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Triplet pregnancy: changes in morbidity and mortality
1Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco 94143.
Insights
Triplet infants often experience neonatal morbidity, with hyperbilirubinemia and hypoglycemia being common. Despite this, triplet perinatal mortality has significantly decreased due to improved neonatal care and cesarean delivery practices.
Area of Science:
- Neonatalogy
- Perinatology
- Maternal-Fetal Medicine
Background:
- Triplet births present unique challenges in neonatal care.
- Historical data indicates significant declines in triplet perinatal mortality over decades.
- Prematurity remains a key factor in neonatal morbidity, though less so for mortality.
Purpose of the Study:
- To analyze the immediate neonatal morbidity in triplet infants.
- To review trends in triplet morbidity and mortality in the US and Europe.
- To identify optimal care strategies for triplet gestations.
Main Methods:
- Retrospective analysis of 13 sets of triplet infants (39 infants) born between 1981-1988.
- Review of published literature on triplet morbidity and mortality.
- Comparison of current findings with historical data.
Main Results:
- No perinatal deaths occurred in the studied triplet cohort.
- 80% of triplet infants experienced some form of neonatal morbidity.
- Common morbidities included hyperbilirubinemia (51.3%), hypoglycemia (30.8%), and respiratory distress syndrome (28.2%).
- All morbidities were observed in infants with low birth weight (<2000g) and preterm gestation (<35 weeks).
- Triplet perinatal mortality has declined to below 10% over 80 years.
Conclusions:
- Neonatal morbidity is prevalent in triplet infants, particularly those born preterm or with low birth weight.
- Improvements in neonatal resuscitation, care, and cesarean delivery have reduced triplet mortality.
- Optimal care involves antenatal and neonatal services at tertiary centers and planned cesarean delivery.
Abstract:
The outcome of 13 sets of triplet infants delivered between January 1, 1981, and December 31, 1988, is analyzed with specific regard to immediate neonatal morbidity. Thirty-nine viable infants were born with no perinatal deaths. Overall, 80% of triplet infants incurred some morbidity, including hyperbilirubinemia (51.3%), hypoglycemia (30.8%), respiratory distress syndrome (28.2%), respiratory compromise (23.1%), anemia (17.9%), patent ductus arteriosus (15.4%), and intraventricular hemorrhage (10.3%). All morbidities occurred in infants who averaged less than 2,000 g and 35 weeks' gestation at birth. As a background to understanding these observations, a review of reports of triplet morbidity and mortality in the United States and Europe is presented. Over the past 80 years, a continual decline in triplet perinatal mortality has occurred despite no change in the average gestational age at delivery over the past 40 years. The triplet perinatal mortality rate is now less than 10%, and prematurity is no longer as influential on perinatal mortality as it is on morbidity. Improvement in neonatal resuscitation and care and delivery by cesarean section are felt to be responsible for lower mortality rates. We believe that the optimum level of care for triplet gestations includes antenatal and neonatal care at tertiary perinatal centers and, except for special circumstances, delivery by cesarean section.