Download PDF
Am J Perinatol 2017; 34(06): 599-605
DOI: 10.1055/s-0037-1600129
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Evaluation of Trichorionic versus Dichorionic Triplet Gestations from 2005 to 2016 in a Large, Referral Maternity Center

Danielle A. Peress
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
,
Alan M. Peaceman
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Lynn M. Yee
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Author Affiliations
Further Information

Publication History

28 December 2016

29 January 2017

Publication Date:
06 March 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Objective To evaluate trends in the proportions and outcomes of dichorionic–triamniotic (DT) compared with trichorionic–triamniotic (TT) triplet gestations.

Methods This is a retrospective cohort of all triplet gestations identified by first trimester ultrasound at an academic center between 2005 and 2016. Primary outcomes were the change in proportion of DT versus TT triplets over time and the number of fetuses at delivery. Secondary outcomes included differences in mode of conception and maternal/perinatal outcomes by chorionicity.

Results Of 258 identified triplet pregnancies, 65.5% (n = 169) were TT. The proportion of DT versus TT triplets increased from 2005 to 2016 (p < 0.001). Women with DT triplets were more likely to deliver a singleton (41.4 vs. 11.2%, p < 0.001). Mode of conception was known for 248 women, of whom 93.5% (n = 232) conceived through infertility treatment. Types of infertility treatment differed by chorionicity (p < 0.001), with DT triplets more likely to conceive through in vitro fertilization (88.3 vs. 60.7%). Women with DT delivered earlier than TT triplets (31.0 ± 5.0 vs. 33.1 ± 3.5 weeks; p = 0.03).

Conclusion The proportion of DT triplet gestations increased significantly over time. Women with DT triplets delivered on average 2 weeks earlier than TT triplets. Women with DT triplets were more likely to reduce to a singleton gestation.

Keywords

chorionicity - triplet gestation - triplet chorionicity - multifetal pregnancy reduction

Note

This abstract was presented as a poster presentation at the Society for Reproductive Investigation 62nd Annual Scientific Meeting, San Francisco, CA, in March 2015.


 

