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Triplet pregnancy

Author
Edward J Hayes, MD
Section Editor
Susan M Ramin, MD
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

The rate of triplet and higher-order multiple births has increased due to medically assisted conception, particularly in vitro fertilization and controlled ovarian hyperstimulation with gonadotropins, in countries where this technology is widely available [1,2]. Increasing maternal age at conception has also contributed to the increased rate of triplet gestations. Triplet and higher-order births accounted for 119.5 per 100,000 births in the United States in 2013 [1] but only 32.3 per 100,000 births in 1977 (before in vitro fertilization) [3]. The rate of higher-order pregnancies has declined from its peak (193.5/100,000 in 1998 [1]) as a result of transfer of fewer embryos and an increase in fetal reduction procedures. (See "Pregnancy outcome after assisted reproductive technology", section on 'Proportion of singleton and multiple gestation'.)

Higher-order multiple gestations are associated with significantly increased risks of maternal and neonatal morbidity compared with twin and singleton gestations, primarily because almost all triplets are born preterm and at an earlier mean gestational age (mean gestational age of delivery for triplets, twins, and singletons: 31.9, 35.3, and 38.7 weeks, respectively [4]) [5,6]. (See 'Preterm birth' below.)

This topic will discuss the potential complications associated with triplet gestations and obstetric management of these pregnancies. Strategies to reduce the occurrence of higher-order multiple births are reviewed separately. (See "Strategies to control the rate of high order multiple gestation" and "Multifetal pregnancy reduction and selective termination".)

ANTEPARTUM MANAGEMENT

Women with triplet pregnancies should be counseled about the specific issues and risks associated with these pregnancies, management of complications, and the high probability of cesarean birth. An ultrasound is performed in the first or early second trimester to ascertain if the triplet pregnancy is trichorionic, fully monochorionic, or has a monochorionic twin pair to help guide counseling and management. Surveillance of triplet pregnancies includes more frequent ultrasound examinations and frequent office visits (discussed below), particularly after 20 weeks of gestation, due to the increased risk of maternal morbidity and perinatal morbidity and mortality. In the second half of pregnancy, these pregnancies are at increased risk for preterm delivery, preeclampsia, or fetal growth discordance when compared with singletons. Delivery planning with an onsite level III neonatal intensive care unit should be considered for women with triplet pregnancies. However, many other issues are the same as in any pregnancy. (See "Initial prenatal assessment and first-trimester prenatal care".)

Basic care

Weight gain and nutrition — Evidenced-based weight gain and nutritional guidelines for triplet pregnancies are lacking. We use the following gestational weight gain targets, which reflect the higher end of Institute of Medicine gestational weight gain guidelines for twins [7]:

                                                

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Literature review current through: Nov 2016. | This topic last updated: Tue Oct 18 00:00:00 GMT+00:00 2016.
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