Search

Author(s): Manjushree Bhate [1]; Komal Agarwal [2]; Padmaja Kumari Rani [2]; Akash Belenje [2]; Deepika C Parmeshwarappa [2]; Subhadra Jalali (corresponding author) [1,2] With the increasing use of in vitro [...], Purpose: To evaluate the incidence and severity of retinopathy of prematurity (ROP) amongst surviving triplets. Methods: Records of preterm babies born to mothers with triplet pregnancies were retrieved from our Indian twin city ROP study database between 1 Jan 2000 and 31 Dec 2020 and analyzed. Results: 253 surviving triplet babies born to 108 mothers were evaluated. 48 out of 108 (44%) mothers received treatment for infertility. Data was available and analyzed for 242 babies (484 eyes). Mean gestational age was 31.76 ± 3.74 weeks (26- 38 weeks). The mean birth weight was 1.44 ± 0.37 kg (0.57-2.76 kg). At the first screening, incomplete vascularization was noted in 67% (131 babies;322 eyes) of which ROP was diagnosed in 14% (28 babies; 56 eyes). Among them, only 18 babies (53%) were the smallest birth weight babies in each of the triplet sets. Treatment with laser or bevacizumab was performed in 14 babies (5.8%), one eye of one baby additionally needed vitreoretinal surgical intervention. Good anatomical outcomes in terms of regression of ROP without sequelae were achieved in all babies. Conclusion: The present study reveals low incidence and favorable outcomes of ROP in triplet pregnancies in a large cohort of babies from a middle-income country. Our cohort did not show any difference in the treatment-requiring ROP among the larger or smaller birth weight babies of the same gestational age. In multiple pregnancies, gestational age remains a critical factor for ROP development; however, this does not necessitate modifying screening or treatment criteria in such triplet pregnancies. Keywords: Discordance, retinopathy of prematurity, triplet pregnancies

It's no secret to moms who've carried twins, let alone triplets, that there can be significant complications along the way. And when Katie Johnson went in for her 12 week [...]

A study on the triplets born in United States from 1995 - 1997, to estimate the African American-American gap in early mortality in triplets shows that the disparity is widest postneonatally. Such findings bear important in clinical and public health implications.

Women who are pregnant with triplets will probably have a good outcome if a previous pregnancy had a good outcome and if the woman gains at least 36 pounds by her 24th week. In a study of 194 triplet pregnancies, both of these factors were associated with a longer pregnancy, better fetal growth, and higher birth weights. Triplets are 12 times more likely to die in the first year of life than single babies.

Most women pregnant with triplets probably do not need multifetal reduction, according to a study of 127 women. Multifetal reduction is used in multiple pregnancies to eliminate one or more fetuses so the remaining fetuses will be more likely to survive.

Reducing a triplet pregnancy to a twin pregnancy can reduce the risk of prematurity and low birth weight as well as other complications. The use of infertility drugs has increased the number of multifetal pregnancies. Researchers compared the outcome of triplet pregnancies, triplet pregnancies that had been reduced to twin pregnancies, and normal twin pregnancies. Compared to triplet pregnancies, both normal twin pregnancies and triplet pregnancies reduced to twin pregnancies had lower premature birth rates, higher birth weights, greater age at birth and lower miscarriage rates.

Vaginal delivery of triplets may be as safe as delivery by cesarean section. Researchers compared the outcome of 33 triplets born vaginally with 33 triplets born by elective cesarean section. Vaginal deliveries were successful in 29 cases, while four cases required cesarean sections during labor complications. Newborns delivered by cesarean section were more likely to develop respiratory distress syndrome than those delivered vaginally.

The survival rate of triplets has increased recently but still exceeds that of single births, and the maternal complication rate remains high. Researchers retrospectively evaluated statistics of 57 triplet deliveries. The triplet mortality rate was 41 per 1000, which is lower than in previous years but is still higher than the 12.2 per 1000 rate of all births in Illinois in 1993. Preterm labor complicated 86% of triplet deliveries. Third-born infants were more likely to be small-for-gestational age than first- or second-born triplets. Cesarean delivery seemed to prevent a higher rate of newborn complications among third-born triplets. Complications rates were similar for triplets conceived spontaneously versus those conceived through reproductive assistance.

