Triplet pregnancy the improving obstetrical outcome

Abstract

Objective: The aim of this study was to evaluate the obstetrical outcomes in patients with triplet pregnancy, with and without antenatal care. Study Design: Case Series. Place and Duration of Study: The study was conducted at the Department of Obstetrics and Gynaecology, Services Hospital Lahore, from 1st January 1998 to 31st December 2003. Patients and Methods: Twelve women, including 6 booked and 6 unbooked patients, with triplet pregnancies of ?24 weeks of gestation, who presented at the Department of Obstetrics and Gynaecology, during the study period, were selected. Obstetrical history, examination and antenatal records were assessed. Obstetrical outcomes including length of fetal gestational ages at delivery, birth weights, apgar scores and neonatal assessment, admission in neonatal intensive care and stillbirths / neonatal deaths were recorded. Data was tabulated and comparison of obstetrical outcomes between booked and unbooked patients was done. Results:. In analyses that were limited to triplet pregnancies presenting of >=24 weeks of gestation thus excluding those which could have ended in miscarriage. There were 6 unbooked patients who came to Labour ward with preterm labour, premature rupture of membranes or preeclampsia and were delivered in the Department. 6 patients with triplet pregnancy were booked in the first trimester and received antenatal care. The data was retrospectively collected over 6 years period. There were 6 nullipara and 6 multipara women in our study. The average maternal age was 30.3 years (range 24-36 years) and average maternal weight was 63.25 Kg (range 53 - 75 kg). 10 patients had conceived by ovulation induction and 2 patients had conceived spontaneously. The average gestational age at delivery in unbooked patients was 32 weeks (range 29-35 weeks) and was 34.8 weeks (range 33 - 37 weeks) in booked patients. Caesarean section was the preferred mode of delivery. However, two unbooked patients presented in active labour at 29 and 30 weeks delivered vaginally. Among the booked patients 15 babies were live-born with apgar score `, two babies required admission in neonatal nursery and were discharged on recovery, however one baby died of sepsis in nursery after 4 days and there were no intrauterine deaths. Among the unbooked patients only 3 babies were live-born with apgar score >=7, five babies were admitted in neonatal nursery and recovered within a week. 7 babies died in the first week of life, mostly due to complications of prematurity. There were three intrauterine fetal deaths among the unbooked patients. Conclusion: It was concluded from the study that with antenatal management the obstetrical outcomes of triplet pregnancy improves.