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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 Glinyanaya, Professor Judith Rankin, Dr Gareth Waring, Dr Stephen Sturgiss, Dr Therese Hannon

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

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Abstract

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

URL: https://doi.org/10.1002/uog.21987

DOI: 10.1002/uog.21987

PubMed id: 31997424


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