title: Perinatal death of triplet pregnancies by chorionicity.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the perinatal risk of death by chorionicity at >22 weeks of gestation of triplet pregnancies.
  
  
  METHODS
  In a retrospective cohort study, the perinatal data were collected from triplet pregnancies in Japanese perinatal care centers between 1999 and 2009. We included maternal characteristics and examined the following factors: prenatal interventions, pregnancy outcome, and neonatal outcome. The association between fetal or neonatal death of triplets and chorionicity was evaluated by logistic regression analysis.
  
  
  RESULTS
  After the exclusion of 253 cases, the study group comprised 701 cases: 507 trichorionic triamniotic (TT) triplet pregnancies, 144 diamniotic triamniotic (DT) triplet pregnancies, and 50 monochorionic triamniotic (MT) triplet pregnancies. The mortality rate (fetal death at >22 weeks of gestation; neonatal death) in triplets was 2.6% and included 2.1% of TT triplet pregnancies, 3.2% of DT triplet pregnancies, and 5.3% of MT triplet pregnancies. No significant risk of death was identified in DT triplet pregnancies; however, MT triplet pregnancies had a 2.6-fold greater risk (adjusted odds ratio, 2.60; 95% confidence interval, 1.17-5.76; P = .019) compared with TT triplet pregnancies. Prophylactic cervical cerclage did not reduce the perinatal mortality rate at >22 weeks of gestation in triplets.
  
  
  CONCLUSIONS
  The risk of death for MT triplet pregnancies is significantly higher than that of TT triplet pregnancies; however, the risk of death for DT triplet pregnancies is not.
authors.affiliation: Department of Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan.
authors.forename: Haruna
authors.initials: H
authors.lastname: Kawaguchi
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ishii
authors.forename: Ryo
authors.initials: R
authors.lastname: Yamamoto
authors.forename: Shusaku
authors.initials: S
authors.lastname: Hayashi
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Mitsuda
mesh_terms: D001724:Birth Weight; D023802:Cerclage, Cervical / Q000706:statistics & numerical data*; D002823:Chorion / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D005313:Fetal Death / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005330:Fetofetal Transfusion / Q000401:mortality*; D005865:Gestational Age; D006801:Humans; D007564:Japan / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D059286:Pregnancy, Triplet; D012189:Retrospective Studies; D014463:Ultrasonography
keywords: chorionicity; fetofetal transfusion syndrome; perinatal outcome; prophylactic cervical cerclage; triplet pregnancy