Maternal and neonatal outcome in triplet, quadruplet and quintuplet gestations following ART: a 11-year study

Chibber, Rachana; Fouda, Mohamed A.; Shishtawy, W.; Al-Dossary, Mariam; Al-Hijji, Jassim; Amen, Ali; Mohammed, Asiya Tasneem

doi:10.1007/s00404-013-2796-x

Cited by 22 publications

(32 citation statements)

References 20 publications

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“…In these pregnancies, the average pregnancy age at delivery ranges from 31 to 33 completed weeks of gestation, with a majority of triplets being born before the 35th week [2–5]. It is evident that this prematurity is accompanied by high rates of neonatal complications which include both neonatal mortality and morbidity [6].…”

Section: Introductionmentioning

confidence: 99%

“…It is evident that this prematurity is accompanied by high rates of neonatal complications which include both neonatal mortality and morbidity [6]. Although gestational hypertension and its complications, first and foremost preeclampsia, also contribute to the risk of preterm delivery in triplet pregnancies, the majority of cases is complicated by preterm labor and cervical shortening [5]. Notably, chorionicity has also been proven to be a risk factor for earlier delivery in triplets with dichorionic pregnancies having been reported to deliver more likely <30 weeks of gestation than trichorionic pregnancies [7].…”

Section: Introductionmentioning

confidence: 99%

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Cervical length dynamics in triplet pregnancies: a retrospective cohort study

Pils

Springer

Wehrmann

et al. 2017

Arch Gynecol Obstet

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PurposeTo review our experience with a screening program that included sequential cervical length measurements in our large population of triplet pregnancies.MethodsSeventy-eight triplet pregnancies were retrospectively included. Cervical length measurements were performed by transvaginal ultrasound in 2-week intervals from week 16 + 0 onwards in a tertiary-care center in Vienna. The main outcome measurement was preterm delivery prior to 32 + 0 weeks of gestation. Statistical analyses were performed using paired and unpaired t tests and a stepwise linear regression model.ResultsThere were 26 cases of preterm delivery (33.3%). Women with preterm delivery revealed significant cervical length shortening from week 22 + 0 (median 33 mm, interquartile range, IQR 17–39) to 24 + 0 (median 21 mm, IQR 7–30; p = 0.005). This was not observed in women without preterm delivery. From week 22 + 0 onwards, both groups showed further significant 2-week differences in cervical length (p < 0.05). Univariate analysis of cervical length in weeks 20 + 0, 22 + 0, and 24 + 0 as well as cervical length dynamics from 22 + 0 to 24 + 0 predicted preterm delivery.ConclusionsIn triplet pregnancies, a decrease in cervical length seems physiological from week 22 + 0 onwards. A sharp decrease in cervical length from the 22 + 0 to the 24 + 0 week as well as the smaller cervical length in weeks 20 + 0, 22 + 0, and 24 + 0 increase the risk of preterm delivery.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cervical length dynamics in triplet pregnancies: a retrospective cohort study

Pils

Springer

Wehrmann

et al. 2017

Arch Gynecol Obstet

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“…In particular, 54% of quadruplet and 100% of quintuplet pregnancies had at least one death, while the average weight at birth was 750 g for dead quadruplets and 1341 g for surviving quadruplets (p < 0.0007). Chibber in 2003 [102] in a study including 100 triplet, 27 quadruplets, and 10 quintuplet pregnancies showed that low birth weight is crucial for perinatal mortality and morbidity, with low birth weight complicating most of the 34 neonatal deaths in the quadruplet and quintuplet groups. Multiples are at increased risk of growth problems compared to singletons, with the degree of intrauterine growth restriction to increase as the number of fetuses increase.…”

Section: Complications and Management Of Quadruplet/quintuplet Pregnamentioning

confidence: 99%

“…A low Apgar score at birth is a common concern for neonatologists when a high-order pregnancy ends. Chibber in 2003 [102] highlighted the differences between triplet and higher pregnancies when the Apgar scores of the first and fifth minute were compared. The mean first-minute Apgar score for triplets was 7.8, while for quadruplets and quintuplets was only 6.2 (p < 0.01).…”

