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TEMPLATE DESIGN © Comparison of outcomes of triplet pregnancy with twin pregnancy Kyu-Sang Kyeong, M.D., Jae-Yoon Shim, M.D.,Mi-Young Lee, M.D., Hye-Sung Won, M.D., Pil-Ryang Lee, M.D., Ahm Kim, M.D. Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea Objectives Results Conclusions References Triplets had a significantly lower 1-minute Apgar score than twins (51 vs 34%, P=0.018). But there were no significant differences between triplets and twins in the incidence of mechanical ventilator support, neonatal intensive care unit admissions, respiratory distress syndrome, apnea of prematurity, sepsis, intraventricular hemorrhage, patent ductus arteriosus, The number of triplet births has risen dramatically over the past 3 decades. 1 The incidence of triplet is influenced by use of assisted reproductive techniques and higher maternal age. 2,3 Triplet pregnancy is associated with significantly increased risks of maternal and neonatal morbidity compared with twin pregnancy. 1 and preterm delivery is the most significant complication of triplet gestaion. 4,5 So the purpose of this study was to compare perinatal outcomes and maternal complications of triplet pregnancies with twin pregnancies matched for gestational age. The birth weight of triplets was slightly lower than twins, but there were no significant difference in neonatal morbidity and mortality when triplets matched for maternal age, parity and gestational age at delivery with twins. This outcomes may be helpful to reassure women with triplet pregnancy who did not consider selective reduction to twin. Methods Medical records of triplet pregnancies delivered in Seoul Asan Medical Center from 1992 to 2011 were reviewed for maternal and neonatal outcomes. And each triplet was matched for maternal age, parity and gestational age at delivery with twin in the same period. All patient included in this study received prenatal care, were delivery and received neonatal care at our hospital. Pregnancies delivered before 24 weeks of gestation were excluded. jaundice requiring phototherapy, retinopathy of prematurity, necrotizing enterocolitis and gastroesophageal reflux. During the 20-year period 38 triplet pregnancies were delivered after a gestational age of 24 weeks or more, and were matched with 38 twin pregnancies. Eighty two percent of the triplets and 86% of the twins were a result of assisted reproduction. Maternal characteristics and outcomes for these groups are presented in Table 1. There are no significant difference in two groups. Table 1. Maternal perinatal outcomes 1.Luke B, Brown MB. Maternal morbidity and infant death in twin vs triplet and quadruplet pregnancies. Am J Obstet Gynecol 2008;198:401.e Jewell SE, Yip R. Increasing trends in plural births in the United States. Obstet Gynecol 1995;85: Black M, Bhattacharya S. Epidemiology of multiple pregnancy and the effect of assisted conception. Semin Fetal Neonatal Med 2010;15: Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final Data for National Vital Statistics Reports 2011;60 5.Newman RB, Hamer C, Miller MC. Outpatient triplet management: a contemporary review. Am J Obstet Gynecol 1989;161:547-53; discussion 53-5 ParameterTriplet (n=38)Twin (n=38)P-value Age * 31.5± ± Gestational age * 32.5± ± Hemoglobin † 10.9± ± Nullipara(%) Preeclampsia(%) PROM ‡ (%) Preterm labor (%) Use Tocolytics (%) Transfusion(%) Cerclage op.(%) * at delivery, † at term PROM, premature rupture of membrane Parameter Triplet (n=38) Twin (n=38) P- value Hospital Stay (days)34.1± ± min Apgar score < 7 (%) min Apgar score < 7 (%) Birth weight (g) ± ± discordanccy <20% (%) NICU admit (%) Mechanical ventilation Respiratory distress syndrome (%) Bronchopulmonary dysplasia (%) Apnea of prematurity (%) Sepsis (%) Intraventricular hemorrhage (%) Retinopathy of prematurity (%) Patent ductus arteriosus Required phototherapy (%) GERD (%) Necrotizing enterocolitis (%) fetal anomaly (%) Table 2. Neonatal perinatal outcomes Neonatal birth-weight (1663 vs 1747 g), neonatal hospital stay (34 vs 31 days) and the incidence of birth-weight discordance (29 vs 36%) were not statistically different in the two groups.
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