Oury JF et al (2009) Ultrasound assessment of the prognosis in triplet pregnancies. Acta Obstet Gynecol Scand 88(4):386–390CrossRefPubMed
11.
go back to reference Hillman SC, Morris RK, Kilby MD (2011) Co-twin prognosis after single fetal death: a systematic review and meta-analysis. Obstet Gynecol 118(4):928–940CrossRefPubMed Hillman SC, Morris RK, Kilby MD (2011) Co-twin prognosis after single fetal death: a systematic review and meta-analysis. Obstet Gynecol 118(4):928–940CrossRefPubMed
12.
go back to reference Kawaguchi H, Ishii K, Yamamoto R, Hayashi S, Mitsuda N (2013) Japan PRNGi. Perinatal death of triplet pregnancies by chorionicity. Am J Obstet Gynecol Kawaguchi H, Ishii K, Yamamoto R, Hayashi S, Mitsuda N (2013) Japan PRNGi. Perinatal death of triplet pregnancies by chorionicity. Am J Obstet Gynecol
13.
go back to reference Luke B, Brown MB (2008) Maternal morbidity and infant death in twin vs triplet and quadruplet pregnancies. Am J Obstet Gynecol 198(4):401.e1–401.e10CrossRef Luke B, Brown MB (2008) Maternal morbidity and infant death in twin vs triplet and quadruplet pregnancies. Am J Obstet Gynecol 198(4):401.e1–401.e10CrossRef
14.
go back to reference Martin JA, Hamilton BE, Osterman MJ (2012) Three decades of twin births in the United States, 1980–2009. NCHS Data Brief 80:1–8PubMed Martin JA, Hamilton BE, Osterman MJ (2012) Three decades of twin births in the United States, 1980–2009. NCHS Data Brief 80:1–8PubMed
15.
go back to reference Monteagudo A, Timor-Tritsch IE, Sharma S (1994) Early and simple determination of chorionic and amniotic type in multifetal gestations in the first fourteen weeks by high-frequency transvaginal ultrasonography. Am J Obstet Gynecol 170(3):824–829CrossRefPubMed Monteagudo A, Timor-Tritsch IE, Sharma S (1994) Early and simple determination of chorionic and amniotic type in multifetal gestations in the first fourteen weeks by high-frequency transvaginal ultrasonography. Am J Obstet Gynecol 170(3):824–829CrossRefPubMed
16.
go back to reference Morikawa M, Cho K, Yamada T, Sato S, Minakami H (2013) Clinical features and short-term outcomes of triplet pregnancies in Japan. Int J Gynaecol Obstet 121(1):86–90CrossRefPubMed Morikawa M, Cho K, Yamada T, Sato S, Minakami H (2013) Clinical features and short-term outcomes of triplet pregnancies in Japan. Int J Gynaecol Obstet 121(1):86–90CrossRefPubMed
17.
go back to reference Salihu HM, Aliyu MH, Rouse DJ, Kirby RS, Alexander GR (2004) The association of parity with mortality outcomes among triplets. Am J Obstet Gynecol 190(3):784–789CrossRefPubMed Salihu HM, Aliyu MH, Rouse DJ, Kirby RS, Alexander GR (2004) The association of parity with mortality outcomes among triplets. Am J Obstet Gynecol 190(3):784–789CrossRefPubMed
18.
go back to reference Salihu HM, Williams MJ, Emusu D (2005) Perinatal mortality in the normal siblings of anomalous triplets. Obstet Gynecol 105(6):1419–1423CrossRefPubMed Salihu HM, Williams MJ, Emusu D (2005) Perinatal mortality in the normal siblings of anomalous triplets. Obstet Gynecol 105(6):1419–1423CrossRefPubMed
19.
go back to reference Tita AT, Salihu HM, Ramsey PS (2006) Impact of anomalous triplets on morbidity outcomes of normal in utero siblings. Obstet Gynecol 107(6):1352–1356CrossRefPubMed Tita AT, Salihu HM, Ramsey PS (2006) Impact of anomalous triplets on morbidity outcomes of normal in utero siblings. Obstet Gynecol 107(6):1352–1356CrossRefPubMed
Metadata
Title
Prediction of perinatal mortality in triplet pregnancies
Authors
Carolina B. Maia
Adolfo W. Liao
Maria L. Brizot
Rossana P. V. Francisco
Marcelo Zugaib
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 3/2016
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-015-3995-4

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