Abstract：
OBJECTIVE: Monochorionic (MC) triplet pregnancies are extremely rare and information on these pregnancies and their complications is limited. We aimed to investigate the risk of early and late pregnancy complications, perinatal outcome and the timing and methods of fetal intervention in these pregnancies.
METHODS: This was a multicenter retrospective cohort study of MC triamniotic (TA) triplet pregnancies managed in 21 participating centers around the world from 2007 onwards. Data on maternal age, mode of conception, diagnosis of major fetal structural anomalies or aneuploidy, gestational age (GA) at diagnosis of anomalies, twin-to-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence (TAPS), twin reversed arterial perfusion (TRAP) sequence and or selective fetal growth restriction (sFGR) were retrieved from patient records. Data on antenatal interventions were collected, including data on selective fetal reduction (three to two or three to one), laser surgery and any other active fetal intervention (including amniodrainage). Data on perinatal outcome were collected, including numbers of live birth, intrauterine demise, neonatal death, perinatal death and termination of fetus or pregnancy (TOP). Neonatal data such as GA at birth, birth weight, admission to neonatal intensive care unit and neonatal morbidity were also collected. Perinatal outcomes were assessed according to whether the pregnancy was managed expectantly or underwent fetal intervention.
RESULTS: Of an initial cohort of 174 MCTA triplet pregnancies, 11 underwent early TOP, three had an early miscarriage, six were lost to follow-up and one was ongoing at the time of writing. Thus, the study cohort included 153 pregnancies, of which the majority (92.8%) were managed expectantly. The incidence of pregnancy affected by one or more fetal structural abnormality was 13.7% (21/153) and that of TRAP sequence was 5.2% (8/153). The most common antenatal complication related to chorionicity was TTTS, which affected just over one quarter (27.6%; 42/152, after removing a pregnancy with TOP < 24 weeks for fetal anomalies) of the pregnancies, followed by sFGR (16.4%; 25/152), while TAPS (spontaneous or post TTTS with or without laser treatment) occurred in only 4.6% (7/152) of pregnancies. No monochorionicity-related antenatal complication was recorded in 49.3% (75/152) of pregnancies. Survival was apparently associated largely with the development of these complications: there was at least one survivor beyond the neonatal period in 85.1% (57/67) of pregnancies without antenatal complications, in 100% (25/25) of those complicated by sFGR and in 47.6% (20/42) of those complicated by TTTS. The overall rate of preterm birth prior to 28 weeks was 14.5% (18/124) and that prior to 32 weeks\' gestation was 49.2% (61/124).
CONCLUSIONS: Monochorionicity-related complications, which can impact adversely perinatal outcome, occur in almost half of MCTA triplet pregnancies, creating a challenge with regard to counseling, surveillance and management. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
METHODS: This was a multicenter retrospective cohort study of MC triamniotic (TA) triplet pregnancies managed in 21 participating centers around the world from 2007 onwards. Data on maternal age, mode of conception, diagnosis of major fetal structural anomalies or aneuploidy, gestational age (GA) at diagnosis of anomalies, twin-to-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence (TAPS), twin reversed arterial perfusion (TRAP) sequence and or selective fetal growth restriction (sFGR) were retrieved from patient records. Data on antenatal interventions were collected, including data on selective fetal reduction (three to two or three to one), laser surgery and any other active fetal intervention (including amniodrainage). Data on perinatal outcome were collected, including numbers of live birth, intrauterine demise, neonatal death, perinatal death and termination of fetus or pregnancy (TOP). Neonatal data such as GA at birth, birth weight, admission to neonatal intensive care unit and neonatal morbidity were also collected. Perinatal outcomes were assessed according to whether the pregnancy was managed expectantly or underwent fetal intervention.
RESULTS: Of an initial cohort of 174 MCTA triplet pregnancies, 11 underwent early TOP, three had an early miscarriage, six were lost to follow-up and one was ongoing at the time of writing. Thus, the study cohort included 153 pregnancies, of which the majority (92.8%) were managed expectantly. The incidence of pregnancy affected by one or more fetal structural abnormality was 13.7% (21/153) and that of TRAP sequence was 5.2% (8/153). The most common antenatal complication related to chorionicity was TTTS, which affected just over one quarter (27.6%; 42/152, after removing a pregnancy with TOP < 24 weeks for fetal anomalies) of the pregnancies, followed by sFGR (16.4%; 25/152), while TAPS (spontaneous or post TTTS with or without laser treatment) occurred in only 4.6% (7/152) of pregnancies. No monochorionicity-related antenatal complication was recorded in 49.3% (75/152) of pregnancies. Survival was apparently associated largely with the development of these complications: there was at least one survivor beyond the neonatal period in 85.1% (57/67) of pregnancies without antenatal complications, in 100% (25/25) of those complicated by sFGR and in 47.6% (20/42) of those complicated by TTTS. The overall rate of preterm birth prior to 28 weeks was 14.5% (18/124) and that prior to 32 weeks\' gestation was 49.2% (61/124).
