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Triplets and Beyond
Anne M. 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. Fennessy KM et al: Triplet pregnancy: is the mode of conception related to perinatal outcomes? Twin Res Hum Genet. 18(3):321-7, 2015
                                2. 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
                                3. American College of Obstetricians and Gynecologists et al: ACOG Practice Bulletin No. 144: Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. Obstet Gynecol. 123(5):1118-32, 2014
                                4. Dutta A et al: Evidence-based triplet delivery: avoiding rocks and hard places. J Obstet Gynaecol. 34(5):439-41, 2014
                                5. 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
                                6. Martin JA et al: Births in the United States, 2013. NCHS Data Brief. 1-8, 2014
                                7. Rafael TJ et al: Cervical stitch (cerclage) for preventing preterm birth in multiple pregnancy. Cochrane Database Syst Rev. 9:CD009166, 2014
                                8. Shiva M et al: Comparison of the outcomes between reduced and nonreduced triplet pregnancies achieved by Assisted Reproductive Technology. Aust N Z J Obstet Gynaecol. 54(5):424-7, 2014
                                9. van de Mheen L et al: The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation. Am J Obstet Gynecol. 211(5):536.e1-6, 2014
                                10. van de Mheen L et al: Prediction of preterm birth in multiple pregnancies: development of a multivariable model including cervical length measurement at 16 to 21 weeks' gestation. J Obstet Gynaecol Can. 36(4):309-19, 2014
                                11. Abi-Nader K et al: Dichorionic triamniotic triplet pregnancy complicated by acardius acormus. Fetal Diagn Ther. 26(1):45-9, 2009
                                12. De Lia JE et al: Placental laser surgery for severe previable feto-fetal transfusion syndrome in triplet gestation. Am J Perinatol. 26(8):559-64, 2009
                                13. Guilherme R et al: Ultrasound assessment of the prognosis in triplet pregnancies. Acta Obstet Gynecol Scand. 88(4):386-90, 2009
                                14. Sepulveda W et al: Nuchal translucency and nasal bone in first-trimester ultrasound screening for aneuploidy in multiple pregnancies. Ultrasound Obstet Gynecol. 33(2):152-6, 2009
                                15. Guilherme R et al: Zygosity and chorionicity in the prognosis of triplet pregnancies: contribution of microsatellites. Twin Res Hum Genet. 11(6):648-55, 2008
                                16. Papageorghiou AT et al: Intrauterine growth in multiple pregnancies in relation to fetal number, chorionicity and gestational age. Ultrasound Obstet Gynecol. 32(7):890-3, 2008
                                17. Nakash A et al: Vaginal triplet delivery. J Obstet Gynaecol. 27(8):861-2, 2007
                                18. Blickstein I: Growth aberration in multiple pregnancy. Obstet Gynecol Clin North Am. 32(1):39-54, 2005
                                19. Bhide A et al: What prenatal diagnosis should be offered in multiple pregnancy? Best Pract Res Clin Obstet Gynaecol. 18(4):531-42, 2004
                                20. Brambati B et al: First-trimester fetal reduction to a singleton infant or twins: outcome in relation to the final number and karyotyping before reduction by transabdominal chorionic villus sampling. Am J Obstet Gynecol. 191(6):2035-40, 2004
                                21. Magee BD: Role of multiple births in very low birth weight and infant mortality. J Reprod Med. 49(10):812-6, 2004
                                22. Topp M et al: Multiple birth and cerebral palsy in Europe: a multicenter study. Acta Obstet Gynecol Scand. 83(6):548-53, 2004
                                23. Salihu HM et al: Potentially preventable excess mortality among higher-order multiples. Obstet Gynecol. 102(4):679-84, 2003
                                24. Farkouh LJ et al: Delayed-interval delivery: extended series from a single maternal-fetal medicine practice. Am J Obstet Gynecol. 183(6):1499-503, 2000
                                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. Fennessy KM et al: Triplet pregnancy: is the mode of conception related to perinatal outcomes? Twin Res Hum Genet. 18(3):321-7, 2015
                                                              2. 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
