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

Glinianaia, SV; Rankin, J; Khalil, A; Binder, J; Waring, G; Curado, J; Pateisky, P; Thilaganathan, B; Sturgiss, SN; Hannon, T; et al. Glinianaia, SV; Rankin, J; Khalil, A; Binder, J; Waring, G; Curado, J; Pateisky, P; Thilaganathan, B; Sturgiss, SN; Hannon, T; NorSTAMP collaborators (2020) Effect of monochorionicity on perinatal outcomes and growth discordance in triplet pregnancies: a collaborative multicentre study in England, 2000-2013. Ultrasound Obstet Gynecol. ISSN 1469-0705 https://doi.org/10.1002/uog.21987
SGUL Authors: Thilaganathan, Baskaran

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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. This article is protected by copyright. All rights reserved.

Item Type: Article
Additional Information: This is the peer reviewed version of the following article: Glinianaia, S.V., Rankin, J., Khalil, A., Binder, J., Waring, G., Curado, J., Pateisky, P., Thilaganathan, B., Sturgiss, S.N., Hannon, T. and (2020), Effect of monochorionicity on perinatal outcomes and growth discordance in triplet pregnancies: a collaborative multicentre study in England, 2000–2013. Ultrasound Obstet Gynecol. Accepted Author Manuscript, which has been published in final form at https://doi.org/10.1002/uog.21987. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Keywords: Northern Survey of Twin and Multiple Pregnancy (NorSTAMP), STORK collaboration, congenital anomalies, monochorionic placentation, perinatal mortality, stillbirth, triplets, NorSTAMP collaborators, 1114 Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Ultrasound Obstet Gynecol
ISSN: 1469-0705
Language: eng
Dates:
DateEvent
29 January 2020Published Online
20 January 2020Accepted
PubMed ID: 31997424
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/111627
Publisher's version: https://doi.org/10.1002/uog.21987

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