Maternal and perinatal outcomes in triplet pregnancy : an audit over 12 years at Inkosi Albert Luthuli Central Hospital.

Abstract

Aim: To determine maternal and neonatal outcomes in triplet gestation. Study Design: Retrospective observational study. Place and Duration of Study: Obstetric and Gynaecological Department, Inkosi Albert Luthuli Central Hospital, Durban from January 2003 to December 2014. Patients and Methods: A retrospective analysis of all triplet pregnancies referred from nearby and outlying hospitals that were delivered at IALCH over a 12-year period was done. Results: Eighty-nine women with triplet pregnancy were studied. Eighty-eight (98.9%) of the women were conceived spontaneously while 1 (1.1%) with the use of ovulation induction. Seventy-seven (86.5%) were booked for antenatal care at the base hospital. Mean duration of gestation was 30.8 weeks. The antenatal complications were preterm delivery in 62%, hypertension in 11%, anaemia in 26 % and preterm premature rupture of membranes in 17% of patients. Nine patients (10%) suffered postpartum haemorrhage. Seventy-five sets of triplets were delivered abdominally. Mean birth weights of the 1st, 2nd and 3rd triplet were 1497, 1499 and 1427 grams respectively. The mean Apgar scores of the 1st, 2nd and 3rd triplet at 1 and 5 minutes after birth were 7.3 and 8.5, 7.2 and 8.4; and 7.0 and 8.3 respectively. Of the 258 infants, 230 (89%) required neonatal intensive care unit admission. Total perinatal mortalities were 36 (13.5%) including 9 cases of intra-uterine demise. One hundred and nine suffered respiratory distress syndrome, 39 had neonatal jaundice and 19 had sepsis. Conclusion: Triplet pregnancies had a high rate of feto-maternal complications in keeping with other retrospective studies. Risk factors in cases of premature delivery at IALCH included a birth weight of less than 1500 g, gestational age of less than 28 weeks and a maternal age between 25-39 years. Caesarean section was the MOD associated with better neonatal outcomes.