Materanal and neonatal outcomes of triplet gestation in a tertiary care centre: a retrospective study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20194874Keywords:
Morbidity, Perinatal mortality, Preterm births, Triplet pregnanciesAbstract
Background: A significant rise in triplet pregnancy rate has occurred recently. This rise is of concern, as these infants are frequently reported as a risk factor of adverse outcome. The aim of this study was to retrospectively study the outcomes of triplet births.
Methods: A retrospective study was undertaken to analyze the clinical data of all patients with triplet gestation admitted to the labour room of Dr. Baba Saheb Ambedkar Hospital, Delhi to study the maternal and fetal outcomes. Authors retrospectively observed and analyzed the database to examine triplet gestations delivered between January 2014 and December 2018.
Results: Over the five-year study period, there were total 44,011 deliveries. Out of these, there were 35 (0.079%) triplet pregnancies. Of all the triplet pregnancies studied 80% resulted from ovulation induction and assisted reproductive technology. The mean gestational age at delivery was 31.6±3.0 weeks, and the mean birth weight was 1,594±460 gm. The most common maternal complications were Preterm labour in 32 pregnancies (92%), anemia in 17 (49%), pre-eclampsia in 11 (31%), post-partum hemorrhage in 8 (22%). Of the total deliveries neonatal complications included Respiratory distress syndrome in 44 (42.2%), Hyperbilirubinemia in 41 (39%), Intrauterine growth restriction in 19 (18.1%). The perinatal mortality rate was 10.5%.
Conclusions: Higher order pregnancies are associated with maternal and neonatal complications. These high risk women need more care and the neonates require intensive care and monitoring after birth, most commonly due to prematurity and low birth weight.
References
Centers for Disease Control and Prevention. Contribution of assisted reproductive technology and ovulation - inducing drugs to triplet and higher-order multiple births - United States, 1980-1997. JAMA. 2000;284:299-300.
Mirzamoradi M, Heidar Z, Saleh M. Fetomaternal outcome in triplet and quadruplet pregnancies: a retrospective study. Int J Med Res Health Sci. 2017;6(6):166-70.
Albrecht JL, Tomich PG. The maternal and neonatal outcome of triplet gestations. Am J Obstet Gynecol. 1996;174(5):1551-6.
Platt MP, Glinianaia SV, Rankin J, Wright C, Renwick M. Northern Region multiple pregnancy register steering group. The North of England multiple pregnancy register: five-year results of data collection. Twin Res Human Genetics. 2006;9(6):913-8.
Garite TJ, Clark RH, Elliott JP, Thorp JA, Pediatrix/obstetrix perinatal research group. Twins and triplets: the effect of plurality and growth on neonatal outcome compared with singleton infants. Am J Obstet Gynecol. 2004;191(3):700-7.
Ho ML, Chen JY, Ling UP, Chen JH, Huang CM, Chang CC, et al. Changing epidemiology of triplet pregnancy: etiology and outcome over twelve years. Am J Perinatol. 1996;13(05):269-75.
Devine PC, Malone FD, Athanassiou A, Harvey-Wilkes K, D'Alton ME. Maternal and neonatal outcome of 100 consecutive triplet pregnancies. Am J Perinatol. 2001;18(04):225-36.
Evans MI, Berkowitz RL, Wapner RJ. Improvement in outcomes of multifetal pregnancy reduction with increased experience. Am J Obstet Gynecol. 2001;184:97-103.
Antsaklis AJ, Drakakis P, Vlazakis GP, Michalas S. Reduction of multifetal pregnancies to wins does not increase obstetric or perinatal risks. Hum Reprod. 1999;14:1338-40.
Bell MJ, Ternberg JL, Feigin RD. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978;187:1-7.
Papile LA, Burstein R. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500g. J Pediatr. 1978;529-34.
Tarter JG, Khoury A, Barton JR. Demographic and obstetric factors influencing pregnancy outcomes in twin gestations. Am J Obstet Gynecol. 2002;18:910-2.
Kaufman GE, Malone FD, Harvey-Wilkes KB. Neonatal morbidity and mortality associated with triplet pregnancy. Obstet Gynecol. 1998;91:342-8.
Suri K, Bhandari V, Lerer T, Rosenkrantz TS, Hussain N. Morbidity and mortality of preterm twins and higher-order multiple births. J Perinatol. 2001;21:293-9.
Macones GA, Shemmer G, Pritis E. Multifetal reduction of triplets to twins improves perinatal outcome. Am J Obstet Gynecol. 1993;169:982-6.
Martin JA, MacDorman MF, Mathew TJ. Triplet births: Trends and Outcomes, 1971-94. National Vital Statistics Reports. Series. 19997;21(55):7.
Leondires MP, Ernst SD, Miller BT, Scott Jr RT. Triplets: outcomes of expectant management versus multifetal reduction for 127 pregnancies. Am journal Obstet Gynecol. 2000;183(2):454-9.
Angel JL, Kalter CS, Morales WJ, Rasmussen C, Caron L. Aggressive perinatal care for high-order multiple gestations: Does good perinatal outcome justify aggressive assisted reproductive techniques?. Am J Obstet Gynecol 1999; 181:253-9.
