Ultrasound assessment of the prognosis in triplet pregnancies.
OBJECTIVE
To assess the diagnostic accuracy and show the prognostic influence of different ultrasonographic criteria in triplet pregnancies(TP).


METHODS
Retrospective study.


METHODS
Tertiary care center in France.


METHODS
Fifty-one consecutive TP in which at least one of the children, live- or stillborn, weighed 500 g or more, and with a gestation period of at least 22 weeks.


METHODS
Chorionicity, abnormal umbilical artery Doppler waveforms, intrauterine weight (IUW) <10th centile and prenatal diagnosis of fetal anomaly were studied simultaneously as prognostic criteria. Chorionicity was confirmed at birth by placental pathology.


METHODS
Diagnosis of chorionicity/amnionicity and IUW <10th centile. Neonatal intensive care unit admission, occurrence of respiratory distress syndrome and perinatal mortality.


RESULTS
Prenatal misclassification of chorionicity/amnionicity after postnatal perinatal pathology review was 12%. The positive predictive value of IUW <10th centile diagnosis was 44% for the prediction of birthweight <10th centile. Prenatal diagnosis of mono- or dichorionic placentation was associated with increased neonatal morbidity in comparison with that of trichorionic triplets. Perinatal mortality was significantly increased where mono- or dichorionic placentation was diagnosed prenatally (OR: 4.2; CI: 1.04-17), IUW <10th centile (OR: 10; CI: 2.4-41), with raised odds for abnormal umbilical Doppler measurements (OR: 9.7; CI: 2-47) and fetal anomaly (OR: 6.4; CI: 1.4-28.9).


CONCLUSIONS
Early prenatal diagnosis of chorionicity is of major importance in triplet pregnancy. Experienced sonographers must quickly evaluate any uncertain diagnosis. In cases of unknown chorionicity, other ultrasonographic criteria can highlight high-risk triplet pregnancy, but at a later stage.
Guilherme
Romain
R
Department of Obstetrics and Gynecology, Robert Debre Hospital, Paris, France. romain.guilherme@psl.aphp.fr
Le Ray
Camille
C
Vuillard
Edith
E
Garel
Catherine
C
Delezoide
Anne-Lise
AL
Oury
Jean-Francois
JF
Luton
Dominique
D
D001724:Birth Weight; D002823:Chorion / Q000000981:diagnostic imaging*; D005260:Female; D005313:Fetal Death / Q000000981:diagnostic imaging* / Q000209:etiology; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging* / Q000209:etiology; D005333:Fetus / Q000002:abnormalities*; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D011379:Prognosis; D012189:Retrospective Studies; D014310:Triplets; D016216:Ultrasonography, Prenatal / Q000379:methods*