Perinatal outcome of dichorionic-triamniotic as compared to trichorionic triplets

Simões, Teresinha; Queirós, Alexandra; Gonçalves, Margarida Rosal; Periquito, Isabel; Silva, Patrı́cia; Blickstein, Isaac

doi:10.1515/jpm-2015-0230

Cited by 8 publications

(35 citation statements)

References 20 publications

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“…Comparison of gestational age at birth between TCTA and DCTA triplets was reported by five studies. Overall, there was no difference in gestational age at birth between TCTA and DCTA triplets (MD, 1.1 weeks (95% CI, –0.3 to 2.5 weeks); I 2 = 85%; P = 0.12).…”

Section: Resultsmentioning

confidence: 99%

“…In TCTA triplets, IUD occurred in 2.1% (95% CI, 1.0–37.0%) of cases, while the corresponding figures for NND and PND were 3.7% (95% CI, 1.8–6.3%) and 5.2% (95% CI, 3.2–7.7%) (Table , Figure S1). In DCTA triplets ( n = 783), the incidence of IUD, NND and PND was 5.2% (95% CI, 2.7–8.5%), 11.5% (95% CI, 1.0–30.8%) and 17.6% (95% CI, 4.1–37.8%), respectively. When assessing those studies reporting a direct comparison between TCTA and DCTA triplet pregnancies, the risk of PND was higher in DCTA than in TCTA triplet pregnancies (OR, 3.3 (95% CI, 1.3–8.0)) (Figure S2).…”

Section: Resultsmentioning

confidence: 99%

“…Seven ( n = 2754) and four ( n = 783) studies reported the incidence of morbidity in TCTA and DCTA triplets, respectively. Neurological morbidity occurred in 2.0% (95% CI, 1.1–3.3%) of TCTA and in 11.6% (95% CI, 1.1–40.0%) of DCTA triplets (Table ).…”

Section: Resultsmentioning

confidence: 99%

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Perinatal mortality and morbidity in triplet pregnancy according to chorionicity: systematic review and meta‐analysis

Curado

D’Antonio

Papageorghiou

et al. 2019

Ultrasound in Obstet & Gyne

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Objective The incidence of perinatal mortality and morbidity in triplet pregnancies according to chorionicity is yet to be established. The aim of this systematic review was to quantify perinatal mortality and morbidity in trichorionic triamniotic (TCTA), dichorionic triamniotic (DCTA) and monochorionic triamniotic (MCTA) triplets. Methods MEDLINE, EMBASE and CINAHL databases were searched in December 2017 for literature published in English describing outcomes of DCTA, TCTA and/or MCTA triplet pregnancies. Primary outcomes were intrauterine death (IUD), neonatal death, perinatal death (PND) and gestational age at birth. Secondary outcomes comprised respiratory, neurological and infectious morbidity, as well as a composite score of neonatal morbidity. Data regarding outcomes were extracted from the included studies. Random‐effects meta‐analysis was used to estimate the risk of mortality and morbidity and to compute the difference in gestational age at birth between TCTA and DCTA triplet pregnancies. Results Nine studies (1373 triplet pregnancies, of which 1062 were TCTA, 261 DCTA and 50 MCTA) were included in the analysis. The risk of PND was higher in DCTA than in TCTA triplet pregnancies (odds ratio (OR), 3.3 (95% CI, 1.3–8.0)), mainly owing to the higher risk of IUD in DCTA triplet pregnancies (OR, 4.6 (95% CI, 1.8–11.7)). There was no difference in gestational age at birth between TCTA and DCTA triplets (mean difference, 1.1 weeks (95% CI, –0.3 to 2.5 weeks); I2 = 85%; P = 0.12). Neurological morbidity occurred in 2.0% (95% CI, 1.1–3.3%) of TCTA and in 11.6% (95% CI, 1.1–40.0%) of DCTA triplets. Respiratory and infectious morbidity affected 28.3% (95% CI, 20.7–36.8%) and 4.2% (95% CI, 2.8–5.9%) of TCTA and 34.0% (95% CI, 21.5–47.7%) and 7.1% (95% CI, 2.7–13.3%) of DCTA triplets, respectively. The incidence of composite morbidity in TCTA and DCTA triplets was 29.6% (95% CI, 21.1–38.9%) and 34.0% (95% CI, 21.5–47.7%), respectively. When translating these figures into a risk analysis, the risk of neurological morbidity (OR, 5.4 (95% CI, 1.6–18.3)) was significantly higher in DCTA than in TCTA triplets, while there was no significant difference in the other morbidities explored. Only one study reported on outcomes of MCTA pregnancies, hence, no formal comparison with the other groups was performed. Conclusion DCTA triplets are at higher risk of perinatal mortality and morbidity than are TCTA triplets. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Perinatal mortality and morbidity in triplet pregnancy according to chorionicity: systematic review and meta‐analysis

