Management and outcome of triplet pregnancy

The parameters involved in obstetrical follow-up of triplet pregnancies were evaluated in a retrospective study between 1975-1993 of the follow-up of 91 triplet pregnancies. During this long interval of time, many changes in management of triplets occurred. Considering these differences, two periods in the present study were compared: 1975-1986, which consists of a previously published retrospective analysis of 21 triplet pregnancies; and 1987-1993, during which the modalities of the 7-year follow-up described previously were applied to 70 triplet pregnancies. No improvement was observed between the two periods. Nineteen pregnancies were spontaneous. Thirty-seven allowed treatment with ovulation induction agents and 35 were due to in vitro Fertilization. Early diagnosis of multiple pregnancies allows installation measures for the prevention of prematurity. Management, initiated upon diagnosis, included home rest and a weekly follow-up at home by a midwife every week. Monthly consultations and ultrasounds were performed at the hospital. Hospitalization was not systematic but was done in cases of maternal complications. The mean term for the diagnosis of triplet pregnancy was 13.9 +/- 5.3 weeks. The mean gestational age was 33.4 weeks; 90% of the deliveries were by cesarean section. The mean weight of the neonates was 1716 g. The mean Apgar score at 1 and 5 m was 7.7 and 9.3, respectively. The perinatal mortality was 80 per 1000. The main neonatal complications resulted from prematurity. Authors compared rates of Hyaline Membrane Disease in infants of patients treated with corticosteroids and of patients who were not. Hyaline Membrane Disease occurred in 13% of the corticotherapy group and in 31% of the untreated group. The present study supports systematic corticotherapy between 28 and 34 weeks for triplet pregnancies.