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This article describes a clinical case of vaginal delivery in nulliparous women 24 years old delayed interval delivery of the second and third fetuses in spontaneous multiple pregnancy dichorionic triamniotic triplet in a tertiary perinatal center. After preterm delivery in 27+5 weeks of gestation the first fetus to reduce perinatal morbidity and mortality of two fetuses that are left in the uterus, with informed consent of the woman preterm delivery the second and third fetuses occurred at intervals of 38 days, in 33+1 weeks of gestation. Careful monitoring of the state of the mother and fetuses was conducted. To increase the interval between the birth of the first fetus and the second and the third fetuses, prevention of obstetric and perinatal complications used tocolysis, antibiotics, progesterone, the prevention of respiratory distress syndrome of the newborn by corticosteroids and bed rest. Three girls were born alive with a weight of 980, 1800 and 1950 grams correspondingly. Childbirth complicated second degree perineal laceration and retained portions of placenta and membranes, puerperal period was uneventful. After 1.5 months, all infants discharged with her mother in a satisfactory condition with a weight of more than 3000 grams. Key words: multiple pregnancy, triplet pregnancy, delayed interval delivery in triplet pregnancy, preterm delivery.

BACKGROUND: Preterm birth complicates almost all triplet pregnancies and no preventive strategy has proven effective. OBJECTIVE: To determine, using individual patient data (IPD) meta-analysis, whether the outcome of triplet pregnancy is affected by prophylactic administration of 17-hydroxyprogesterone caproate (17OHPc). SEARCH STRATEGY: We searched literature databases, trial registries and references in published articles. SELECTION CRITERIA: Randomised controlled trials (RCTs) of progestogens versus control that included women with triplet pregnancies. DATA COLLECTION AND ANALYSIS: Investigators from identified RCTs collaborated on the protocol and contributed their IPD. The primary outcome was a composite measure of adverse perinatal outcome. The secondary outcome was the rate of birth before 32 weeks of gestation. Other pre-specified outcomes included randomisation-to-delivery interval and rates of birth at

Introduction Heterotopic pregnancy is a rare condition characterized by the occurrence of two or more simultaneous pregnancies in two or more implantation sites. Aim To report a case of spontaneous ectopic pregnancy co-existing with twin living intra-uterine pregnancies of 10 weeks gestation. Case study A 29-years-old woman 10-weeks pregnant presented to the emergency department with acute abdomen. Transvaginal ultrasound revealed di-amniotic intrauterine living twins and right adnexal mass inseparable from the ovary. Laparoscopy revealed intact right tubal pregnancy managed by salpingostomy. Results and discussion Diagnosis of heterotopic ectopic is difficult as we cannot depend on β-subunit of human chorionic gonadotropin level because of the presence of a co-existent intrauterine pregnancy which affects the hormonal level and the false sense of security that may be present on visualizing an intrauterine pregnancy by ultrasonography (USG), therefore, it is important to visualize the adnexa even in the presence of an intrauterine pregnancy to avoid missing a possible co-existent ectopic pregnancy. Surgery is the gold standard treatment. Other treatment modalities as laparoscopic or transvaginal USG guided injection of hyperosmolar glucose or potassium chloride have less success rates. Conclusions It is important to scan the adnexa even in the presence of an intrauterine pregnancy to avoid missing a possible co-existent ectopic pregnancy. Surgery is the gold standard treatment, however, other modalities were described with less success.

