Perinatal and obstetric outcomes of dichorionic vs trichorionic triplet pregnancies

• Published in: American journal of obstetrics and gynecology Vol. 214; no. 5; pp. 659.e1 - 659.e5
• Main Authors: Lopes Perdigao, Joana, MD, Straub, Heather, MD, Zhou, Ying, PhD, Gonzalez, Anna, MD, Ismail, Mahmoud, MD, Ouyang, David W., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2016
• Subjects: Adult; Chicago - epidemiology; Chorion; chorionicity; Cohort Studies; Female; Fetofetal Transfusion - mortality; Gestational Age; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Very Low Birth Weight; Middle Aged; Obstetrics and Gynecology; perinatal and obstetric outcome; Pregnancy; Pregnancy, Triplet; Premature Birth - etiology; Retrospective Studies; triplets; Young Adult; perinatal and obstetric outcome; triplets; chorionicity
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2015.11.013

Background Clinical management and outcome of multiple gestation can be affected by chorionicity. In triplet pregnancies, fetal death has been associated with dichorionic (DC) and monochorionic placentation. Studies evaluating triplet pregnancy outcomes in relation to chorionicity have been few and may not reflect contemporary antenatal and neonatal care. Objective The objective of this study was to compare obstetric and perinatal outcomes in DC and trichorionic (TC) triplet pregnancies. Study Design We performed a retrospective cohort study of triplet pregnancies that delivered at ≥20 weeks’ gestation at 2 Chicago area hospitals from January 1999 through December 2010. Chorionicity was determined by pathology specimen. Maternal and infant charts were reviewed for obstetric and perinatal outcomes. Results The study population included 159 pregnancies (477 neonates) of which 108 were TC (67.9%) and 51 were DC (32.1%). Over 94% of mothers in this study had all 3 infants survive to discharge regardless of chorionicity. No difference was found in perinatal mortality rate between DC and TC triplets (3.3% vs 4.6%; P  = .3). DC triplets were significantly more likely to be very low birthweight (41.8% vs 22.2%; odds ratio, 2.2; 95% confidence interval, 1.2–4.2; P  = .02) and to deliver at <30 weeks (25.5% vs 8.3%; odds ratio, 6.1; 95% confidence interval, 1.9–19.4; P  = .002) compared to TC triplets. Criteria for twin-twin transfusion syndrome (TTTS) were present in 3 DC triplet pregnancies (5.9%). Neonates in pregnancies complicated by TTTS were less likely to survive 28 days as compared to neonates from DC pregnancies that were not affected by TTTS ( P  = .02) or TC neonates ( P  = .02) Neonatal survival was similar in DC pregnancies not affected by TTTS and TC pregnancies (98.6% and 96.6%; P  = .7). Conclusion Although perinatal mortality did not correlate with chorionicity, DC pregnancies were more likely to deliver <30 weeks’ gestational age and have very low birthweight neonates. Neonatal mortality appears to be mediated by the presence or absence of TTTS as 28-day survival was worse in DC pregnancies complicated by TTTS, but similar between DC pregnancies not affected by TTTS and TC pregnancies.