Perinatal and Neonatal Outcomes of Triplet Gestations Based on Placental Chorionicity

Spencer, Jeffrey; Ingardia, Charles J.; Nold, Christopher; Borgida, Adam; Herson, Victor; Egan, James

doi:10.1055/s-0029-1220776

Cited by 20 publications

(33 citation statements)

References 8 publications

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“…Comparison of gestational age at birth between TCTA and DCTA triplets was reported by five studies. Overall, there was no difference in gestational age at birth between TCTA and DCTA triplets (MD, 1.1 weeks (95% CI, –0.3 to 2.5 weeks); I 2 = 85%; P = 0.12).…”

Section: Resultsmentioning

confidence: 99%

“…Seven ( n = 2754) and four ( n = 783) studies reported the incidence of morbidity in TCTA and DCTA triplets, respectively. Neurological morbidity occurred in 2.0% (95% CI, 1.1–3.3%) of TCTA and in 11.6% (95% CI, 1.1–40.0%) of DCTA triplets (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…Of the 717 articles identified through the search, 71 were assessed in full text with respect to their eligibility for inclusion, and nine studies 7,8,[19][20][21][22][23][24][25] were finally included in the systematic review (Table 1, Figure 1). These nine studies reported on 1373 triplet pregnancies (1062 TCTA, 261 DCTA and 50 MCTA) for which outcome data were available for inclusion in the meta-analysis.…”

Section: General Characteristicsmentioning

confidence: 99%

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Perinatal mortality and morbidity in triplet pregnancy according to chorionicity: systematic review and meta‐analysis

Curado

D’Antonio

Papageorghiou

et al. 2019

Ultrasound in Obstet & Gyne

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Objective The incidence of perinatal mortality and morbidity in triplet pregnancies according to chorionicity is yet to be established. The aim of this systematic review was to quantify perinatal mortality and morbidity in trichorionic triamniotic (TCTA), dichorionic triamniotic (DCTA) and monochorionic triamniotic (MCTA) triplets. Methods MEDLINE, EMBASE and CINAHL databases were searched in December 2017 for literature published in English describing outcomes of DCTA, TCTA and/or MCTA triplet pregnancies. Primary outcomes were intrauterine death (IUD), neonatal death, perinatal death (PND) and gestational age at birth. Secondary outcomes comprised respiratory, neurological and infectious morbidity, as well as a composite score of neonatal morbidity. Data regarding outcomes were extracted from the included studies. Random‐effects meta‐analysis was used to estimate the risk of mortality and morbidity and to compute the difference in gestational age at birth between TCTA and DCTA triplet pregnancies. Results Nine studies (1373 triplet pregnancies, of which 1062 were TCTA, 261 DCTA and 50 MCTA) were included in the analysis. The risk of PND was higher in DCTA than in TCTA triplet pregnancies (odds ratio (OR), 3.3 (95% CI, 1.3–8.0)), mainly owing to the higher risk of IUD in DCTA triplet pregnancies (OR, 4.6 (95% CI, 1.8–11.7)). There was no difference in gestational age at birth between TCTA and DCTA triplets (mean difference, 1.1 weeks (95% CI, –0.3 to 2.5 weeks); I2 = 85%; P = 0.12). Neurological morbidity occurred in 2.0% (95% CI, 1.1–3.3%) of TCTA and in 11.6% (95% CI, 1.1–40.0%) of DCTA triplets. Respiratory and infectious morbidity affected 28.3% (95% CI, 20.7–36.8%) and 4.2% (95% CI, 2.8–5.9%) of TCTA and 34.0% (95% CI, 21.5–47.7%) and 7.1% (95% CI, 2.7–13.3%) of DCTA triplets, respectively. The incidence of composite morbidity in TCTA and DCTA triplets was 29.6% (95% CI, 21.1–38.9%) and 34.0% (95% CI, 21.5–47.7%), respectively. When translating these figures into a risk analysis, the risk of neurological morbidity (OR, 5.4 (95% CI, 1.6–18.3)) was significantly higher in DCTA than in TCTA triplets, while there was no significant difference in the other morbidities explored. Only one study reported on outcomes of MCTA pregnancies, hence, no formal comparison with the other groups was performed. Conclusion DCTA triplets are at higher risk of perinatal mortality and morbidity than are TCTA triplets. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: General Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Perinatal mortality and morbidity in triplet pregnancy according to chorionicity: systematic review and meta‐analysis