CONCLUSIONS: Monochorionicity-related complications, which can impact adversely perinatal outcome, occur in almost half of MCTA triplet pregnancies, creating a challenge with regard to counseling, surveillance and management. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
摘要：
目的：单胎三胎妊娠极为罕见，有关这些妊娠及其并发症的信息有限。我们旨在调查妊娠早期和晚期并发症的风险，围产期结局,以及在单绒毛膜三胎妊娠中进行胎儿干预的时机和方法。
方法：这是一项多中心回顾性队列研究，包括单绒毛膜羊膜（MCTA）三胎妊娠。排除标准是双胞胎，或高于三胞胎的多胎妊娠（例如四胞胎，五重奏)，和二胎或三胎三胎妊娠。产妇年龄数据，观念模式，诊断主要胎儿结构异常或非整倍性，诊断异常时的胎龄（GA），双胞胎对双胞胎输血综合征（TTTS），双胎贫血红细胞增多症综合征（TAPS），双反向动脉灌注序列（TRAP），或从患者记录中确定选择性胎儿生长受限(sFGR).收集了产前干预措施的数据，包括选择性（胎儿）减少（3到2或3到1），激光手术,或任何积极的胎儿干预（包括羊膜引流）。最后,围产期结局包括活产，宫内消亡（宫内节育器），新生儿死亡（NND），围产期死亡（PND）和终止妊娠（TOP）。新生儿数据，如出生时的GA，出生体重,新生儿重症监护病房（NICU）入院，和新生儿发病率也被收集。
结果：在我们的MCTA三胎妊娠队列中（排除早期流产后，n=153，TOP和后续损失)，大多数（90％）得到了预期的管理。胎儿畸形和TRAP的发生率分别为13.7%和5.2%,分别。与绒毛膜相关的最常见的产前并发症是TTTS，使超过四分之一（27.6%）的怀孕复杂化，其次是sFGR（16.4%），而TAPS（自发和激光后）仅发生在3.3％；在49.3％的妊娠中未记录到产前并发症。生存率在很大程度上与这些并发症的发展有关：85.1％，100%和47.6%的孕妇在没有产前并发症的人中至少有一名存活的新生儿，复杂的sFGR，或者被TTTS复杂化，分别。妊娠28周前和妊娠32周前的总早产率为14.5%和49.2%，分别。
结论：MCTA三胎妊娠在咨询方面是一个挑战，作为单绒毛膜相关并发症的监测和管理，几乎一半的妊娠发生，这对他们的围产期结局产生了负面影响。本文受版权保护。保留所有权利。
方法：这是一项多中心回顾性队列研究，包括单绒毛膜羊膜（MCTA）三胎妊娠。排除标准是双胞胎，或高于三胞胎的多胎妊娠（例如四胞胎，五重奏)，和二胎或三胎三胎妊娠。产妇年龄数据，观念模式，诊断主要胎儿结构异常或非整倍性，诊断异常时的胎龄（GA），双胞胎对双胞胎输血综合征（TTTS），双胎贫血红细胞增多症综合征（TAPS），双反向动脉灌注序列（TRAP），或从患者记录中确定选择性胎儿生长受限(sFGR).收集了产前干预措施的数据，包括选择性（胎儿）减少（3到2或3到1），激光手术,或任何积极的胎儿干预（包括羊膜引流）。最后,围产期结局包括活产，宫内消亡（宫内节育器），新生儿死亡（NND），围产期死亡（PND）和终止妊娠（TOP）。新生儿数据，如出生时的GA，出生体重,新生儿重症监护病房（NICU）入院，和新生儿发病率也被收集。
结果：在我们的MCTA三胎妊娠队列中（排除早期流产后，n=153，TOP和后续损失)，大多数（90％）得到了预期的管理。胎儿畸形和TRAP的发生率分别为13.7%和5.2%,分别。与绒毛膜相关的最常见的产前并发症是TTTS，使超过四分之一（27.6%）的怀孕复杂化，其次是sFGR（16.4%），而TAPS（自发和激光后）仅发生在3.3％；在49.3％的妊娠中未记录到产前并发症。生存率在很大程度上与这些并发症的发展有关：85.1％，100%和47.6%的孕妇在没有产前并发症的人中至少有一名存活的新生儿，复杂的sFGR，或者被TTTS复杂化，分别。妊娠28周前和妊娠32周前的总早产率为14.5%和49.2%，分别。
结论：MCTA三胎妊娠在咨询方面是一个挑战，作为单绒毛膜相关并发症的监测和管理，几乎一半的妊娠发生，这对他们的围产期结局产生了负面影响。本文受版权保护。保留所有权利。
