Triplet pregnancies: perinatal outcome evolution

Almeida, Patrícia de; Domingues, Ana Patrícia; Belo, Adriana; Fonseca, Etelvina; Moura, Paulo

doi:10.1590/so100-720320140005066

Cited by 5 publications

(17 citation statements)

References 8 publications

(15 reference statements)

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“…In our setting, Revello published a study in 2019 describing the prevalence of maternal and obstetric complications in triplet pregnancies from their experience in another tertiary hospital in our city, where the most frequently observed obstetric complication in triplet pregnancies overall is the threat of preterm labor (56%), premature rupture of membranes (28.9%) and preeclampsia (20.4%) [ 18 ]. Similar findings regarding premature labor and pregnancy-induced hypertensive states have been described in studies of other countries and settings [ 12 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ].…”

Section: Introductionsupporting

confidence: 87%

“…The main obstetric complication in this study, as well as in Revello’s study, was the threat of preterm labor (TPL), although in both cases, it was more than double the value reported in the meta-analysis (44% and 56% vs. 26.39%) [ 16 , 19 ], which included 25 studies [ 12 , 19 , 20 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. The precise causes underlying these findings remain unclear, although they could be explained by the variability of the diagnostic criteria in the cut-off points of sonographic cervical length, differences in access to a referral hospital and the bias corresponding to a high-risk population [ 19 ].…”

Section: Discussionmentioning

confidence: 98%

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Maternal, Perinatal and Neonatal Outcomes of Triplet Pregnancies According to Chorionicity: Our 15-Year Experience in a Tertiary-Level Center

Bernal Claverol,

Aracil Moreno,

Ruiz Minaya

et al. 2024

JCM

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Introduction: The goal of this study was to evaluate the effect of chorionicity on maternal, fetal and neonatal morbidity and mortality in triplet pregnancies in our environment. Methods: A retrospective observational study was carried out on triplet pregnancies that were delivered in a tertiary center between 2006 and 2020. A total of 76 pregnant women, 228 fetuses and 226 live newborns were analyzed. Of these triplet pregnancies, half were non-trichorionic. We analyzed maternal characteristics and obstetric, fetal, perinatal and neonatal complications based on their chorionicity, comparing trichorionic vs. non-trichorionic triplet pregnancies. Prematurity was defined as <34 weeks. We measured perinatal and neonatal mortality, composite neonatal morbidity and composite maternal morbidity. Results: Newborns with a monochorionic component had a lower gestational age at birth, presented greater prematurity under 34 weeks, lower birth weight, greater probability of birth weight under 2000 g and an APGAR score below 7 at 5 min after birth, more respiratory distress syndrome and, overall, higher composite neonatal morbidity. The monochorionic component of triple pregnancies may entail the development of complications intrinsic to shared circulation and require premature elective termination. This greater prematurity is also associated with a lower birth weight and to the main neonatal complications observed. These findings are in line with those that were previously published in the meta-analysis by our research group and previous literature. Discussion: Triplet gestations with a monochorionic component present a higher risk of obstetric, fetal and neonatal morbidity and mortality.

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Section: Introductionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 98%

Maternal, Perinatal and Neonatal Outcomes of Triplet Pregnancies According to Chorionicity: Our 15-Year Experience in a Tertiary-Level Center

Bernal Claverol,

Aracil Moreno,

Ruiz Minaya

et al. 2024

JCM

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“…Both our systematic review and meta-analysis collected data on a wide range of outcome measures from a large population sample. This systematic review brings together a large population sample from a large number of studies (46 studies with a total of 43,653 triplet pregnancies and 128,145 live births), collecting information on 47 variables [ 14 , 16 , 21 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ]. Similarly, this meta-analysis included many articles with a large total population sample (12 studies, 2188 pregnant women, 5790 fetuses, and 5441 live newborns), collecting up to 18 variables [ 14 , 16 , 21 , 24 , 26 ,…”

Section: Discussionmentioning

confidence: 99%

Maternal, Perinatal and Neonatal Outcomes of Triplet Pregnancies According to Chorionicity: A Systematic Review of the Literature and Meta-Analysis

