Duyos MI, de la Calle M, Revello R, Salas P, Zapardiel I, González A

Language: Spanish
References: 14
Page: 86-91
PDF size: 329.04 Kb.

ABSTRACT

Background: During the last ten years multiple pregnancies have been increased as a result of assisted reproduction techniques, increases of even 470% are published. Multiple pregnancies are related to a higher risk of maternal and neonatal morbidity and mortality, as well as to increased use of health resources.
Objectives: To review the fetal and perinatal early complications in triple pregnancies.
Patients and method: An observational and retrospective study of triple pregnancies followed up at the Obstetrics Department of La Paz University Hospital, Madrid, Spain, from January 2000 until May 2011.
Results: We reviewed the medical records of 147 triplets. The prevalence of triplets was 1 in 640 deliveries (0.15%). Among all, 79% were achieved using assisted reproductive techniques, 73% were obtained by means of in vitro fertilization. Regarding the pregnancy zigosity we found: 85% trichorionic triamniotic, 10% bichorionic triamniotic and 5% monochorionic tramniotic. Out of 402 fetuses, 35 (9%) had the following complications: 19 (5%) growth retardation or oligohydramnios, nine (2%) intrauterine death, three (0.74%) postnatal death due to suspected chorioamnionitis, three (0.74%) major malformations and one case (0.24%) of twin to twin transfusion. The average duration of gestation was 33 weeks: 8% were born before 28 weeks of gestation, 30% between 28 and 32 weeks and 62% after 32 weeks. The mean birth weight was 1,906 ± 400 g. In 29 cases (7%) arterial pH was less than 7.20. Any type of resuscitation was required by 60% of newborns and 47% were admitted to the intensive care unit. There were no significant differences in neonatal early outcomes among the first, second and third newborn.
Conclusions: The risk of neonatal mortality and morbidity seems to be higher in triple pregnancies. Adverse neonatal outcomes are related to the high rate of severe prematurity.

REFERENCES

1. Albretch J, Tomich P. The maternal and neonatal outcome of triplet gestations. Am J Obstet Gynecol 1996;174:1551-1556.

2. Ventura S, Martin J, Curtin S. Births: final data for 1998. Nat Vital Stat Rep 2000;48(3):1-100.

3. Matorras Weinig JR. Embarazo múltiple. En: Matorras Weinig JR. Estudio y tratamiento de la pareja estéril. 1ª ed. Adalia Farma, 2007;395-398.

4. Fuster V, Zuluaga P, Roman Busto J, Colantorio S. Temporal and territorial analysis of multiple deliveries in Spain (1900-2006). Twin Research and Human Genetics 2010;13(2):207-216.

5. Huertas Fernández MA, Martínez Cortés L. En: Gestación gemelar: Manejo y tratamiento. Complicaciones maternas y fetales del embarazo gemelar. Editorial Glosa, 2010;37-54.

6. Bolton P, Yamashita Y, Farquhar CM. Role of fertility treatments in multiple pregnancy at National Women’s hospital from 1996 to 2001. Aust N J Obstet Gynecol 2003;65:430-434.

7. Wörner NT, Perapoch López J, Sánchez de Toledo Sancho J, Higueras Sanz T, Fina Martí A. Evolución neonatal de los recién nacidos trillizos (desde el nacimiento hasta el alta hospitalaria). Anales de Pediatría 2007;68:213-217.

8. Bajoria R, Ward SB, Adegbite AL. Comparative study of perinatal outcome of dichorionic and trichorionic iatrogenic triplets. Am J Obstet Gynecol 2006;194:415-419.

9. Adegbite AL, Ward SB, Bajoria R. Perinatal outcome of spontaneously conceived triplet pregnancies in relation to chorionicity. Am J Obstet Gynecol 2005;193:1463-1467.

10. Chasen ST, Al- Kouatly HB, Ballabh P, Skupski DW, Chervenak A. Outcomes of Dichorionic triplets pregnancies. Am J Obstet Gynecol 2002;186:765-767.

11. Rao A, Sairam S, Sheheta H. Obstetric complications of twin pregnancies. Best Pract Res Clin Obstet Gynecol 2004;18(4):557-560.

12. Rodis JF, Arky L, Egan JF, Borgida AF, et al. Comprehensive fetal ultrasonographic growth measurements in triplet gestations. Am J Obstet Gyencol 1999;181:1128-1132.

13. Tandberg A, Bjorge T, Nygard O, Bordahl PE, Skjaerven R. Trends in incidence and mortality for triplets in Norway: 1967- 2006: the influence of assited reproductive technologies. BJOG 2010;117:667-675.

14. Lamb DJ, Middeldorp CM, Van Beijsterveld C, Vink JM, et al. Birth weight in a large series of triplets. BMC Pediatrics 2011;11:24-27.