The two terms, pseudocyesis and delusion of pregnancy, were frequently used for pseudopregnancy. Delusion of pregnancy is a special form of hypochondriacal/somatic delusion reported in various psychiatric and organic disorders. The origin of the delusion of pregnancy in schizophrenia has often been explained by psycho-analytic interpretations attributing wish fulfilling, protective role to false beliefs, and mother establishes an undisturbed union with her fetus during pregnancy, which eliminate loneliness and helplessness. The current case is a 49-year-old married female with an illness of total duration of 10 years. Initial symptoms were delusion of infidelity and persecution and 2nd and 3rd person auditory hallucination; however, the patient started reporting around 2 years back that she was pregnant and there were three female children inside her abdominal cavity rather than in uterus. She was firm on this belief and was not convinced by family members even giving evidence contrary to her belief like showing ultrasonography report. She firmly believed that these are gift of God, and they are special children who would be delivered through special procedure. Blood investigation revealed raised prolactin level, blood sugar and ultra sonography suggestive of cholelithisis. Patient's psychiatric symptoms including delusion of pregnancy were significantly improved with treatment, and medical and surgical comorbidities were managed with appropriate consultations.

Rate and number of multifetal gestations have increased dramatically largely due to infertility therapy. A number of pregnancies are multifetal to start with followed by spontaneous reduction of one or more embryos. The final outcomes of such pregnancies vary in relation to zygosity, chorionicity and gestational age. In this case report we present a triplet pregnancy resulting from controlled ovarian hyperstimulation followed by intrauterine-insemination in a primarily infertile patient and how it ended up into a singleton pregnancy with no conscious attempts at selective reduction or selective termination. While fighting with problem of multiple pregnancies which comes along with the widespread infertility treatment nature has its own miraculous way to get rid of such. Little patience and watchful expectancy from the part of obstetrician can achieve a healthy live baby without inadvertent complication.

We performed a dual-gate Doppler examination for a twin reversed arterial perfusion (TRAP) sequence in a monochorionic-triamniotic triplet pregnancy at 16 weeks of gestation and were able to identify the pump twin by arterial pulse rate synchronicity. We performed radiofrequency ablation to coagulate blood flow in the acardius at 16 weeks of gestation without any postoperative complication. At 29 weeks of gestation, we performed a cesarean section due to preterm rupture of the membranes and the patient delivered 1167/1237-g female neonates and a macerated acardius. Examination of the placenta revealed two thickened vessels from the pump twin to the acardius, which had been prenatally identified by dual-gate Doppler. This new technology launches the new field of noninvasive fetal identification for triplet TRAP sequence.

Conjoined twins are derived from division of a single fertilized ovum after the twelfth day of fertilization. Triplet conjoined twin is considered as a unique phenomenon that is accompanied with a wide variety of congenital abnormalities and also hazardous consequences for both fetuses and parents. We present an extremely rare case of conjoined twins in a triplet pregnancy with symmetric thoracoomphalopagus that was diagnosed in prenatal period by using ultrasound scanning and MRI. In triplet pregnancies, we should be aware about the possibility of conjoined twins. If there are severe congenital malformations, termination of pregnancy should be recommended immediately after the diagnosis regardless of gestational age, particularly in early gestational age.

The well-known hypervolemia associated with normal pregnancy averages 40 to 45 percent above blood volume in non-pregnant women after 32 to 34 weeks. The case was on Mrs. FN, 40 years old, a patient reffered due to sinus bradycardia before the insertion of permanent pacemaker. After 6 month-use of the permanent pacemaker, she became pregnant with triplet pregnancy. This case report evaluated the patient's condition from her hypervolemic condition to her cardiac function.

Introduction: The case of preeclampsia and triplet pregnancy is likely to cause hypertension in uncontrolled pregnant women if they are not managed properly, which may harm both the mother and the fetus. References for the treatment of similar cases are still uncommon. Therefore, this case study provides an overview of midwifery care management on cases of triplet pregnancy and severe preeclampsia.Case presentation: A case of exacerbated triplet pregnancy with severe preeclampsia is described in a 36-year-old woman who was recently detected at the third-trimester visit at 31 weeks four days' pregnancy.Conclusion: Management of patients with triplet pregnancies and severe preeclampsia is to perform standard antenatal care, ultrasound examinations in each trimester, hospital care, as well as psychological assistance.