Curado

D’Antonio

Papageorghiou

et al. 2019

Ultrasound in Obstet & Gyne

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“…Nevertheless, 51 of these pregnancies resulted in a dichorionic triplet gestation. It has been demonstrated that dichorionic triplets are at increased risk for earlier deliveries and have higher perinatal mortality rates compared with trichorionic triplets [1] [14]. It is therefore imperative to try to understand what factors contribute to embryo splitting in this population.…”

Section: Discussionmentioning

confidence: 99%

Demographic and Assisted Reproduction Related Factors Associated with Dichorionic Triplet Gestations

Parilla¹,

Goldman²,

Jasulaitis³

et al. 2015

OJOG

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Our objective was to evaluate which demographic factors or assisted reproductive technologies were associated with IVF triplet gestations where one of the embryos split, resulting in a dichorionic triplet gestation. This was a case-control study of dichorionic versus trichorionic triplet gestations that underwent assisted reproductive technology over the last 5 years at our fertility center. There were 53 cases of dichorionic triamniotic triplet gestations compared to 119 trichorionic triplet controls. There were no significant demographic differences between the cases and controls. 51/53 dichorionic triplets and 86/119 trichorionic triplets were conceived through IVF, the remaining utilized intrauterine insemination. ICSI was performed in virtually all patients that underwent IVF. Of the potential risk factors studied, hatching was used in 70.6% of dichorionic compared to 89.5% of trichorionic IVF triplets (p = 0.005); embryo transfer was performed on Day 5 or 6 compared to Day 3 in 88.0% dichorionic vs 71.8% trichorionic (p = 0.028). Frozen sperm was utilized more frequently with dichorionic than with trichorionic triplets, 26.0% vs 10.9% (p < 0.011). Only 4 (7.5%) of the IVF cases underwent pre-implantation genetics. Certain assisted reproductive technologies appear to be associated with embryo splitting and a dichorionic triplet gestation. More research is needed in this area to further elucidate these findings.

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“…In this study, groups based on trio and on triplet zygosity and chorionicity were compared on gestational age, as it has been proposed that, with less chorions in a triplet pregnancy, gestational age is lower (Spencer et al, 2009 the trios of which more triplets had shared a chorion. Although no significant effects were found for lower gestational age, this characteristic was entered in the regression analysis, to correct for even small effects.…”

Section: Discussionmentioning

confidence: 99%

Effects of Chorionicity and Zygosity on Triplet Birth Weight

et al. 2012

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Birth weight in triplets is, on average, lower than in singletons and twins, and more children are classified as having very low or extremely low birth weight. Still, there is limited research on factors that affect triplet birth weight, and samples under study are often small. Chorionicity and zygosity influence triplet birth weight, but it is unknown whether the effect of zygosity can be entirely ascribed to the effect of chorionicity or whether zygosity has an additional effect on triplet birth weight. This question was investigated in 346 triplets (from 116 trios) registered with the Netherlands Twin Register for whom data on chorionicity were available. ‘Triplet’ refers to one child and the set of three triplets is referred to as ‘trio’. Trios and triplets were classified based on zygosity and chorionicity. With regression analysis, the effects of zygosity and chorionicity on triplet birth weight were examined, while controlling for gestational age, sex, and maternal smoking during pregnancy. In addition, within the dizygotic trios a within-family comparison was made between the birth weight of the triplets that were part of a monozygotic pair (with some pairs sharing a chorion), and the birth weight of the dizygotic triplet. Based on the classification on individual level, monozygotic, monochorionic triplets had a lower mean birth weight than dizygotic, dichorionic triplets. Most remarkably, in dizygotic trios, monozygotic pairs only had a lower mean birth weight than their dizygotic sibling triplet when the pair shared a chorion. We conclude that having shared a chorion, rather than being monozygotic, increases the risk of a low birth weight.

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Perinatal and Neonatal Outcomes of Triplet Gestations Based on Placental Chorionicity

Cited by 20 publications

References 8 publications

Perinatal mortality and morbidity in triplet pregnancy according to chorionicity: systematic review and meta‐analysis

Perinatal mortality and morbidity in triplet pregnancy according to chorionicity: systematic review and meta‐analysis

Demographic and Assisted Reproduction Related Factors Associated with Dichorionic Triplet Gestations

Effects of Chorionicity and Zygosity on Triplet Birth Weight

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