Prediction of Time to Delivery Week-by-Week in Women with a Triplet Pregnancy

Abstract

Objective Some clinicians advise prophylactic administration of antenatal steroids for fetal lung maturation in women with a triplet pregnancy. However, the effect of corticosteroids is limited to 10 to 14 days after administration. The aim of this study was to assess the natural course of triplet pregnancies to allow a better anticipation for administration of corticosteroids. Study Design We collected data on all triplet pregnancies in the Netherlands from 1999 to 2007 from the Netherlands Perinatal Registration. We calculated time to delivery, the risk of delivery in 2-week intervals at different gestational ages, and the time frame between hospital admission and delivery of the first child. Results Median gestational age at delivery of 494 women with a triplet pregnancy was 33 þ4 weeks (interquartile range of 31-35 þ1 weeks). Twenty-one women (4.3%) delivered between 22 and 24 weeks and 146 women (29.6%) delivered before 32 weeks. At a gestational age of 24 weeks, the chance to deliver within the next week was 0.6%.

Cervical length dynamics in triplet pregnancies: a retrospective cohort study

“…This is comparable to the literature reporting rates of 13–64.7% [4, 15] with the majority of incidences ranging from 16 to 31.4% [10, 11, 13, 14]. …”

“…However, a sharp decline in cervical length from week 22 + 0 to 24 + 0 seems to be specific for women with ongoing triplet pregnancies at risk for PTD between 24 + 0 and 32 + 0 weeks (Table 2). The predictive value of CL on PTD has already been demonstrated in previous studies [2, 4, 8, 9, 11–16, 19]. Notably, optimized cut-off values for absolute CL were 34–35 mm in our study which resulted in sensitivity and specificity values of 60–80 and 70–90%, respectively.…”

“…Notably, the optimized cut-off values in our study provide quite high negative predictive values (nearly 90% in weeks 20 + 0, 22 + 0, and 24 + 0) which are reassuring for the patient. Only van den Mheen et al used a higher CL cut-off of 30 mm for the prediction of PTD <32 + 0 weeks [4]. Applying this criterion, they achieved a similar negative predictive value of 87.4%.…”

General Principles for Counseling and Management of Triplet Pregnancies

“…The risk of periviable delivery (22-24 wk) is 4.3% and for 24 to 28 weeks, the risk is 4.9%. 12 Very premature deliveries increase the risk of early neonatal death and contribute to the overall high rate of perinatal loss compared with singleton or twin pregnancies. Neonatal outcome of a triplet is similar to an age-matched singleton.…”

“…Despite the goal for 35 weeks, the average gestational age at delivery for triplet pregnancies has remained at 32 to 33 weeks over the last 30 years. 12,35 Strategies to reduce preterm birth, such as intramuscular or transvaginal progesterone, 36,37 cervical length screening, 38 or cerclage, 39 have not been proven to prolong triplet pregnancies. In addition, complete bedrest 40 and tocolytics 41 have not demonstrated any benefit for multifetal pregnancies.…”