Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(9):393-397
DOI 10.1590/SO100-720320140005066
To evaluate the obstetric and perinatal outcomes evolution of triplet pregnancies.
A prospective observational study was conducted in triplet pregnancies delivered over 16 years in a tertiary obstetric center with differentiated perinatal support. Evaluation of demographic factors, obstetric complications, gestational age at delivery, mode of delivery, birth weight and immediate newborn outcome were done over a 16 years period. A global characterization of the sample was performed considering the listed parameters. Variables were categorized in three groups according to year of occurrence: 1996-2000, 2001-2006, 2007-2011, and all parameters were compared.
Of the 33 triplets included, 72.7% resulted from induced pregnancies. All except one patient received prenatal corticosteroids and five received tocolytics. All women delivered prenatally and no significant differences were seen in the mean gestational age at delivery or birth weight towards time. There were three intrauterine fetal deaths. Neonatal immediate outcomes were not significantly different over the years.
Despite remarkable progresses in perinatal and neonatal cares, no noticeable impact in triplet gestations' outcomes was seen, sustaining that triplets should be avoided due to their great risk of prematurity and neonatal morbidities, either by limiting the numbers of embryos transferred or by fetal reduction.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(7):413-419
DOI 10.1590/S0100-72032000000700003
Purpose: to analyze maternal complications and perinatal results of triplet pregnancies. Method: retrospective study of maternal and perinatal data on all triplets weighing >500 g delivered in a period of 8 years at Maternidade Escola de Vila Nova Cachoeirinha. Results: between 1990-1998, 18 women gave birth to triplets, representing 1 in every 2,060 deliveries. The main complications were preterm delivery (94.4%) and preeclampsia (44.4%) and 83.3% of these patients needed hospitalization before delivery, for 1-50 days, most in order to inhibit preterm labor. Cesarean section was performed in 88.9%, the mean gestational age at birth was 34.2 weeks (+ 1.8), mean weight 1,827 g (+ 421), 20.4% weighed <1,500 g and 75.9% weighed 1,500-2,499 g. Birth weight discrepancy (> 25%) occurred in 38.9% of these pregnancies and 35.2% of the 54 fetuses were small for gestational age. Eighty-six percent of live-born infants had neonatal morbidity and 3.7% had evident congenital anomalies. Perinatal mortality was 16.7%, 7.4% due to intrauterine demise and 9.3% due to neonatal death. The mean duration of hospitalization in the neonatal ward was 18.5 days; late neonatal sepsis was the main cause of death. Conclusion: triplet pregnancies had high a incidence of obstetric complications, demanded prolonged maternal hospitalization and ended almost always in surgical delivery. Intrauterine and neonatal death rates were high, neonatal morbidity was detected in almost all live-born infants and their hospitalization was long, exposing these prematures to infection, their main cause of death. Triplet pregnancies carry high maternal and fetal risks and should be managed at tertiary facilities.