Triplet Gestation- Prevention, Risks, & Management Dilemmas

ABSTRACT

The increased popularity of assisted reproductive technology [ART] has been associated with a significant increase in the incidence of multiple pregnancies. Indeed, 43.5 % of triplet and higher order multiple births in the US were generated by ART, 38.5% were attributed to ovulation-inducing drugs without ART, and 18% occurred spontaneously. The escalating frequencies of multiple gestations, combined with the inevitable increased risks for adverse perinatal outcomes, have a significant influence on the overall measures of neonates’ and infants’ health and well being. In addition, multifetal pregnancies are associated with increased risks of maternal complications such as preeclampsia and other hypertensive disorders, cesarean delivery, postpartum hemorrhage, anemia, diabetes, premature rupture of membranes, placental abruption, fatty liver, and maternal death. Three maternal preconception characteristics are associated with improved outcome of triplets: multiparous, older, and tall women fare better than nulliparous, younger, and shorter controls, respectively. Whereas many obstetricians recommend on iatrogenic multifetal reduction, it may increase the risk of miscarriage, premature rupture of membranes and adverse psychological effects. In triplet gestation where the couple, is reluctant to undergo this procedure for moral or religious reasons, or due to the fear of losing the long awaited pregnancy, the recent information whereby taller patients are at a significantly lower risk of very premature delivery as compared to shorter patients, may be helpful

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