Women with a multiple pregnancy are at increased risk of developing hypertensive disorders of pregnancy. We describe a case of a dichorionic triamniotic triplet pregnancy complicated by severe hypertension, proteinuria and maternal symptoms, fitting with the diagnosis of pre-eclampsia, apart from the early gestational age of only 16 weeks. After reduction of the monochorionic pair, the disease resolved and pre-eclampsia was diagnosed again at 30 weeks of gestation, resulting in a delivery on maternal indication at 33 weeks of gestation. In a review of the literature, we found six papers including eight cases on multifetal pregnancy reduction on maternal indication. Multifetal pregnancy reduction resulted in a prolongation of pregnancy of two to 21 weeks and may be considered in extreme early onset pre-eclampsia in dichorionic multiple pregnancies.

Background The management of the pregnancy after delivery of the first fetus during second trimester miscarriage or very early preterm birth has not been well defined. Objective To evaluate whether delayed interval delivery of the remaining fetus(es) in twins/triplets is associated with improved survival, when compared with immediate delivery, after miscarriage or very preterm birth of the first fetus in multiple pregnancy. Data sources PubMed, MEDLINE and Cochrane Library were systematically searched through January 2019. Study eligibility criteria (study design, populations, and interventions) The following eligibility criteria applied: full-text original article; included at least five cases of delayed interval delivery for remaining fetus(es); reported the survival rate of the first born and the remaining fetus(es). Study appraisal and synthesis methods K.W.C. and W.W. searched, screened and reviewed the articles. The quality of the studies was assessed according to the ‘Strengthening the Reporting of Observational studies in Epidemiology’ checklist. If possible data were stratified for assigned chorionicity. Effect sizes were pooled through meta-analysis. Results A total of 2295 published article and abstracts were identified. Only 16 studies met inclusion criteria. Meta-analysis of 492 pregnancies (432 twins (88%), 56 triplets (11%), 3 quadruplets and 1 quintuplets) showed delayed interval delivery significantly improved the perinatal survival of remaining fetus(es) compared to the first born (OR 5.22, 95% CI 2.95-9.25, I2 = 53%), before 20+0 weeks (OR 6.32, 95% CI 1.99-20.13, I2 = 0%), between 20+0 and 23+6 weeks (OR 3.31, 95% CI 1.95-5.63, I2 = 0%), and after 24+0 weeks (OR 1.92, 95% CI 1.21-3.05, I2 = 0%), in dichorionic twin pregnancy (OR 14.89, 95% CI 6.19, 35.84, I2 = 0%) and unselected triplet pregnancy (OR 2.33, 95% CI 1.02-5.32, I2 = 0%. ). Among the survivors, there were no significant differences in the short-term and long-term neonatal morbidities between the first born and the remaining fetus(es) . Serious maternal morbidity was reported in 39% (71/183) of pregnancy after delayed interval delivery. In addition, two cases were managed by post-partum hysterectomy and one reported post-operative uterovaginal fistula. There were no recorded cases of maternal mortality. Conclusions Delayed interval delivery when a fetus has delivered in a multiple pregnancy is an effective management option to increase the survival rate of the remaining fetus(es). About 39% of women may experience morbidity following this management option.

Of 816 patients who became clinically pregnant by assisted reproductive techniques between September 2000 and August 2004, we experienced 10 cases (1.2%) of monozygotic twinning, and in five of these 10 cases, implantation of another embryo resulted in dizygotic triplets. Here, we report these five cases of dizygotic triplets. Fresh embryo transfer was performed in all five cases. Intracytoplasmic sperm injection or assisted hatching was not carried out in these cases. Blastocyst transfer was performed in three cases. Three embryos were transferred in case 1 (40-year-old female). While only two embryos were transferred in the other four cases so as to avoid triplet pregnancy, triplet pregnancies were confirmed. Triplet pregnancy was maintained in three cases, but in the other two cases, monochorionic twinning resulted in miscarriage during the first trimester. For the three patients who delivered the triplets, while the postnatal growth has been normal for all nine babies, the mothers were hospitalized for a long period of time, and an emergency cesarean section was performed on two patients. Because triplet pregnancy could not be completely prevented even when only two embryos were transferred, physicians should be sure to obtain informed consent in similar cases. (Reprod Med Biol 2005; 4: 59-64).

