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Effect of monochorionicity on perinatal outcomes and growth discordance in triplet pregnancies: a collaborative multicentre study in England, 2000-2013

Lookup NU author(s): Dr Svetlana Glinianaia, Professor Judith Rankin, Dr Gareth Waring, Dr Stephen Sturgiss, Dr Therese Hannon



This is the authors' accepted manuscript of an article that has been published in its final definitive form by Wiley, 2021.

For re-use rights please refer to the publisher's terms and conditions.


OBJECTIVES: To compare perinatal outcomes and growth discordance between trichorionic-triamniotic (TCTA) and dichorionic-triamniotic/monochorionic-triamniotic (DCTA/MCTA) triplets.METHODS: This multicentre cohort study used population-based data from 11 Northern Survey of Twin and Multiple Pregnancy (NorSTAMP) and the Southwest Thames Region of London Obstetric Research Collaborative (STORK) multiple pregnancy cohort for 2000-2013. Perinatal outcomes (from ≥ 24 weeks' gestation to the first 28 days of life), inter-triplet fetal growth and birth weight discordance, and neonatal morbidity were analysed in relation to chorionicity.RESULTS: Monochorionic placentation in a triplet pregnancy (n=72) was associated with a significantly increased risk of perinatal mortality (RR=2.7, 1.3-5.5) compared with TCTA pregnancies (n=68), mainly due to a much higher stillbirth risk (RR=5.4, 1.6-18.2), in 57% resulting from feto-fetal transfusion syndrome. This persisted in pregnancies not affected by a major congenital anomaly, but there was no significant difference in neonatal mortality (P=0.60). DCTA/MCTA triplets had lower birth weights and demonstrated higher rates of birth weight discordance than TCTA triplets (P=0.049). Severe BW discordance of greater than 35% was also 2.5-fold higher in DCTA/MCTA (26.1% vs 10.4%), but this did not reach statistical significance (P=0.06) presumably due to low numbers. Triplets in both groups were delivered by caesarean section in over 95% of cases at a similar gestational age (median=33 weeks' gestation). The frequencies of respiratory (P=0.28) or infectious (P=0.08) neonatal morbidity were also similar.CONCLUSIONS: Despite close antenatal surveillance, monochorionic placentation in a triplet pregnancy was associated with a significantly increased stillbirth risk, mainly due to feto-fetal transfusion syndrome and selective fetal growth restriction. For live born triplets there was no adverse effect of monochorionicity on neonatal outcomes.

Publication metadata

Author(s): Glinianaia SV, Rankin J, Khalil A, Binder J, Waring G, Curado J, Pateisky P, Thilaganathan B, Sturgiss SN, Hannon T

Publication type: Article

Publication status: Published

Journal: Ultrasound in Obstetrics & Gynecology

Year: 2021

Volume: 57

Issue: 3

Pages: 440-448

Print publication date: 01/03/2021

Online publication date: 29/01/2020

Acceptance date: 20/01/2020

Date deposited: 18/02/2020

ISSN (print): 0960-7692

ISSN (electronic): 1469-0705

Publisher: Wiley


DOI: 10.1002/uog.21987

PubMed id: 31997424


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