  • References

  • 1 Nakhuda GS, Sauer MV. Addressing the growing problem of multiple gestations created by assisted reproductive therapies. Semin Perinatol 2005; 29 (5) 355-362
    CrossrefPubMedGoogle Scholar
  • 2 Kulkarni AD, Jamieson DJ, Jones Jr HW , et al. Fertility treatments and multiple births in the United States. N Engl J Med 2013; 369 (23) 2218-2225
    CrossrefPubMedGoogle Scholar
  • 3 Lee MS, Evans BT, Stern AD, Hornstein MD. Economic implications of the Society for Assisted Reproductive Technology embryo transfer guidelines: healthcare dollars saved by reducing iatrogenic triplets. Fertil Steril 2016; 106 (1) 189-195.e3
    CrossrefPubMedGoogle Scholar
  • 4 Vitthala S, Gelbaya TA, Brison DR, Fitzgerald CT, Nardo LG. The risk of monozygotic twins after assisted reproductive technology: a systematic review and meta-analysis. Hum Reprod Update 2009; 15 (1) 45-55
    CrossrefPubMedGoogle Scholar
  • 5 Sobek Jr A, Zbořilová B, Procházka M , et al. High incidence of monozygotic twinning after assisted reproduction is related to genetic information, but not to assisted reproduction technology itself. Fertil Steril 2015; 103 (3) 756-760
    CrossrefPubMedGoogle Scholar
  • 6 Morlando M, Ferrara L, D'Antonio F , et al. Dichorionic triplet pregnancies: risk of miscarriage and severe preterm delivery with fetal reduction versus expectant management. Outcomes of a cohort study and systematic review. BJOG 2015; 122 (8) 1053-1060
    CrossrefPubMedGoogle Scholar
  • 7 Hruby E, Sassi L, Görbe E, Hupuczi P, Papp Z. The maternal and fetal outcome of 122 triplet pregnancies [in Hungarian]. Orv Hetil 2007; 148 (49) 2315-2328
    CrossrefPubMedGoogle Scholar
  • 8 Gonen R, Heyman E, Asztalos EV , et al. The outcome of triplet, quadruplet, and quintuplet pregnancies managed in a perinatal unit: obstetric, neonatal, and follow-up data. Am J Obstet Gynecol 1990; 162 (2) 454-459
    CrossrefPubMedGoogle Scholar
  • 9 Børlum KG. Third-trimester fetal death in triplet pregnancies. Obstet Gynecol 1991; 77 (1) 6-9
    PubMedGoogle Scholar
  • 10 Witteveen T, Van Den Akker T, Zwart JJ, Bloemenkamp KW, Van Roosmalen J. Severe acute maternal morbidity in multiple pregnancies: a nationwide cohort study. Am J Obstet Gynecol 2016; 214 (5) 641.e1-641.e10
    CrossrefPubMedGoogle Scholar
  • 11 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 (8) 587-590
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Bajoria R, Ward SB, Adegbite AL. Comparative study of perinatal outcome of dichorionic and trichorionic iatrogenic triplets. Am J Obstet Gynecol 2006; 194 (2) 415-424
    CrossrefPubMedGoogle Scholar
  • 13 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 (5) 659.e1-659.e5
    CrossrefPubMedGoogle Scholar
  • 14 Sunderam S, Kissin DM, Crawford SB , et al; Centers for Disease Control and Prevention (CDC) Assisted Reproductive Technology Surveillance - United States, 2013. MMWR Surveill Summ 2015; 64 (11) 1-25
    PubMedGoogle Scholar
  • 15 Wimalasundera RC. Selective reduction and termination of multiple pregnancies. Semin Fetal Neonatal Med 2010; 15 (6) 327-335
    CrossrefPubMedGoogle Scholar
  • 16 Papageorghiou AT, Avgidou K, Bakoulas V, Sebire NJ, Nicolaides KH. Risks of miscarriage and early preterm birth in trichorionic triplet pregnancies with embryo reduction versus expectant management: new data and systematic review. Hum Reprod 2006; 21 (7) 1912-1917
    CrossrefPubMedGoogle Scholar
  • 17 van de Mheen L, Everwijn SM, Knapen MF , et al. The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation. Am J Obstet Gynecol 2014; 211 (5) 536.e1-536.e6
    CrossrefPubMedGoogle Scholar
  • 18 van de Mheen L, Everwijn SM, Haak MC , et al. Outcome of multifetal pregnancy reduction in women with a dichorionic triamniotic triplet pregnancy to a singleton pregnancy: a retrospective nationwide cohort study. Fetal Diagn Ther 2016; 40 (2) 94-99
    CrossrefPubMedGoogle Scholar
  • 19 Chasen ST, Al-Kouatly HB, Ballabh P, Skupski DW, Chervenak FA. Outcomes of dichorionic triplet pregnancies. Am J Obstet Gynecol 2002; 186 (4) 765-767
    CrossrefPubMedGoogle Scholar
  • 20 Adegbite AL, Ward SB, Bajoria R. Perinatal outcome of spontaneously conceived triplet pregnancies in relation to chorionicity. Am J Obstet Gynecol 2005; 193 (4) 1463-1471
    CrossrefPubMedGoogle Scholar
  • 21 Kawaguchi H, Ishii K, Yamamoto R, Hayashi S, Mitsuda N ; Perinatal Research Network Group in Japan. Perinatal death of triplet pregnancies by chorionicity. Am J Obstet Gynecol 2013; 209 (1) 36.e1-36.e7
    CrossrefPubMedGoogle Scholar
  • 22 Kanter JR, Boulet SL, Kawwass JF, Jamieson DJ, Kissin DM. Trends and correlates of monozygotic twinning after single embryo transfer. Obstet Gynecol 2015; 125 (1) 111-117
    CrossrefPubMedGoogle Scholar
  • 23 Guilherme R, Drunat S, Delezoide A-L, Oury J-F, Luton D. Zygosity and chorionicity in triplet pregnancies: new data. Hum Reprod 2009; 24 (1) 100-105
    PubMedGoogle Scholar
  • 24 Shetty A, Smith AP. The sonographic diagnosis of chorionicity. Prenat Diagn 2005; 25 (9) 735-739
    CrossrefPubMedGoogle Scholar
  • 25 Tulandi T, King L, Zelkowitz P. Public funding of and access to in vitro fertilization. N Engl J Med 2013; 368 (20) 1948-1949
    CrossrefPubMedGoogle Scholar
  • 26 Chandra A, Stephen EH. Infertility service use among U.S. women: 1995 and 2002. Fertil Steril 2010; 93 (3) 725-736
    CrossrefPubMedGoogle Scholar
  • 27 Martin J, Osterman M, Toma M. Declines in Triplet and Higher-order Multiple Births in the United States, 1998–2014. NCHS Data Brief No. 243. Hyattsville, MD: National Center for Health Statistics; 2016
    Google Scholar