Background: The aim of this study is to assess the post diagnostic outcome of Gestational Trophoblastic Disease, a heterogeneous group of disorders, in a government obstetrical tertiary care centre. Methods: The study was conducted in the Institute of Obstetrics & Gynecology, Madras Medical College as a retrospective study. A total of 75 cases were studied over a 3 year period from January 2012 to December 2015. The parameters which were studied included age group, antecedent pregnancy, beta hCG values, histopathological types and Treatment profile. Results: Of the 75 cases, 55 cases (73%) were in the 21-39 age group. The spectrum of disorders that were studied included 69 cases of complete mole, 2 cases of partial mole, 1 case of twin pregnancy with single live foetus and partial mole, 1 case of triplet pregnancy with two live foetuses and partial mole, 1 case of epithelioid trophoblastic tumour and 1 case of choriocarcinoma. Of the 75 cases, 16 cases underwent chemotherapy. No mortality was observed during the study period. Conclusions: Close monitoring and follow up with beta hCG values is of utmost importance in the management of Gestational trophoblastic disease. In cases of gestational trophoblastic neoplasia (GTN), WHO/FIGO scoring should be done and managed with chemotherapy according to the risk assessment.

Introduction: To decrease the risks associated with triplets pregnancies MFPR is preformed. The most frequently applied method is through ultrasound guided transabdominal injection of potassium chloride into the fetal heart or chest cavity at 11-14 weeks of gestation. Aim: The main objective of this study was to evaluate perinatal outcomes in triplet pregnancies after transabdominal MFPR as compared with ongoing triplet pregnancies and twin pregnancies. Material and methods: In this retrospective study, all women with trichorionic triplet pregnancies undergoing MFPR to a twin pregnancy, women with an ongoing trichorionic triplet pregnancy and with those with a primary dichorionic twin pregnancy were included. Results: Median gestation age at delivery was 35.6 ( interquartile range [IQR], 32.8-37 weeks) for triplets reduced to twins, 32.8 weeks (IQR, 27.6-34.7 weeks) for ongoing triplets, and 37 weeks ( IQR, 35.1-38.3 weeks) for primary twins (p

Background: Triplet pregnancies, though uncommon, occur with much higher maternal discomfort, morbidities, mortalities and perinatal morbidity and mortality when compared to singleton pregnancies. It is a well‑known fact that the incidence of triplet pregnancies differ in different regions of the world and even in different parts of the same country and that they are increasing around the world due to assisted reproductive technologies. The incidence and outcome of naturally occurring triplet pregnancies has never been evaluated in our center for us to know and have a baseline to compare any increase brought about by assisted reproduction along with other factors, and hence, we conducted this study.Materials and Methods: This is a retrospective study of all the cases of triplet pregnancies delivered in Mile Four Maternity Hospital, Abakaliki, Ebonyi state in southeast Nigeria from January 1995 to December 2005. The cases were from the antenatal, labour ward and theater registers, and relevant information were retrieved and analysed.Results: There were 22 triplet pregnancies over the 10‑year period under review and 23126 deliveries, giving an incidence of triplet pregnancy of 0.1% or 1 triplet pregnancy in 1051 deliveries. Many of the women 10 (45.5%) were in the 31–35 years age group, and half (11) were grand multiparas. Half of the gestational ages at delivery 11 (50%) were 35–37 weeks. The major antenatal complication was preterm labour in 5 or 22.7% of the women or half (50%) of the complications that occurred in the women. Two or 9.1% of the women had preeclampsia, 1 each or 4.5% had prolonged rupture of membrane, polyhydramnious and anaemia. Majority of the women, 18 (81.8%) were delivered vaginally and 4 (18.2%) by caesarean section. The babies had a weight range of 0.6–3.4 kg, with an average weight of 1.73 kg. Sixty babies (90.9%) were born alive and 6 (9.1%) were dead, giving a perinatal mortality rate of 91 babies per 1000. Of the alive babies, 42 (63.6%) had good Apgar score of 8–10 in 1 minute and 7 (19.6%) Apgar score of 1–4.Conclusion: Triplet pregnancies are rare and high risk pregnancies that are associated with many fetal and maternal complications that are of great importance to the parents, care giver, and the health system. Obstetricians must find ways to optimize the outcome of these pregnancies, especially now that the incidence is bound to increase due to assisted reproductive technologies.Keywords: Antenatal complications; Ebonyi State; incidence; increased medical bill; perinatal mortality; triplet pregnancies

