Triplet pregnancy: is the mode of conception related to perinatal outcomes?
Many triplets are conceived as a consequence of assisted reproductive technology (ART). Concerns have been raised that triplet pregnancies conceived by ART are more complicated than those conceived spontaneously. The purpose of this study was to evaluate all triplet pregnancies managed over a 12-year period to determine if there were any differences in outcome based on the mode of conception. All triplet pregnancies between 1999 and 2011 that reached at least 20 weeks' gestation and that were managed at the Royal Women's Hospital (RWH), Melbourne, Victoria were identified. Maternal and neonatal outcomes were compared between ART conceived and spontaneously conceived triplets. In the study period, 53 sets of triplets managed in our institution met the eligibility criteria. Twenty-five triplet sets were conceived by ART and 28 were conceived spontaneously. More ART conceptions resulted in trichorionic triamniotic (TCTA) triplets than did spontaneous conceptions (p = .015). There were no differences between ART and spontaneously conceived triplets for any of the maternal or neonatal complications studied. Trichorionic (TC) triplets delivered at a later gestation than other triplets: 32.1 (SD 2.9) versus 30.4 (SD 3.9) weeks (p = .08). TC triplets were significantly less likely to die than monochorionic (MC) or dichorionic (DC) triplets: 3/93 (3%) versus 13/66 (20%) (p = .025). In conclusion, triplets conceived by ART are more likely to have TCTA placentation and TCTA triplet sets had lower mortality rates than other triplet combinations. Outcomes for triplets conceived by ART were similar to those of triplets conceived spontaneously.
Department of Women's Health,The Royal Women's Hospital,Melbourne,Victoria,Australia.
Kristy M
KM
Fennessy
Clinical Research Development,The Royal Women's Hospital,Melbourne,Victoria,Australia.
Lex W
LW
Doyle
Department of Obstetrics and Gynaecology,Royal Alexandra Hospital,Edmonton,Alberta,Canada.
Kentia
K
Naud
Pregnancy Research Centre,Department of Perinatal Medicine,The Royal Women's Hospital,Melbourne,Victoria,Australia.
Karen
K
Reidy
Department of Obstetrics and Gynaecology,The University of Melbourne,Melbourne,Victoria,Australia.
Mark P
MP
Umstad
D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D001724:Birth Weight; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005306:Fertilization; D005330:Fetofetal Transfusion / Q000401:mortality; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology; D008297:Male; D008423:Maternal Age; D007744:Obstetric Labor Complications / Q000453:epidemiology; D054238:Perinatal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome; D059286:Pregnancy, Triplet / Q000502:physiology*; D011295:Prenatal Care; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies
assisted reproductive technology; chorionicity; maternal outcomes; neonatal outcomes; triplet pregnancy