[The maternal and fetal outcome of 122 triplet pregnancies].
BACKGROUND
The wide use of infertility drugs and assisted reproduction has resulted in 4- to 5-fold increase in the incidence of triplet pregnancies, which carry an extremely high risk of maternal complications and adverse perinatal outcome. In Hungary, reduction of multifetal pregnancies is available for all pregnant women with multifetal gestation since 1998. The goal of the procedure is to ensure better outcome for surviving fetuses. Counseling of pregnant patients should include the maternal and fetal risks of triplet gestation without multifetal pregnancy reduction.


OBJECTIVE
To assess the risk of maternal complications, stillbirth, perinatal and neonatal mortality rates, and risk of neonatal morbidity in non-reduced triplets in a large case series, representing the Hungarian triplet population.


METHODS
The study population consisted of triplets delivered between July 1st, 1990 and June 30th, 2006, at the 1st Department of Obstetrics and Gynecology. All three fetuses had to be alive on the 18th-week ultrasound scan to be eligible.


RESULTS
Out of the 122 cases, 8 (6.6%) ended in midtrimester miscarriage, 114 (93.4%) ended in delivery. There were no maternal deaths. The most common antepartum maternal complications were pregnancy-induced hypertension (16.7%), gestational diabetes mellitus (18.4%), thrombocytopenia (20.2%), anemia (16.7%) and intrahepatic cholestasis (9.7%). Preterm labor requiring tocolysis occurred in 57.9%, preterm premature rupture of membranes in 32.5%. Prophylactic cerclage was performed in 15.8% of cases, and 69.3% of patients received steroid prophylaxis. The mean gestational age at delivery was 32.3 +/- 3.2 weeks. The rates of very early (<28 weeks) and early (<32 weeks) preterm deliveries were 8.8% and 42.1%, respectively. The mean 5-minute Apgar score was 9.2 +/- 0.8, and the mean birth weight at delivery was 1664 +/- 506 g. 38.0% of infants were very low birth weight (<1500 g). Stillbirth, crude perinatal mortality and corrected perinatal mortality rates were 23.4 per thousand, 64.3 per thousand and 27.4 per thousand, respectively. 11.7 per thousand of infants had some major congenital anomaly. 54.4% of infants required ventilation or oxygen therapy or both. The most common neonatal complication were respiratory distress (17.1%), transitory tachypnea (5.2%), sepsis or pneumonia (25.5%), intraventricular hemorrhage (4.3%) and jaundice (11.4%).


CONCLUSIONS
Both the maternal and neonatal risks should be considered when patients with triplets are counseled before the decision to continue the triplet gestation or to choose multifetal pregnancy reduction is made.
Semmelweis Egyetem, Altalános Orvostudományi Kar, I. Szülészeti és Nogyógyászati Klinika, Budapest. hrubi@noi1.sote.hu
Ervin
E
Hruby
Lilla
L
Sassi
Eva
E
Görbe
Petronella
P
Hupuczi
Zoltán
Z
Papp
D000328:Adult; D000740:Anemia / Q000453:epidemiology / Q000209:etiology; D002780:Cholestasis, Intrahepatic / Q000453:epidemiology / Q000209:etiology; D003376:Counseling; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology* / Q000209:etiology*; D054238:Perinatal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology*; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology / Q000209:etiology; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal; D018570:Risk Assessment; D013921:Thrombocytopenia / Q000453:epidemiology / Q000209:etiology; D014310:Triplets