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Triplets and Beyond
Anne Kennedy, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Synonyms

            • Higher order multiple gestation
            • Multifetal pregnancy
          • Definitions

            • 3 or more fetuses
              • Separate or shared chorionic sacs
              • Separate or shared amniotic sacs

          IMAGING

          • Ultrasonographic Findings

            • Imaging Recommendations

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • General Features

                  • Gross Pathologic & Surgical Features

                    CLINICAL ISSUES

                    • Presentation

                      • Demographics

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Consider

                              • Reporting Tips

                                Selected References

                                1. Gibson JL et al: Updated guidance for the management of twin and triplet pregnancies from the National Institute for Health and Care Excellence guidance, UK: what's new that may improve perinatal outcomes? Acta Obstet Gynecol Scand. 99(2):147-52, 2020
                                2. Curado J et al: Perinatal mortality and morbidity in triplet pregnancy according to chorionicity: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 54(5):589-95, 2019
                                3. Dyr B et al: A new era in aneuploidy screening: cfDNA testing in >30,000 multifetal gestations: experience at one clinical laboratory. PLoS One. 14(8):e0220979, 2019
                                4. Mol BW et al: Perinatal outcomes according to the mode of delivery in women with a triplet pregnancy in The Netherlands. J Matern Fetal Neonatal Med. 32(22):3771-7, 2019
                                5. NICE: Twin and triplet pregnancy NICE guideline [NG137]. Published September 2019. Reviewed January 2021. Accessed January 2021. https://www.nice.org.uk/guidance/NG137
                                6. Yokoyama Y: The new West Japan Twins and Higher Order Multiple Births Registry. Twin Res Hum Genet. 22(6):602-5, 2019
                                7. Fichera A et al: Cervical-length measurement in mid-gestation to predict spontaneous preterm birth in asymptomatic triplet pregnancy. Ultrasound Obstet Gynecol. 51(5):614-20, 2018
                                8. Zipori Y et al: Multifetal pregnancy reduction of triplets to twins compared with non-reduced triplets: a meta-analysis. Reprod Biomed Online. 35(3):296-304, 2017
                                9. Committee on Practice Bulletins—Obstetrics. et al: Practice bulletin no. 169: multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. Obstet Gynecol. 128(4):e131-46, 2016
                                10. Fennessy KM et al: Triplet pregnancy: is the mode of conception related to perinatal outcomes? Twin Res Hum Genet. 18(3):321-7, 2015
                                11. Morlando M et al: Dichorionic triplet pregnancies: risk of miscarriage and severe preterm delivery with fetal reduction versus expectant management. Outcomes of a cohort study and systematic review. BJOG. 122(8):1053-60, 2015
                                12. Dutta A et al: Evidence-based triplet delivery: avoiding rocks and hard places. J Obstet Gynaecol. 34(5):439-41, 2014
                                13. Haas J et al: Pregnancy outcome of early multifetal pregnancy reduction: triplets to twins versus triplets to singletons. Reprod Biomed Online. 29(6):717-21, 2014
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Imaging

                                    • Clinical Issues

                                      • Diagnostic Checklist

                                        TERMINOLOGY

                                        • Synonyms

                                          • Higher order multiple gestation
                                          • Multifetal pregnancy
                                        • Definitions

                                          • 3 or more fetuses
                                            • Separate or shared chorionic sacs
                                            • Separate or shared amniotic sacs

                                        IMAGING

                                        • Ultrasonographic Findings

                                          • Imaging Recommendations

                                            DIFFERENTIAL DIAGNOSIS

                                              PATHOLOGY

                                              • General Features

                                                • Gross Pathologic & Surgical Features

                                                  CLINICAL ISSUES

                                                  • Presentation

                                                    • Demographics

                                                      • Natural History & Prognosis

                                                        • Treatment

                                                          DIAGNOSTIC CHECKLIST

                                                          • Consider

                                                            • Reporting Tips

                                                              Selected References

                                                              1. Gibson JL et al: Updated guidance for the management of twin and triplet pregnancies from the National Institute for Health and Care Excellence guidance, UK: what's new that may improve perinatal outcomes? Acta Obstet Gynecol Scand. 99(2):147-52, 2020
                                                              2. Curado J et al: Perinatal mortality and morbidity in triplet pregnancy according to chorionicity: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 54(5):589-95, 2019
                                                              3. Dyr B et al: A new era in aneuploidy screening: cfDNA testing in >30,000 multifetal gestations: experience at one clinical laboratory. PLoS One. 14(8):e0220979, 2019
                                                              4. Mol BW et al: Perinatal outcomes according to the mode of delivery in women with a triplet pregnancy in The Netherlands. J Matern Fetal Neonatal Med. 32(22):3771-7, 2019
                                                              5. NICE: Twin and triplet pregnancy NICE guideline [NG137]. Published September 2019. Reviewed January 2021. Accessed January 2021. https://www.nice.org.uk/guidance/NG137
                                                              6. Yokoyama Y: The new West Japan Twins and Higher Order Multiple Births Registry. Twin Res Hum Genet. 22(6):602-5, 2019
                                                              7. Fichera A et al: Cervical-length measurement in mid-gestation to predict spontaneous preterm birth in asymptomatic triplet pregnancy. Ultrasound Obstet Gynecol. 51(5):614-20, 2018
                                                              8. Zipori Y et al: Multifetal pregnancy reduction of triplets to twins compared with non-reduced triplets: a meta-analysis. Reprod Biomed Online. 35(3):296-304, 2017
                                                              9. Committee on Practice Bulletins—Obstetrics. et al: Practice bulletin no. 169: multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. Obstet Gynecol. 128(4):e131-46, 2016
                                                              10. Fennessy KM et al: Triplet pregnancy: is the mode of conception related to perinatal outcomes? Twin Res Hum Genet. 18(3):321-7, 2015
                                                              11. Morlando M et al: Dichorionic triplet pregnancies: risk of miscarriage and severe preterm delivery with fetal reduction versus expectant management. Outcomes of a cohort study and systematic review. BJOG. 122(8):1053-60, 2015
                                                              12. Dutta A et al: Evidence-based triplet delivery: avoiding rocks and hard places. J Obstet Gynaecol. 34(5):439-41, 2014
                                                              13. Haas J et al: Pregnancy outcome of early multifetal pregnancy reduction: triplets to twins versus triplets to singletons. Reprod Biomed Online. 29(6):717-21, 2014