                                                              3. American College of Obstetricians and Gynecologists et al: ACOG Practice Bulletin No. 144: Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. Obstet Gynecol. 123(5):1118-32, 2014
                                                              4. Dutta A et al: Evidence-based triplet delivery: avoiding rocks and hard places. J Obstet Gynaecol. 34(5):439-41, 2014
                                                              5. 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
                                                              6. Martin JA et al: Births in the United States, 2013. NCHS Data Brief. 1-8, 2014
                                                              7. Rafael TJ et al: Cervical stitch (cerclage) for preventing preterm birth in multiple pregnancy. Cochrane Database Syst Rev. 9:CD009166, 2014
                                                              8. Shiva M et al: Comparison of the outcomes between reduced and nonreduced triplet pregnancies achieved by Assisted Reproductive Technology. Aust N Z J Obstet Gynaecol. 54(5):424-7, 2014
                                                              9. van de Mheen L et al: The effectiveness of multifetal pregnancy reduction in trichorionic triplet gestation. Am J Obstet Gynecol. 211(5):536.e1-6, 2014
                                                              10. van de Mheen L et al: Prediction of preterm birth in multiple pregnancies: development of a multivariable model including cervical length measurement at 16 to 21 weeks' gestation. J Obstet Gynaecol Can. 36(4):309-19, 2014
                                                              11. Abi-Nader K et al: Dichorionic triamniotic triplet pregnancy complicated by acardius acormus. Fetal Diagn Ther. 26(1):45-9, 2009
                                                              12. De Lia JE et al: Placental laser surgery for severe previable feto-fetal transfusion syndrome in triplet gestation. Am J Perinatol. 26(8):559-64, 2009
                                                              13. Guilherme R et al: Ultrasound assessment of the prognosis in triplet pregnancies. Acta Obstet Gynecol Scand. 88(4):386-90, 2009
                                                              14. Sepulveda W et al: Nuchal translucency and nasal bone in first-trimester ultrasound screening for aneuploidy in multiple pregnancies. Ultrasound Obstet Gynecol. 33(2):152-6, 2009
                                                              15. Guilherme R et al: Zygosity and chorionicity in the prognosis of triplet pregnancies: contribution of microsatellites. Twin Res Hum Genet. 11(6):648-55, 2008
                                                              16. Papageorghiou AT et al: Intrauterine growth in multiple pregnancies in relation to fetal number, chorionicity and gestational age. Ultrasound Obstet Gynecol. 32(7):890-3, 2008
                                                              17. Nakash A et al: Vaginal triplet delivery. J Obstet Gynaecol. 27(8):861-2, 2007
                                                              18. Blickstein I: Growth aberration in multiple pregnancy. Obstet Gynecol Clin North Am. 32(1):39-54, 2005
                                                              19. Bhide A et al: What prenatal diagnosis should be offered in multiple pregnancy? Best Pract Res Clin Obstet Gynaecol. 18(4):531-42, 2004
                                                              20. Brambati B et al: First-trimester fetal reduction to a singleton infant or twins: outcome in relation to the final number and karyotyping before reduction by transabdominal chorionic villus sampling. Am J Obstet Gynecol. 191(6):2035-40, 2004
                                                              21. Magee BD: Role of multiple births in very low birth weight and infant mortality. J Reprod Med. 49(10):812-6, 2004
                                                              22. Topp M et al: Multiple birth and cerebral palsy in Europe: a multicenter study. Acta Obstet Gynecol Scand. 83(6):548-53, 2004
                                                              23. Salihu HM et al: Potentially preventable excess mortality among higher-order multiples. Obstet Gynecol. 102(4):679-84, 2003
                                                              24. Farkouh LJ et al: Delayed-interval delivery: extended series from a single maternal-fetal medicine practice. Am J Obstet Gynecol. 183(6):1499-503, 2000