Curado

D’Antonio

Papageorghiou

et al. 2019

Ultrasound in Obstet & Gyne

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“…These findings evidently do not support elective preterm birth for uncomplicated MC twins proposed by several authorities. At present it appears that close surveillance is recommended rather than elective preterm birth.A second paper of the Lisbon group analyzed outcomes of DC triplets, notorious for having the combined risks of triplets as well as the risk of MC twins [8]. The immediate reaction of many scholars to this pregnancy would be to reduce the set of MC twins, leaving a singleton.…”

mentioning

confidence: 99%

“…A second paper of the Lisbon group analyzed outcomes of DC triplets, notorious for having the combined risks of triplets as well as the risk of MC twins [8]. The immediate reaction of many scholars to this pregnancy would be to reduce the set of MC twins, leaving a singleton.…”

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confidence: 99%

Multiple gestation: more research challenges to come

Blickstein

2016

Journal of Perinatal Medicine

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Nearly 1500 papers were published in the past 5 years with the subject heading of "twin" or "multiple pregnancies". This figure undoubtedly represents the ever increasing interest in this group of high-risk pregnancies. It is very impossible to encompass the myriad issues that caught the attention of clinicians when dealing with difficult clinical cases related to twins and triplets which prompted research. This issue of the Journal of Perinatal Medicine includes 10 papers on various aspects of multiple pregnancy and birth. Three papers deal with the quarter-century-old issue of discordant birth weight [1]. In the first, Biron-Shental and her colleagues [2] evaluated the possible association between intermediate birth weight discordance (> 20% difference) and infertility treatment. As in all likelihood the two embryos were conceived by the same method of infertility treatment [intracytoplasmic sperm injection (ICSI) vs. in vitro fertilization (IVF), ovulation induction vs. IVF, fresh vs. thawed embryos, etc.], the authors unsurprisingly found similar discordant levels as well as similar outcomes. As the authors did not detail the incidence of nulliparas (but the average parity) one is unable to appreciate the influence of this important confounding variable. The second paper reviews available data on outcomes related to estimated fetal weight (EFW) and crown-rump length (CRL) discordance [3]. Whereas the former was found to be associated with adverse outcomes, the latter was not. The authors also wonder about the best cut-off of EFW difference to describe severe discordance. As EFW is a poor predictor of discordance (because of the ± situation that exists [4,5]), one should aim for a higher value (i.e. 25%-30% difference) to avoid over diagnosis. Moreover, it appears that discordance, per se, is not that important unless the smaller twin is small for gestational age (SGA) or exhibits clear growth restriction on repeated scans [i.e. selective intrauterine growth restriction (IUGR)] [6]. In fact, moderate levels of discordance have been shown to be an adaptive measure to increase gestational age.The authors rightly noted the differences between the mechanism and significance of selective IUGR in monochorionic (MC) and dichorionic (DC) twins.Three papers of this batch discuss various aspects of monochorionicity. The Lisbon research group repeated their seminal study related to the prospective risk of intrauterine fetal death in MC twins [7]. Despite the publication of several studies on this subject, significant differences exist in recruitment and management of these sets. Thus, the paper of Simoes and her colleagues [6] showed that, with doubling of the sample size over time since the last report in 2006, and with implementation of intensive prenatal surveillance, a relatively low unexpected fetal death rate after 33 weeks' gestation could be achieved. These findings evidently do not support elective preterm birth for uncomplicated MC twins proposed by several authorities. At present it appears that close surveil...

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Characteristics, management and outcomes of very preterm triplets in 19 European regions

Dudenhausen

Misselwitz²,

Piedvache

et al. 2019

Intl J Gynecology & Obste

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Objective To describe obstetrical care and in‐hospital outcomes in very preterm triplet pregnancies in a European multiregional cohort. Methods Data from a prospective population‐based study of very preterm births between 22 + 0 and 31 + 6 weeks of gestation in 19 regions from 11 European countries participating in the EPICE project in 2011/2012 were used to describe triplet pregnancies and compare them with twins and singletons. Results Triplets constituted 1.1% of very preterm pregnancies (97/8851) and 3.3% of very preterm live births (258/7900); these percentages varied from 0% to 2.6% and 0% to 6% respectively across the regions. In‐hospital mortality after live birth was 12.4% and did not differ significantly from singletons or twins or by birth order. However, 28.9% of mothers with a triplet pregnancy experienced at least one neonatal death. Ninety percent of live‐born triplets were delivered by cesarean. Vaginal delivery was associated with an Apgar score of less than 7, but not with in‐hospital mortality. Conclusions The prevalence of very preterm triplets varies across European regions. Most triplets were born by cesarean and those born vaginally had lower Apgar scores. Overall, in‐hospital mortality after live birth was similar to singletons and twins.

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Perinatal outcome of dichorionic-triamniotic as compared to trichorionic triplets

Abstract: Our data indicate that DC twins are not significantly disadvantaged compared to TC triplets and the similar outcomes might be reassuring for those who consider continuing their DC triplet pregnancy.

Cited by 8 publications

References 20 publications

Perinatal mortality and morbidity in triplet pregnancy according to chorionicity: systematic review and meta‐analysis

Perinatal mortality and morbidity in triplet pregnancy according to chorionicity: systematic review and meta‐analysis

Multiple gestation: more research challenges to come

Characteristics, management and outcomes of very preterm triplets in 19 European regions

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