Perinatal and obstetric outcomes of dichorionic vs trichorionic triplet pregnancies

Perdigao, Joana Lopes; Straub, Heather; Zhou, Ying; Gonzalez, Anna; Ismail, Mahmoud; Ouyang, David

doi:10.1016/j.ajog.2015.11.013

Cited by 17 publications

(29 citation statements)

References 19 publications

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“…The 2-week CL decreases from week 22 + 0 on reached statistical significance in the trichorionic group more often which is likely due to the smaller patient population with mono-/dichorionic triplets. Moreover, chorionicity was not a predictive parameter for PTD <32 + 0 in the logistic regression model (Table 2) which somehow is in contrast to a recent report [7]. Thus, our data suggest that chorionicity is of only minor impact on CL.…”

Section: Commentcontrasting

confidence: 99%

“…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]. Moreover, one could also hypothesize that chorionicity and/or the amount of amniotic fluid might influence cervical length (CL) in triplet pregnancies, probably even without having a major impact on gestational length.…”

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: Commentcontrasting

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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“…6,18 Prior studies have shown differences in outcomes based on triplet placentation, 12,19,20 although more contemporary studies have failed to observe a mortality difference between DT and TT triplets. 13,21 We also did not observe a mortality difference, although we did observe an earlier gestational age at delivery for DT triplets. This difference did not remain significant when considering only triplets born after at 23 weeks' gestation, which is also consistent with recent studies.…”

Section: Commentmentioning

confidence: 41%

“…12 More recent data has shown an increased rate of adverse outcomes among dichorionic triplets, including delivery at less than 30 weeks and very low birthweight. 13 Despite clinical observations that the proportion of shared chorionic triplet sets is increasing, data examining this issue remain scant. Existing data are limited by either small sample sizes or, in the example of population databases, lack of granular data.…”

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confidence: 99%

Evaluation of Trichorionic versus Dichorionic Triplet Gestations from 2005 to 2016 in a Large, Referral Maternity Center

2017

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To evaluate trends in the proportions and outcomes of dichorionic-triamniotic (DT) compared with trichorionic-triamniotic (TT) triplet gestations. This is a retrospective cohort of all triplet gestations identified by first trimester ultrasound at an academic center between 2005 and 2016. Primary outcomes were the change in proportion of DT versus TT triplets over time and the number of fetuses at delivery. Secondary outcomes included differences in mode of conception and maternal/perinatal outcomes by chorionicity. Of 258 identified triplet pregnancies, 65.5% ( = 169) were TT. The proportion of DT versus TT triplets increased from 2005 to 2016 ( < 0.001). Women with DT triplets were more likely to deliver a singleton (41.4 vs. 11.2%, < 0.001). Mode of conception was known for 248 women, of whom 93.5% ( = 232) conceived through infertility treatment. Types of infertility treatment differed by chorionicity ( < 0.001), with DT triplets more likely to conceive through in vitro fertilization (88.3 vs. 60.7%). Women with DT delivered earlier than TT triplets (31.0 ± 5.0 vs. 33.1 ± 3.5 weeks; = 0.03). The proportion of DT triplet gestations increased significantly over time. Women with DT triplets delivered on average 2 weeks earlier than TT triplets. Women with DT triplets were more likely to reduce to a singleton gestation.

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“…Number of several studies on twins and triplets have reported fetal reduction in multifetal pregnancy. 13,14 Limited reports are available from studies of quadruplets in comparison, [10][11][12] and fewer reports are available on higher order multifetal pregnancy. 8,15,16 Many studies have reported higher order multifetal pregnancy reduction but often they are neither conducted in single centers nor performed by the same physician.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Higher Order Multifetal Pregnancy Reduction: A Single-Center Retrospective Study

Liu

Wang

et al. 2020

AJP Rep

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Objective This research was aimed to study the safety and efficacy of higher order multifetal pregnancy reduction (MFPR). Study Design This was a retrospective study of patients from an academic maternity center between 2005 and 2015. We evaluated outcomes of 131 consecutive patients who underwent higher order MFPR (quadruplets and greater). MFPR was performed at 11 to 18 weeks of gestation in all cases. In total, 122 of 131 cases of higher order multiple pregnancy were reduced to twins. We discuss the perinatal outcomes of patients who underwent higher order MFPR, followed by a comparative analysis between the 122 cases of MFPR that were reduced to twins and 101 cases of nonreduced twin pregnancies. Results The study included 104 sets of quadruplets, 20 sets of quintuplets, 5 sets of sextuplets, 1 set of septuplets, and 1 set of octuplets. The perinatal outcomes of the 131 cases were as follows: pregnancy loss, preterm deliveries at 28 to 33 (+6/7) weeks, and preterm deliveries at 34 to 36 (+6/7) weeks occurred in 23.66, 9, and 37% of cases, respectively. The mean time of delivery was 36.56 ± 1.77 weeks, and mean birth weight was 2,409.90 ± 458.16 g, respectively. A total of 122 cases that were reduced to twins were compared with nonreduced twins. The pregnancy loss rate for reduced twins was significantly higher than that for nonreduced twins. The preterm labor rate, mean delivery week, mean birth weight, birth-weight discordance, incidence of gestational diabetes mellitus, and pregnancy-induced hypertension were not significantly different between the groups (p > 0.05). Conclusion Perinatal outcomes were significantly improved by reducing the number of fetuses in higher order multifetal pregnancies. This study involved a large, diverse sample population, and the results can be used as a reference while conducting prenatal counseling.

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Perinatal and obstetric outcomes of dichorionic vs trichorionic triplet pregnancies

Cited by 17 publications

References 19 publications

Cervical length dynamics in triplet pregnancies: a retrospective cohort study

Cervical length dynamics in triplet pregnancies: a retrospective cohort study

Evaluation of Trichorionic versus Dichorionic Triplet Gestations from 2005 to 2016 in a Large, Referral Maternity Center

Safety and Efficacy of Higher Order Multifetal Pregnancy Reduction: A Single-Center Retrospective Study

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