Data on 393 002 parturitions and performance in the following production cycle were collected from the SYMLEK database for 145 457 Polish Holstein-Friesian cows representing the active population in the Pomorze and Kujawy regions. The animals first calved during 2000–2012 and were used or culled by the end of 2013. GLM and FREQ procedures of the SAS package were used for the statistical calculations. The frequency of twin and triplet births depended on the cow's age (0.64% in primiparous and 2.88% in multiparous cows), calving season (1.79% in winter, 2.41% in summer), previous lactation milk yield (increase of 2.15 to 3.73% with increasing milk production level), and year of calving of primiparous cows (increase from 0.43% during 2000–2003 to 0.78% during 2010–2012). Dams of twins were superior to dams of singles in terms of milk yield, but a significant difference was manifest only in multiparous cows. Despite the higher perinatal mortality of the twins and triplets (especially those born to primiparous cows), multiple pregnancy resulted in a greater number of calves born compared to single pregnancy. A negative effect of multiple pregnancies was a decrease in fertility, especially in multiparous cows (e.g. calving interval was longer by 18 days, reproductive rest period by 9 days, and service period by 10 days, while services per conception increased by 0.15). In addition, twin pregnancy (especially in heifers) and triplet pregnancy (especially in cows) considerably decreased chance of survival until the next calving.

Heterotopic pregnancies are an unusual phenomenon, which have recently become more prevalent with assisted reproductive technologies (ART). Triplets that are part of a heterotopic pregnancy are exceedingly rare. Here, we describe a case of a woman who presented at 15+1 weeks of gestational age with a known monochorionic-monoamniotic intrauterine pregnancy with several days of abdominal pain with an otherwise unremarkable gastrointestinal (GI) assessment. Salpingectomy was performed, and pathology revealed chorionic villi within the fallopian tube consistent with a heterotopic triplet pregnancy. This pregnancy was conceived spontaneously. Even without the prior use of ART, physicians need to be aware of the risk of heterotopic pregnancy in a patient with a known twin gestation. In addition, this case highlights how heterotopic triplets can present even within the second trimester.

We described the first case of para-commissural cleft of the lower lip in a 2 year-old child. He is from a trichorionic triamniotic triplet pregnancy after ovarian stimulation. He has no history except a selective fetal reduction of the mother. We correct this cleft of the lower lip with a double plasty of Malek. The functional and aesthetic result is satisfactory. This particular cleft cannot be explained by the embryological theory. We favor two hypothesis to explain this anomaly: a vascular origin with the stapedial artery and the selective fetal reduction.

WOS: 000426177100001, PubMed ID: 29666724, Hereditary angioedema due to C1-inhibitor deficiency (C1-INH-HAE) is a rare, autosomal dominant disorder. The management of pregnant patients with C1-INH-HAE is a challenge for the physician. Intravenous plasma-derived nanofiltered C1-INH (pdC1INH) is the only recommended option throughout pregnancy, postpartum, and breast feeding period. In order to increase pregnancy rates, physicians use fertilization therapies increasing endogen levels of estrogens. Therefore, these techniques can provoke an increase in the number and severity of edema attacks in C1-INH-HAE. Our patient is a 32-year-old female, diagnosed with C1-INH-HAE type 1 since 2004. She had been taking danazol 50-200 mg/day for 9 years. Due to her pregnancy plans in 2013, danazol was discontinued. PdC1INH was prescribed regularly for prophylactic purpose. Triplet pregnancy occurred by in vitro fertilization using luteinizing hormone-releasing hormone (LHRH) injections. In our patient, LHRH injections were done four times without causing any severe attack during in vitro fertilization. Angioedema did not worsen during pregnancy and delivery due to the prophylactic use of intravenous pdC1INH in our patient. According to the attack frequency and severity, there was no difference between the three pregnancy trimesters. To our knowledge, this is the first published case of C1-INH-HAE receiving in vitro fertilization therapies without any angioedema attacks during pregnancy and delivery and eventually having healthy triplets with the prophylactic use of intravenous pdC1INH.