Section: Complications and Management Of Quadruplet/quintuplet Pregnamentioning

confidence: 99%

Quadruplets and Quintuplets

Fiorentzis¹,

Salta²,

Pargianas³

et al. 2019

Multiple Pregnancy - New Challenges

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A high-order pregnancy is always a challenge not only for the couple but also for the obstetrician, the pediatricians, the midwives, and the whole stuff of an obstetric clinic. The breakthroughs of infertility treatments have made more couples to postpone the birth of their children until they feel professionally and financially safe, many times after the age of 40. The advanced age of the mother puts extra pressure to the clinician for immediate success, leading to a rise of high-order pregnancies until the introduction of regulations and laws in many countries. The cost of a quadruplet and quintuplet pregnancy can be unbearable, not only financially but also psychologically. The management of such a pregnancy is also challenging since its beginning and to the end. Modern techniques and methods can also be difficult to be implemented on a quadruplet of quintuplet pregnancy because of the fear of losing four or five embryos at once. At the same time, the limited number of cases makes it almost impossible for studies to be made and guidelines to be established for most of the cases.

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“…1–6 Triplets are admitted to a neonatal intensive care unit in 50–90% of cases, 4,7–9 compared with about 24% of twins and 3% of singletons. 10 Perinatal death occurs in 4.5–15% of triplets, 4,5,7,9,11–15 compared with 2.0% of twins and 0.45% of singletons. 2 Most of the excess neonatal morbidity and mortality among triplets is directly attributable to extremely preterm birth.…”

Section: Introductionmentioning

confidence: 99%

17‐Hydroxyprogesterone caproate in triplet pregnancy: an individual patient data meta‐analysis

Combs

Schuit

Caritis

et al. 2015

BJOG

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Background Preterm birth complicates almost all triplet pregnancies and no preventive strategy has proven effective. Objective To determine, using individual patient data (IPD) meta-analysis, whether the outcome of triplet pregnancy is affected by prophylactic administration of 17-hydroxyprogesterone caproate (17OHPc). Search strategy We searched literature databases, trial registries and references in published articles. Selection criteria Randomised controlled trials (RCTs) of progestogens versus control that included women with triplet pregnancies. Data collection and analysis Investigators from identified RCTs collaborated on the protocol and contributed their IPD. The primary outcome was a composite measure of adverse perinatal outcome. The secondary outcome was the rate of birth before 32 weeks of gestation. Other pre-specified outcomes included randomisation-to-delivery interval and rates of birth at < 24, < 28 and < 34 weeks of gestation. Main results Three RCTs of 17OHPc versus placebo included 232 mothers with triplet pregnancies and their 696 offspring. Risk-of-bias scores and between-study heterogeneity were low. Baseline characteristics were comparable between 17OHPc and placebo groups. The rate of the composite adverse perinatal outcome was similar among those treated with 17OHPc and those treated with placebo (34% and 35%, respectively; risk ratio [RR] 0.98, 95% confidence interval [95% CI] 0.74–1.3). The rate of birth at < 32 weeks was also similar in the two groups (35% and 38%, respectively; RR 0.92, 95% CI 0.55–1.56). There were no significant between-group differences in perinatal mortality rate, randomisation-to-delivery interval, or other specified outcomes. Conclusion Prophylactic 17OHPc given to mothers with triplet pregnancies had no significant impact on perinatal outcome or pregnancy duration. Tweetable abstract 17-Hydroxyprogesterone caproate had no significant impact on the outcome or duration of triplet pregnancy.

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Maternal and neonatal outcome in triplet, quadruplet and quintuplet gestations following ART: a 11-year study

Abstract: Preterm labor and preterm prematurity were the commonest complications. Neonatal mortality and morbidity was significantly increased in quadru- and quintuplets. Prophylactic interventions were not used in an attempt to prevent preterm labor.

Cited by 22 publications

References 20 publications

Cervical length dynamics in triplet pregnancies: a retrospective cohort study

Cervical length dynamics in triplet pregnancies: a retrospective cohort study

Quadruplets and Quintuplets

17‐Hydroxyprogesterone caproate in triplet pregnancy: an individual patient data meta‐analysis

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