Claverol

Minaya

Moreno

et al. 2022

JCM

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Triplet pregnancies are rare events that affect approximately 93 in 100,000 deliveries in the world, especially due to the increased use of assisted reproductive techniques and older maternal age. Triplet pregnancies are associated with a higher risk of fetal and maternal morbidity and mortality compared to twins and singletons. Chorionicity has been proposed as a major determinant of perinatal and maternal outcomes in triplet pregnancies, although further evidence is needed to clarify the extent and real influence of this factor. Thus, the aim of this study was to conduct a systematic review of the literature and a meta-analysis of the maternal and perinatal outcomes of triplet pregnancies, evaluating how chorionicity may influence these results. A total of 46 studies with 43,653 triplet pregnancies and 128,145 live births were included. Among the main results of our study, we found a broad spectrum of fetal and maternal complications, especially in the group of monochorionic and dichorionic pregnancies. Risk of admission to NICU, respiratory distress, sepsis, necrotizing enterocolitis, perinatal and intrauterine mortality were all found to be higher in non-TCTA pregnancies than in TCTA pregnancies. To date, our meta-analysis includes the largest population sample and number of studies conducted in this field, evaluating a wide variety of outcome measures. The heterogeneity and retrospective design of the studies included in our research represent the main limitations of this review. More evidence is needed to fully assess outcome measures that could not be studied in this review due to scarcity of publications or insufficient sample size.

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“…[4][5][6][7][8][9][10][11] A gravidez bifetal representa a maioria dos casos de gravidez múltipla (98%).…”

Section: Introductionunclassified

“…15 A maior morbimortalidade materna e fetal/neonatal na gravidez múltipla relativamente à unifetal está relacionada não apenas com o número de fetos mas também com o tipo de corionicidade. 1,2,[6][7][8]13 Vários estudos têm demonstrado taxas de morbilidade e mortalidade mais elevadas nos gé-meos monocoriónicos comparativamente com os bicorióni-cos. 1,4,9,16 Isto pode ser explicado pela ocorrência frequente de anastomoses vasculares entre os fetos e de inserção anómala do cordão umbilical e pela partilha muitas vezes desigual da placenta, fatores responsáveis pela síndrome de transfusão feto-fetal (STFF), restrição de crescimento intra-uterino (RCIU) e crescimento fetal discordante (CFD), com potenciais consequências nefastas para ambos os fetos. 4,[11][12][13]16,17 Os objetivos deste trabalho foram: caracterizar a população de gémeos fruto de gravidez bifetal nascidos num hospital nível três e avaliar o impacto da corionicidade na morbimortalidade perinatal.…”

Section: Introductionunclassified

Impacto da Corionicidade nas Complicações Perinatais da Gestação Gemelar

et al. 2017

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The incidence of multiple gestations is increasing worldwide and many studies have shown higher perinatal morbidity and mortality rates in monochorionic twins compared to dichorionic. The aim of this study was to assess the twin population born at a tertiary center and to evaluate the impact of chorionicity on perinatal outcomes of twin pregnancies. Material and Methods:Retrospective study of all twins born in a tertiary center from January 2004 to December 2013. Results: In this period, 1051 twins were born, related to 540 gestations (26.7% monochorionic; 73.3% dichorionic). There was no statistical significant difference between the groups concerning obstetric complications. The monochorionic group had a higher incidence of intrauterine growth restriction (20.5 vs 11.3%, p < 0.001), lower mean maternal age (29.9 vs 31.9 years, p < 0.001), lower mean gestational age (33.4 vs 34.3 weeks, p < 0.05) and lower mean birth weight (1943 vs 2147 g, p < 0.001). Monochorionic twins had a higher incidence of hyaline membrane disease (7 vs 4%, p < 0.05), sepsis (10.3 vs 5.8%, p < 0.05) and anemia (9.5 vs 5.4%, p < 0.05). There were no statistical significant differences concerning necrotizing enterocolitis, intraperiventricular hemorrhage or retinopathy of prematurity. Perinatal mortality was higher in the monochorionic group (5.2 vs 2.9%, p < 0.05). Discussion: Monochorionic twins represent considerable challenges to both obstetricians and neonatologists and should be monitored and delivered at tertiary centers. Conclusion: Currently gemelarity has a major impact on total births. It would be interesting to develop protocols to standardize clinical approach to twins.

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Triplet pregnancies: perinatal outcome evolution

Cited by 5 publications

References 8 publications

Maternal, Perinatal and Neonatal Outcomes of Triplet Pregnancies According to Chorionicity: Our 15-Year Experience in a Tertiary-Level Center

Maternal, Perinatal and Neonatal Outcomes of Triplet Pregnancies According to Chorionicity: Our 15-Year Experience in a Tertiary-Level Center

Maternal, Perinatal and Neonatal Outcomes of Triplet Pregnancies According to Chorionicity: A Systematic Review of the Literature and Meta-Analysis

Impacto da Corionicidade nas Complicações Perinatais da Gestação Gemelar

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