The practice of assisted reproductive technology (“ART”) carries with it significant legal and ethical challenges, particularly in the area of third party reproduction. Because the physician's role will include treating both his/her patient (the intended parent(s)) and the “third party patient” (the gamete provider or surrogate), the physician should be aware of the potential for conflicting desires about medical treatment (i.e., an intended parent may desire a triplet pregnancy, while the surrogate may prefer to reduce). In addition, unlike other areas of medicine, the purpose of reproductive technology is to create a child, raising issues of disclosure and the rights of donor conceived offspring.

Background: This study examined the outcomes of triplet pregnancies selectively reduced to twin pregnancies, compared with non-reduced triplet pregnancies using a standardized approach. Methods: This study is an observational retrospective study of all women who presented to the Fetal Diagnostic Center between 1999 and 2009, had triplet pregnancies in the first trimester, received prenatal care and delivered at Abington Memorial Hospital. Data analysis was performed with SPPS version 15 for Windows using analysis of variance and Fisher’s exact test. Results: One hundred thirty-two triplet pregnancies were identified. In the reduced group (n = 30) compared to the non-reduced triplet group (n = 102), average gestational age of delivery was longer 34.6 weeks versus 31.2 weeks gestation (P ≤ 0.0005) and days in hospital were less 9.0 versus 26.7 days (P = 0.001). There was a significantly lower incidence of gestational diabetes and preterm labor in reduced pregnancies. Rate of loss, defined as delivery less than 24 weeks, was similar (3.3% versus 4.9%). Conclusion: Women electing to reduce a triplet pregnancy to twins have higher gestational ages at delivery, lower rates of gestational diabetes and preterm labor, and spend fewer days in hospital than non-reduced triplet pregnancies. J Clin Gynecol Obstet. 2015;4(1):160-163 doi: http://dx.doi.org/10.14740/jcgo322w

Intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) in nonhuman primates, e.g. rhesus and cynomolgus monkeys, has been widely used in researches of reproductive and developmental biology, and the success rate has been improved significantly. However, unwanted multiple pregnancy occurs frequently during the ICSI-ET in monkeys, most of which leads to miscarriages. To improve the birth rate of pregnancies and to safeguard health of host and baby monkeys, multifetal pregnancy reduction (MPR) is necessary. In this study, a total of 10 monkeys with multiple pregnancies received MPR through transabdominal ultrasound-guided potassium chloride injection into beating hearts of selective fetuses. To assess MPR efficiency, 31 monkeys with normal singleton pregnancies and 25 monkeys with twin pregnancies without MPR were used as controls. The aim of the reduction is to keep only one fetus, no matter twin or triplet pregnancy originally. Our results show that six cases of MPR were successful and all of them retained single fetus. Moreover, about 1 month (30.2 ± 1.2 days) of gestation is a better timing for MPR than later stage (50.7 ± 1.9 days). We also found that the remaining fetuses developed normally with full-term gestation and normal birth weight. In conclusion, transabdominal ultrasound-guided potassium chloride injection is a safe and effective MPR method for monkeys with multiple pregnancies.

