Effect of monochorionicity on perinatal outcome and growth discordance in triplet pregnancy: collaborative multicenter study in England, 2000-2013.
Birth Weight
Cesarean Section
/ statistics & numerical data
Chorion
/ embryology
England
/ epidemiology
Female
Fetal Development
Fetal Growth Retardation
/ epidemiology
Fetofetal Transfusion
/ epidemiology
Gestational Age
Humans
Infant, Newborn
Perinatal Mortality
Pregnancy
Pregnancy Outcome
/ epidemiology
Pregnancy, Triplet
/ statistics & numerical data
Stillbirth
/ epidemiology
Triplets
/ statistics & numerical data
NorSTAMP
Northern Survey of Twin and Multiple Pregnancy
STORK collaboration
congenital anomalies
monochorionic placentation
perinatal mortality
stillbirth
triplets
Journal
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
ISSN: 1469-0705
Titre abrégé: Ultrasound Obstet Gynecol
Pays: England
ID NLM: 9108340
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
05
12
2019
revised:
17
01
2020
accepted:
20
01
2020
pubmed:
31
1
2020
medline:
15
12
2021
entrez:
31
1
2020
Statut:
ppublish
Résumé
To compare perinatal outcome and growth discordance between trichorionic triamniotic (TCTA) and dichorionic triamniotic (DCTA) or monochorionic triamniotic (MCTA) triplet pregnancies. This was a multicenter cohort study using population-based data on triplet pregnancies from 11 Northern Survey of Twin and Multiple Pregnancy (NorSTAMP) maternity units and the Southwest Thames Region of London Obstetric Research Collaborative (STORK) multiple pregnancy cohort, for 2000-2013. Perinatal outcomes (from ≥ 24 weeks' gestation to 28 days of age), intertriplet fetal growth and birth-weight (BW) discordance and neonatal morbidity were analyzed in TCTA compared with DCTA/MCTA pregnancies. Monochorionic placentation of a pair or trio in triplet pregnancy (n = 72) was associated with a significantly increased risk of perinatal mortality (risk ratio, 2.7 (95% CI, 1.3-5.5)) compared with that in TCTA pregnancies (n = 68), due mainly to a much higher risk of stillbirth (risk ratio, 5.4 (95% CI, 1.6-18.2)), with 57% of all stillbirth cases resulting from fetofetal transfusion syndrome, while there was no significant difference in neonatal mortality (P = 0.60). The associations with perinatal mortality and stillbirth persisted when considering only pregnancies not affected by a major congenital anomaly. DCTA/MCTA triplets had lower BW and demonstrated greater BW discordance than did TCTA triplets (P = 0.049). Severe BW discordance of > 35% was 2.5-fold higher in DCTA/MCTA compared with TCTA pregnancies (26.1% vs 10.4%), but this difference did not reach statistical significance (P = 0.06), presumably due to low numbers. Triplets in both groups were delivered by Cesarean section in over 95% of cases, at a similar gestational age (median, 33 weeks' gestation). The rate of respiratory (P = 0.28) or infectious (P = 0.08) neonatal morbidity was similar between the groups. Despite close antenatal surveillance, monochorionic placentation of a pair or trio in triamniotic triplet pregnancy was associated with a significantly increased stillbirth risk, mainly due to fetofetal transfusion syndrome, and with greater size discordance. In liveborn triplets, there was no adverse effect of monochorionicity on neonatal outcome. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
440-448Subventions
Organisme : Medical Research Council
ID : MR/K02325X/1
Pays : United Kingdom
Investigateurs
Nicola Miller
(N)
Danielle Martin
(D)
Informations de copyright
© 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Références
Blickstein I, Keith LG. The decreased rates of triplet births: temporal trends and biologic speculations. Am J Obstet Gynecol 2005; 193: 327-331.
Simmons R, Doyle P, Maconochie N. Dramatic reduction in triplet and higher order births in England and Wales. BJOG 2004; 111: 856-858.
Smith LK, Manktelow BN, Draper ES, Boyle EM, Johnson SJ, Field DJ. Trends in the incidence and mortality of multiple births by socioeconomic deprivation and maternal age in England: population-based cohort study. BMJ Open 2014; 4: e004514.
Martin JA, Osterman MJ, Thoma ME. Declines in Triplet and Higher-order Multiple Births in the United States, 1998-2014. NCHS Data Brief 2016: 1-8.
Tandberg A, Bjorge T, Nygard O, Bordahl PE, Skjaerven R. Trends in incidence and mortality for triplets in Norway 1967-2006: the influence of assisted reproductive technologies. BJOG 2010; 117: 667-675.
Luke B, Brown MB. The changing risk of infant mortality by gestation, plurality, and race: 1989-1991 versus 1999-2001. Pediatrics 2006; 118: 2488-2497.
Martin JA, Hamilton BE, Ventura SJ, Osterman MJ, Kirmeyer S, Mathews TJ, Wilson EC. Births: final data for 2009. Natl Vital Stat Rep 2011; 60: 1-70.
Adegbite AL, Ward SB, Bajoria R. Perinatal outcome of spontaneously conceived triplet pregnancies in relation to chorionicity. Am J Obstet Gynecol 2005; 193: 1463-1471.
Bajoria R, Ward SB, Adegbite AL. Comparative study of perinatal outcome of dichorionic and trichorionic iatrogenic triplets. Am J Obstet Gynecol 2006; 194: 415-424.