Reduction of a triplet pregnancy to a twin pregnancy may decrease a woman's risk of losing the entire pregnancy. Pregnancy reduction involves injecting a fatal substance into the heart of one or more fetuses of a multiple pregnancy so that the remaining fetuses have a better chance of survival. It is usually presented as an option to women carrying four or more fetuses. Researchers followed 140 triplet pregnancies at one medical center. Although pregnancy reduction is not routinely offered to women carrying triplets, 34 of these women requested it. Thirty-three of these pregnancies were reduced to twin pregnancies, and one was reduced to a singleton pregnancy. Of the 106 triplet pregnancies that were not reduced, 20.7% ended in miscarriage before 25 weeks' gestation. This compares with an 8.7% miscarriage rate during the same time period for the triplet pregnancies that were reduced to twin pregnancies. Also, there were 11 neonatal deaths in the triplet pregnancy group and none in the pregnancy reduction group.

Objectives--To examine the rate of cerebral palsy in twins and triplets in births from 1980 to 1989 in Western Australia and to identify factors associated with increase in risk. Design--Pluralities [...]

The use of fertility drugs has increased the incidence of multiple pregnancies, those involving more than two fetuses. The outcome of a multiple pregnancy depends on the number of fetuses and the quality of medical care given to the mother and the fetuses. Improved diagnostic methods, improved neonatal care and the use of selective termination to reduce the number of fetuses carried to term, has influenced the outcome of multiple pregnancies. An evaluation of 24 triplet, five quadruplet and one quintuplet pregnancies from one hospital over a 10-year period was conducted. The rate of death occurring during the first seven days of life was 31.6 per 1000 live infants and the late mortality (the rate of death occurring between seven and 28 days after birth) was 21. The perinatal death rate (during pregnancy and one week after birth) was 51.5. The number of infants surviving and discharged from the hospital was 98 percent. Respiratory distress syndrome, a breathing disorder caused by immature lung tissue, affected 43 percent of the infants. Bronchopulmonary dysplasia, abnormal tissue in the breathing structures, was present in six percent. Other complications included disorders of the eye (retinopathy of immaturity) in three percent, bleeding in the brain (intraventricular hemorrhage) in four percent and cerebral palsy in two percent. Only one child had a moderate handicap (spastic diplegia) at follow-up 10 years later. The remaining 99 percent of the infants had no evidence of further medical problems. A favorable outcome of multiple pregnancies is improved by early diagnosis, meticulous care during pregnancy, continuous monitoring of fetal well-being, early hospitalization, cesarean delivery and the immediate availability of a neonatologist during delivery. Although selective termination of fetuses in multiple pregnancies may be an option in some obstetrical cases, the 90 percent survival rate of multiple pregnancies does not support this type of management. (Consumer Summary produced by Reliance Medical Information, Inc.)

Although this miraculous story appeared in December, I just learned about it in early January, courtesy of Life News. There is a medical condition we've written about in the past--Twin [...]

Triplet fetuses who have a velamentous cord insertion are more likely to be born small for their gestational age than other triplets, according to a study of 39 sets of triplets. A velamentous cord insertion means the umbilical cord does not attach to the placenta in the right place.

Triplets in which two of the fetuses share a single placenta are more likely to develop twin-twin transfusion syndrome or to miscarry. In a study of 17 triplet pregnancies, 30% miscarried or developed twin-twin transfusion syndrome. Twin-twin transfusion syndrome occurs when one twin grows at the expense of the other.

Triplet pregnancies may be safely delivered vaginally when appropriate patient selection and monitoring devices are utilized. Researcher tested a delivery protocol in 23 women carrying three fetuses. Nine patient attempted vaginal delivery, and eight were successful. In twelve pregnancies, the fetuses were not properly positioned for safe delivery, and fetal monitoring was not sufficient in two pregnancies. Women delivered vaginally stayed an average of 2.8 days in the hospital, compared to 4.5 days for women delivered surgically. Vaginal delivery was not associated with worse fetal health.

Dr. Craigo is Assistant Professor of Ob/Gyn, Division of Maternal-Fetal Medicine, Tufts University School of Medicine, New England Medical Center, Boston, Mass. Is there proof that it improves overall survival? [...]