Introduction Triplet and higher-order multiple pregnancies are well known to be associated with increased adverse outcomes. This study reviewed the perinatal outcomes in women with a triplet pregnancy who underwent fetal reduction versus expectant management at a university hospital in Hong Kong. Methods This was a retrospective review of triplet pregnancies at Prince of Wales Hospital in Hong Kong from 1 January 2008 to 30 September 2014. Women carrying a triplet pregnancy were classified as having had expectant management, fetal reduction to twins, or fetal reduction to a singleton. Maternal and pregnancy characteristics were compared. Outcome measures included fetal loss, gestational age at delivery, birth weight, neonatal survival rate, neonatal death, neonatal complications, and need for and length of neonatal intensive care unit stay. Results A total of 52 triplet pregnancies were identified. One pregnancy that was lost to follow-up and one that was terminated were excluded. The majority of pregnancies (84%) were the result of assisted reproductive technology. Fetal reduction was performed in 26 (52%) pregnancies, of which 22 were reduced to twins and four to a singleton. The mean gestations at delivery were 32.6, 35.2, and 39.6 weeks in the expectant management, fetal reduction to twins, and fetal reduction to a singleton groups, respectively. Significantly more pregnancies with expectant management resulted in a preterm birth. All pregnancies with fetal reduction to a singleton resulted in a term birth. A higher mean birth weight, lower neonatal death rate, and reduced need for admission to and length of stay in the neonatal intensive care unit were observed in the fetal reduction groups. Conclusions Approximately 50% of women with a triplet pregnancy in Hong Kong elected to undergo fetal reduction. This was associated with a significant reduction in extreme preterm delivery and associated morbidity and mortality.

Objective This study aims to determine the efficacy of multifetal pregnancy reduction (MFPR) in improving obstetrical outcomes for trichorionic triplet gestations. Study Design Retrospective cohort study of patients with multiple gestations delivered by a single maternal-fetal medicine practice from 2005 to 2016. We compared patients with trichorionic triamniotic triplet gestations who underwent MFPR to those with an ongoing triplet pregnancy (TT), as well as primary dichorionic diamniotic twin gestations (DD). Logistic regression analysis was used to control for any differences at baseline. Results There were 42 patients in the MFPR group, 43 women in the TT group, and 693 women in the DD group. Comparing MFPR to TT, the likelihood of preterm birth Conclusion In trichorionic triamniotic triplet pregnancies, our study suggests that obstetrical outcomes may not be as dramatically improved with MFPR as seen in older studies.

Background We describe two cases of dichorionic triplet pregnancy after a frozen-thawed poor-stage embryo transfer. Main body of the abstract A 39-year-old and a 41-year-old woman underwent ART treatment. The first patient underwent intracytoplasmic sperm injection (ICSI) at 34 years of age, and two frozen-thawed poor-stage embryos were transferred at 39 years of age with assisted hatching, resulting in a trichorionic triamniotic triplet pregnancy. The second patient underwent ICSI, and two poor-grade blastocysts were transferred followed by assisted hatching, resulting in a dichorionic triamniotic triplet pregnancy. In the first case, the heartbeat of one monozygotic twin fetus had stopped on day 48 post-transfer (9 weeks 2 days), resulting in a dichorionic diamniotic twin pregnancy. A healthy boy and girl were delivered by elective caesarean section at 36 weeks, 5-days gestation. In the second case, the patient underwent selective reduction of the monochorionic twins, resulting in a single pregnancy that was vaginally delivered without any problems at 38 weeks 0-days gestation. Short conclusions Numerous factors may be associated with the development of a monochorionic pregnancy; however, controversies still remain. The present morphological grading for embryos is insufficient for inhibiting the development of a monochorionic pregnancy.

