Maternal and Neonatal Outcome of 100 Consecutive Triplet Pregnancies

ABSTRACT

The objective of this study is to determine the maternal and neonatal outcome of a large group of triplet gestations. A retrospective review of 100 triplet gestations managed and delivered between January 1992 and September 1999 by a single perinatal group is examined. These pregnancies were managed on an outpatient basis. Prophylactic interventions were not utilized. Ninety-six percent of the pregnancies had at least one complication, with preterm labor the most common. The median gestational age at delivery was 33 weeks (range 20.4 to 37, SD 4.1 weeks) with 14% of pregnancies delivering prior to 28 weeks' gestation. The corrected perinatal mortality rate was 97/1000. Minimal long-term morbidity was seen with delivery after 27 weeks' gestation. Pregnancy outcome did not vary with birth order or mode of conception. Triplet pregnancy is associated with a high rate of antenatal complications. Favorable neonatal outcome can be obtained without the use of prophylactic interventions.

KEYWORD

Triplet gestation - maternal and neonatal outcome

REFERENCES

• 1 Cunningham F C, MacDonald P C, Gant N F, et al eds.. Multifetal pregnancy In: Williams Obstetrics 19th ed. Norwalk, CT: Appleton and Lange 1993: 891-918
• 2 Chitkara U, Berkowitz R L. Multiple gestations. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies 3rd ed. New York: Churchill Livingston 1996: 821-862
• 3 Benirschke K. Multiple gestation: incidence, etiology, and inheritance. In: Creasy RK, Resnik R, eds. Maternal Fetal Medicine: Principles and Practice 4th ed. Philadelphia: Saunders 1999: 585-615
• 4 Kaufman G E, Malone F D, Harvey-Wilkes K B, Chelmow D, Penzias A S, D'Alton M E. Neonatal morbidity and mortality associated with triplet pregnancy.  Obstet Gynecol . 1998;  91 341-348
• 5 Malone F D, Kaufman G E, Chelmow D, Athanassiou A, Nores J A, D'Alton M E. Maternal morbidity associated with triplet gestation.  Am J Perinat . 1998;  15 73-77
• 6 American College of Obstetricians and Gynecologists. Hypertension in pregnancy. ACOG technical bulletin No 219. Washington, DC: American College of Obstetricians and Gynecologists; 1996
• 7 Luke B. The changing pattern of multiple births in the United States: maternal and infant characteristics, 1973 and 1990.  Obstet Gynecol . 1994;  84 101-106
• 8 Itzkowic D. A survey of 59 triplet pregnancies.  Br J Obstet Gynecol . 1979;  86 23-28
• 9 Daw E. Triplet pregnancy.  Br J Obstet Gynecol . 1978;  85 505-509
• 10 Holcberg G, Biale Y, Lewenthal H, Insler V. Outcome of pregnancy in 31 triplet gestations.  Obstet Gynecol . 1982;  59 472-476
• 11 Loucopoulos A, Jewelewicz R. Management of multifetal pregnancies: sixteen years' experience at the Sloane Hospital for Women.  Am J Obstet Gynecol . 1982;  143 902-905
• 12 {Lipitz S, Reichman B, Paret G. The improving outcome of triplet pregnancies.  Am J Obstet Gynecol . 1989;  161 1279-1284
• 13 Gonen R, Heyman E, Asztalos E V. The outcome of triplet, quadruplet, and quintuplet pregnancies managed in a perinatal unit: obstetric, neonatal and follow-up data.  Am J Obstet Gynecol . 1990;  162 454-459
• 14 Newman R B, Hamer C, Miller M C. Outpatient triplet management: a contemporary review.  Am J Obstet Gynecol . 1989;  161 547-555
• 15 Seoud M AF, Toner J P, Kruithoff C, Muasher S J. Outcome of twin, triplet and quadruplet in vitro fertilization pregnancies: the Norfolk experience.  Fertil Steril . 1992;  l57 825-834
• 16 Boulot P, Hedon B, Pelliccia G. Favorable outcome in 33 triplet pregnancies managed between 1985-1990.  Eur J Obstet Gynecol Reprod Biol . 1992;  43 123-129
• 17 Santema J G, Bourdrez P, Wallenburg H CS. Maternal and perinatal complications in triplet compared with twin pregnancy.  Eur J Obstet Gynecol Reprod Biol . 1995;  60 143-147
• 18 Peaceman A M, Dooley S L, Tamura R K, Socol M L. Antepartum management of triplet gestations.  Am J Obstet Gynecol . 1992;  167 1117-1120
• 19 Albrecht J L, Tomich P G. The maternal and neonatal outcome of triplet gestations.  Am J Obstet Gynecol . 1996;  174 1551-1556
• 20 Skrablin S, Kuvacic I, Pavicic D, Kalafatic D, Goluza T. Maternal and neonatal outcome in quadruplet and quintuplet versus triplet gestation.  Eur J Obstet Gynecol . 2000;  88 147-152
• 21 Malone F D, Chelmow D, Athanassiou A, D'Alton M E. Impact of gestational age at delivery on the economics of triplet pregnancy.  J Mat Fetal Med . 1999;  8 256-261
• 22 Michlewitz H, Kennedy J, Kawada C, Kennison R. Triplet pregnancies.  J Reprod Med . 1981;  26 243-246
• 23 Grobman W A, Peaceman A M, Haney E I, Silver R K, MacGregor S N. Neonatal outcomes in triplet gestations after a trial of labor.  Am J Obstet Gynecol . 1998;  179 942-945
• 24 Hardardottir H, Kelly K, Bork M D, Cusick W, Campbell W A, Rodis J F. Atypical presentation of preeclampsia in high-order multifetal gestations.  Obstet Gynecol . 1996;  87 370-374
• 25 Knox T A, Olans L B. Liver disease in pregnancy.  N Engl J Med . 1996;  335 569-576
• 26 Tan S L, Doyle P, Campbell S. Obstetric outcome of in vitro fertilization pregnancies compared with normally conceived pregnancies.  Am J Obstet Gynecol . 1992;  167 778-784