Viability of Successful Vaginal Delivery in Triplet Pregnancies: A Retrospective Cohort Study Over 20 Years

Triplet pregnancies are increasingly leaning toward planned cesarean deliveries (CD), yet data on determining factors and outcomes remain limited.

To assess the success of vaginal delivery (VD) in triplet pregnancies and compare neonatal and maternal outcomes with those of CD.

A retrospective cohort study included triplet pregnancies from 26 weeks' gestation onward in a tertiary center between 2000 and 2020. The primary outcome was the actual mode of delivery (successful VD, planned CD, or unplanned CD). Secondary outcomes included indications for CD, as well as neonatal and maternal outcomes.

Seventy-one women were included. Of these, 41% attempted VD, with 90% successfully delivering vaginally. Planned CD was chosen by 59%, mainly for fetal (64%) or maternal (19%) indications, or patient preference (17%). Neonatal mortality did not differ significantly between planned VD and CD (aOR: 0.29; 95% CI: 0.06-1.50; p = 0.14). However, neonates born via VD compared to CD had lower risks for sepsis (aOR: 0.19; 95% CI: 0.04-0.94; p = 0.04) and retinopathy of prematurity (aOR: 0.17; 95% CI: 0.03-0.93; p = 0.04). Neonates born after VD had higher risks of infant respiratory distress syndrome (OR: 2.70; 95% CI: 1.03-7.08; p = 0.04) and interventricular hemorrhage (OR: 4.00; 95% CI: 1.20-13.35; p = 0.02), though these associations were not significant after adjusting for gestational age (p = 0.92 and p = 0.32, respectively).

Women opting for VD in triplet pregnancies had a 90% success rate. VD can be safe after careful case selection and access to highly trained personnel at a tertiary center. Centralization might enhance safety and outcomes, offering essential insights for clinicians.