Abstract:Objective This study describes the frequency, pregnancy complications and outcomes of non-trichorionic triplet pregnancies. Design A retrospective observational study.Setting Two tertiary level referral centres of Obstetrics and Prenatal Medicine, Germany.Population All women booked to receive targeted ultrasound screening between January 1998 and June 2003.The mixed low and high risk population included 36,430 women with ultrasound examinations between 11 and 24 weeks of gestation. Of those with available out… Show more
“…This translates into even earlier preterm delivery rates with increased morbidity, mortality, and long-term sequelae of prematurity as well as total pregnancy loss [5]. This trend is also noted in higher-order multifetal gestations [6]; for example, a triplet gestation that has a monochorionic twin pair is at higher risk of complications than a triplet gestation that is trichorionic [7].…”
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.
“…This translates into even earlier preterm delivery rates with increased morbidity, mortality, and long-term sequelae of prematurity as well as total pregnancy loss [5]. This trend is also noted in higher-order multifetal gestations [6]; for example, a triplet gestation that has a monochorionic twin pair is at higher risk of complications than a triplet gestation that is trichorionic [7].…”
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.
“…They are at risk of pre-term delivery, low birth weight, infant mortality, and increased long-term disability in survivors (Bernhard et al, 2009;Centers for Disease Control and Prevention, 2009;Kiely, 1998). Monochorionicity further increases the risk of morbidity and mortality (Geipel et al, 2005).…”
Many triplets are conceived as a consequence of assisted reproductive technology (ART). Concerns have been raised that triplet pregnancies conceived by ART are more complicated than those conceived spontaneously. The purpose of this study was to evaluate all triplet pregnancies managed over a 12-year period to determine if there were any differences in outcome based on the mode of conception. All triplet pregnancies between 1999 and 2011 that reached at least 20 weeks' gestation and that were managed at the Royal Women's Hospital (RWH), Melbourne, Victoria were identified. Maternal and neonatal outcomes were compared between ART conceived and spontaneously conceived triplets. In the study period, 53 sets of triplets managed in our institution met the eligibility criteria. Twenty-five triplet sets were conceived by ART and 28 were conceived spontaneously. More ART conceptions resulted in trichorionic triamniotic (TCTA) triplets than did spontaneous conceptions (p = .015). There were no differences between ART and spontaneously conceived triplets for any of the maternal or neonatal complications studied. Trichorionic (TC) triplets delivered at a later gestation than other triplets: 32.1 (SD 2.9) versus 30.4 (SD 3.9) weeks (p = .08). TC triplets were significantly less likely to die than monochorionic (MC) or dichorionic (DC) triplets: 3/93 (3%) versus 13/66 (20%) (p = .025). In conclusion, triplets conceived by ART are more likely to have TCTA placentation and TCTA triplet sets had lower mortality rates than other triplet combinations. Outcomes for triplets conceived by ART were similar to those of triplets conceived spontaneously.
“…Thus we could conclude that the rate of error in the classification of chorionicities by our referral department of placental anatomopathology was 2% (1/50). This misclassification rate takes into account the fact that retrospective studies like those of Agdebite et al (2005), Barjoria et al (2006) and Geipel et al (2005), which do not control their chorionicity with zygosity analysis, have at least a two per cent margin of error in their reported chorionicities. Studies conducted in this manner could thus appear partially skewed.…”
Section: Discussionmentioning
confidence: 99%
“…There are numerous recent studies showing the role of chorionicity in the prognosis of TP (Adegbite et al, 2005;Bajoria et al, 2006;Geipel et al, 2005); however, very few reports have evaluated the role of zygosity (a prime factor in chorionicity) in the prognosis of multiple pregnancies. Dubé et al (2002) compared the complications of twin pregnancies according to both their chorionicity and their zygosity.…”
ResultsThe total cohort of the study included 53 TP, namely 159 triplets, for whom molecular, anatomopathological, ultrasonographic, obstetric and neonatal data were collected. Four TP were excluded from the analysis.
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