Effect of monochorionicity on perinatal outcome and growth discordance in triplet pregnancy: collaborative multicenter study in England, 2000–2013
| العنوان: | Effect of monochorionicity on perinatal outcome and growth discordance in triplet pregnancy: collaborative multicenter study in England, 2000–2013 |
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| المؤلفون: | Asma Khalil, Basky Thilaganathan, Judith Rankin, GJ Waring, Petra Pateisky, Julia Binder, Therese Hannon, Svetlana V. Glinianaia, Joana Curado, Stephen Sturgiss |
| المصدر: | Ultrasound in Obstetrics & Gynecology. 57:440-448 |
| بيانات النشر: | Wiley, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | medicine.medical_specialty, Population, Gestational Age, Fetal Development, 03 medical and health sciences, 0302 clinical medicine, Obstetrics and gynaecology, Pregnancy, Triplet Pregnancy, Birth Weight, Humans, Medicine, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, education, Perinatal Mortality, education.field_of_study, Fetal Growth Retardation, Triplets, 030219 obstetrics & reproductive medicine, Radiological and Ultrasound Technology, Cesarean Section, business.industry, Obstetrics, Infant, Newborn, Pregnancy Outcome, Obstetrics and Gynecology, Gestational age, Chorion, Fetofetal Transfusion, General Medicine, Stillbirth, Pregnancy, Triplet, medicine.disease, England, Reproductive Medicine, Relative risk, Gestation, Female, business, Cohort study |
| الوصف: | Objectives To compare perinatal outcome and growth discordance between trichorionic triamniotic (TCTA) and dichorionic triamniotic (DCTA) or monochorionic triamniotic (MCTA) triplet pregnancies. Methods 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. Results 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. Conclusions 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. |
| تدمد: | 1469-0705 0960-7692 |
| DOI: | 10.1002/uog.21987 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ff9862b9eea63ba072ba307035de1329 https://doi.org/10.1002/uog.21987 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....ff9862b9eea63ba072ba307035de1329 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14690705 09607692 |
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| DOI: | 10.1002/uog.21987 |