Geipel A, Berg C, Katalinic A, Plath H, Hansmann M, Germer U, Gembruch U. Prenatal diagnosis and obstetric outcomes in triplet pregnancies in relation to chorionicity. BJOG 2005; 112: 554-558.
Simoes T, Queiros A, Goncalves MR, Periquito I, Silva P, Blickstein I. Perinatal outcome of dichorionic-triamniotic as compared to trichorionic triplets. J Perinat Med 2016; 44: 875-879.
Kawaguchi H, Ishii K, Yamamoto R, Hayashi S, Mitsuda N, Perinatal Research Network Group in J. Perintal death of triplet pregnancies by chorionicity. Am J Obstet Gynecol 2013; 209: 36.e1-7.
Lopes Perdigao J, Straub H, Zhou Y, Gonzalez A, Ismail M, Ouyang DW. Perinatal and obstetric outcomes of dichorionic vs trichorionic triplet pregnancies. Am J Obstet Gynecol 2016; 214: 659.e1-5.
National Institute for Health and Care Excellence (NICE). Multiple pregnancy: antenatal care for twin and triplet pregnancies. NICE clinical guideline CG129. https://www.nice.org.uk/guidance/cg129
Curado J, D'Antonio F, Papageorghiou A, Bhide A, Thilaganathan B, Khalil A. Perinatal mortality and morbidity in triplet pregnancies according to chorionicity: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2019; 54: 589-595.
National Institute for Health and Care Excellence (NICE). Antenatal care for uncomplicated pregnancies. NICE clinical guideline CG62. http://guidance.nice.org.uk/CG62/NiceGuidance/pdf/English
Ward Platt MP, Glinianaia SV, Rankin J, Wright C, Renwick M. The North of England Multiple Pregnancy Register: five-year results of data collection. Twin Res Hum Genet 2006; 9: 913-918.
Glinianaia SV, Rankin J, Sturgiss SN, Ward Platt MP, Crowder D, Bell R. The North of England Survey of Twin and Multiple Pregnancy. Twin Res Hum Genet 2013; 16: 112-116.
NorSTAMP Steering Group. Northern Survey of Twin and Multiple Pregnancy (NorSTAMP): Standards of Care for Multiple Pregnancies. Final Version - July 2009. http://www.nepho.org.uk/uploads/doc/vid_3497_Twins%20standards-Final%20version.pdf.
D'Antonio F, Khalil A, Dias T, Thilaganathan B, Southwest Thames Obstetric Research C. Early fetal loss in monochorionic and dichorionic twin pregnancies: analysis of the Southwest Thames Obstetric Research Collaborative (STORK) multiple pregnancy cohort. Ultrasound Obstet Gynecol 2013; 41: 632-636.
Acharya G, Wilsgaard T, Berntsen GK, Maltau JM, Kiserud T. Reference ranges for serial measurements of umbilical artery Doppler indices in the second half of pregnancy. Am J Obstet Gynecol 2005; 192: 937-944.
Blickstein I, Jacques DL, Keith LG. A novel approach to intertriplet birth weight discordance. Am J Obstet Gynecol 2003; 188: 1026-1030.
Glinianaia SV, Rankin J, Khalil A, Binder J, Waring G, Sturgiss SN, Thilaganathan B, Hannon T. Prevalence, antenatal management and perinatal outcome of monochorionic monoamniotic twin pregnancy: a collaborative multicenter study in England, 2000-2013. Ultrasound Obstet Gynecol 2019; 53: 184-192.
Bell R, Glinianaia SV, Rankin J, Wright C, Pearce MS, Parker L. Changing patterns of perinatal death, 1982-2000: a retrospective cohort study. Arch Dis Child Fetal Neonatal Ed 2004; 89: F531-536.
Hey EN, Lloyd DJ, Wigglesworth JS. Classifying perinatal death: fetal and neonatal factors. Br J Obstet Gynaecol 1986; 93: 1213-1223.
Wigglesworth JS. Monitoring perinatal mortality. A pathophysiological approach. Lancet 1980; 2: 684-686.
Richmond S, Atkins J. A population-based study of the prenatal diagnosis of congenital malformation over 16 years. BJOG 2005; 112: 1349-1357.
Kilby MD, Bricker L. on behalf of the Royal College of Obstetricians and Gynaecologists. Management of Monochorionic Twin Pregnancy: GreenTop Guideline No. 51. BJOG 2017; 124: e1-45.
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 144: Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. Obstet Gynecol 2014; 123: 1118-1132.
Abel JS, Flock A, Berg C, Gembruch U, Geipel A. Expectant management versus multifetal pregnancy reduction in higher order multiple pregnancies containing a monochorionic pair and a review of the literature. Arch Gynecol Obstet 2016; 294: 1167-1173.
Zipori Y, Haas J, Berger H, Barzilay E. Multifetal pregnancy reduction of triplets to twins compared with non-reduced triplets: a meta-analysis. Reprod Biomed Online 2017; 35: 296-304.
Downing M, Sulo S, Parilla BV. Perinatal and Neonatal Outcomes of Triplet Gestations Based on Chorionicity. AJP Rep 2017; 7: e59-63.
Spencer JV, Ingardia CJ, Nold CJ, Borgida AF, Herson VC, Egan JF. Perinatal and neonatal outcomes of triplet gestations based on placental chorionicity. Am J Perinatol 2009; 26: 587-590.