Abstract：
OBJECTIVE: Premature births are a health problem arising in triplet pregnancies, resulting in high levels of morbidity and mortality. The objective of this study is to evaluate the utility of cervical pessaries in reducing prematurity (<34 weeks) in triplet pregnancies.
METHODS: This is a single-center, retrospective case-control study regarding triplet pregnancies with follow-up at the La Paz University Hospital between 2000 and 2023. Maternal characteristics, obstetric and perinatal outcomes, and the use of cervical pessaries were examined.
RESULTS: 165 triplet pregnancies were analyzed: 87 (52.7 %) in the case group (premature triplet pregnancies) and 78 in the control group (non-premature triplet pregnancies). A cervical pessary was inserted in 15 (17.2 %) triplet pregnancies in the case group and in 12 (16.7 %) triplet pregnancies in the control group (p = 0.92; OR = 1.04 (0.46-2.35)). A pessary was later inserted in the non-premature group (p = 0.01). The risk of preterm labor and the use of tocolytics ± glucocorticoids were found to be significantly more frequent in the premature group, with p = 0.01; OR = 2.30 (1.21-4.36) and p < 0.01; OR = 2.36 (1.23-4.44), respectively. Protocol-based cesarean sections were more frequent in the non-premature group (p < 0.01), while cesarean sections due to maternal complications (p < 0.01) and premature membrane rupture (p < 0.01) were more frequent in the premature group.
CONCLUSIONS: The cervical pessary is not useful in preventing preterm births (< 34 weeks) in triplet pregnancies. It is likely that being pregnant with triplets is a powerful independent factor associated with prematurity, despite other pregnancy conditions. Women who are pregnant with triplets and at risk of preterm labor and those taking tocolytics ± glucocorticoids may benefit from pessary insertion.
METHODS: This is a single-center, retrospective case-control study regarding triplet pregnancies with follow-up at the La Paz University Hospital between 2000 and 2023. Maternal characteristics, obstetric and perinatal outcomes, and the use of cervical pessaries were examined.
RESULTS: 165 triplet pregnancies were analyzed: 87 (52.7 %) in the case group (premature triplet pregnancies) and 78 in the control group (non-premature triplet pregnancies). A cervical pessary was inserted in 15 (17.2 %) triplet pregnancies in the case group and in 12 (16.7 %) triplet pregnancies in the control group (p = 0.92; OR = 1.04 (0.46-2.35)). A pessary was later inserted in the non-premature group (p = 0.01). The risk of preterm labor and the use of tocolytics ± glucocorticoids were found to be significantly more frequent in the premature group, with p = 0.01; OR = 2.30 (1.21-4.36) and p < 0.01; OR = 2.36 (1.23-4.44), respectively. Protocol-based cesarean sections were more frequent in the non-premature group (p < 0.01), while cesarean sections due to maternal complications (p < 0.01) and premature membrane rupture (p < 0.01) were more frequent in the premature group.
CONCLUSIONS: The cervical pessary is not useful in preventing preterm births (< 34 weeks) in triplet pregnancies. It is likely that being pregnant with triplets is a powerful independent factor associated with prematurity, despite other pregnancy conditions. Women who are pregnant with triplets and at risk of preterm labor and those taking tocolytics ± glucocorticoids may benefit from pessary insertion.
摘要：
目的：早产是三胞胎妊娠中出现的健康问题，导致高发病率和死亡率。这项研究的目的是评估宫颈子宫托在减少三胎妊娠早产（<34周）中的实用性。
方法：这是一个单中心，2000年至2023年在拉巴斯大学医院进行的三胎妊娠回顾性病例对照研究及随访.产妇特征,产科和围产期结局，并检查了宫颈子宫托的使用情况。
结果：分析了165例三胎妊娠：病例组（早产三胎妊娠）87例（52.7%），对照组（非早产三胎妊娠）78例。在病例组中的15例（17.2％）三胎妊娠和对照组的12例（16.7％）三胎妊娠中插入了宫颈子宫托（p=0.92；OR=1.04（0.46-2.35））。后来在非早产组中插入子宫托（p=0.01）。在早产组中，早产的风险和使用保胎剂±糖皮质激素的频率明显更高。p=0.01；OR=2.30（1.21-4.36），p<0.01；OR=2.36（1.23-4.44），分别。基于方案的剖宫产在非早产组中更常见（p<0.01），而早产组产妇并发症(p<0.01)和胎膜早破(p<0.01)引起的剖宫产发生率更高。
结论：在三胞胎妊娠中，宫颈子宫托对预防早产（<34周）没有用。怀孕三胞胎很可能是与早产相关的一个强大的独立因素，尽管其他怀孕条件。怀孕三胞胎并有早产风险的妇女以及服用保胎剂±糖皮质激素的妇女可能会从子宫托插入中受益。
方法：这是一个单中心，2000年至2023年在拉巴斯大学医院进行的三胎妊娠回顾性病例对照研究及随访.产妇特征,产科和围产期结局，并检查了宫颈子宫托的使用情况。
结果：分析了165例三胎妊娠：病例组（早产三胎妊娠）87例（52.7%），对照组（非早产三胎妊娠）78例。在病例组中的15例（17.2％）三胎妊娠和对照组的12例（16.7％）三胎妊娠中插入了宫颈子宫托（p=0.92；OR=1.04（0.46-2.35））。后来在非早产组中插入子宫托（p=0.01）。在早产组中，早产的风险和使用保胎剂±糖皮质激素的频率明显更高。p=0.01；OR=2.30（1.21-4.36），p<0.01；OR=2.36（1.23-4.44），分别。基于方案的剖宫产在非早产组中更常见（p<0.01），而早产组产妇并发症(p<0.01)和胎膜早破(p<0.01)引起的剖宫产发生率更高。
结论：在三胞胎妊娠中，宫颈子宫托对预防早产（<34周）没有用。怀孕三胞胎很可能是与早产相关的一个强大的独立因素，尽管其他怀孕条件。怀孕三胞胎并有早产风险的妇女以及服用保胎剂±糖皮质激素的妇女可能会从子宫托插入中受益。