Objective Spontaneous heterotopic triplets, a tubal ectopic pregnancy and a twin pregnancy, are rare disorders. The study aimed to examine all available evidence regarding signs and symptoms, imaging findings, management and newborn outcome of spontaneous heterotopic triplets. Design A literature search in Medline and EMBASE databases from 2000 to 2016 was conducted. The following key words were employed: ‘spontaneous heterotopic pregnancy’, OR ‘heterotopic triplets’. Only cases of spontaneous heterotopic triplets without assisted reproduction techniques were included. Results Six cases were identified and included in the present review. All cases presented with abdominal pain and one case presented in shock. Hemoperitoneum was present in five cases. Laterouterine mass with adnexal gestational sac is not systematically described (3 cases/6), but was a good ultrasonographic sign of heterotopic pregnancy. All patients had tubal rupture, but anyone had vaginal bleeding. The surgical treatment was made by salpingectomy in five cases to ensure successful treatment. The mean and median gestational age at delivery were 29.9 and 37.54 weeks, respectively (range 6–41 weeks). The neonatal outcome was good for 6 newborns. Conclusion Spontaneous heterotopic triplets are rare. Early surgical intervention is the key to successful treatment of heterotopic triplet pregnancy and allows good neonatal outcome.

We introduce a case of triplet pregnancy with a complete hydatidiform mole coexisting two viable fetuses and important issues for prenatal care in both mothers and fetuses due to a significantly high risk for both mothers and fetuses. A 32-year-old patient conceived a triplet pregnancy after intrauterine insemination. At 14 weeks of gestation, ultrasonography revealed hydatidiform moles that were adjacent to two fetuses. Fetal karyotyping of the two fetuses showed normal results. The second baby developed fetal growth restriction at 24 weeks of gestation and preeclampsia developed at 29 weeks of gestation. At 31 weeks and one day of gestation, cesarean section was performed due to fetal distress of the second baby. Microscopically, the molar tissue was favorably diagnosed as complete hydatidiform mole. This is successful delivery report of a pregnant woman who had triplet pregnancy complicated with one complete hydatidiform mole coexisting two viable fetuses in Korea.

Monochorionic twins as part of a high order multiple pregnancy can be an unintended consequence of the increasingly common practice of blastocyst transfer for couples requiring in vitro fertilisation (IVF) for infertility. Dichorionic triamniotic (DCTA) triplets is the most common presentation, and these pregnancies are particularly high risk because of the additional risks associated with monochorionicity. Surveillance for twin-to-twin transfusion syndrome, including twin anemia polycythemia sequence, may be more difficult, and any intervention to treat the monochorionic pair needs to balance the proposed benefits against the risks posed to the unaffected singleton. Counseling of families with DCTA triplets is therefore complex. Here, we report a case of DCTA triplets, where the pregnancy was complicated by threatened preterm labour, and twin anemia polycythemia sequence (TAPS) was later diagnosed at 28 weeks. The TAPS was managed with a single intraperitoneal transfusion, enabling safe prolongation of the pregnancy for over 2 weeks until recurrence of TAPS and preterm labour supervened. Postnatal TAPS was confirmed, and all three infants were later discharged home at term corrected age, and were normal at follow-up. This case highlights that in utero therapy has an important role in multiple pregnancies of mixed chorionicity, and can achieve safe prolongation of pregnancy at critical gestations.

The aim of this study was to analyze the specificity and dynamics of psychomotor development in children from triplet pregnancy. The studied group was composed of siblings from triple pregnancy (T1, T2, T3), including two girls and one boy. This longitudinal study comprised three stages: stage I – children aged 25 months, stage II – children aged 29 months, and stage III – children aged 38 months. At each stage, the psychomotor development of children was examined with the Third Edition of Bayley Scales of Infant and Toddler Development (BSID-III) and subjectively by their mother. Additionally, medical and nursing documentation was analyzed. Individual psychomotor development of children from triple pregnancy is different with regards to various spheres, and has different rates and dynamics throughout consecutive years. Psychomotor development of children from triple pregnancies is determined by gender and postnatal clinical parameters, i.e. birth weight, head circumference, postnatal morbidity, and prematurity-related conditions.

Background: There has been an upsurge in the number of multiple pregnancies with its attributability to increasing use of artificial reproductive techniques. To study clinical outcome of post IVF triplet pregnancy reduced to twin pregnancies compared to those without triplet reduction.Methods: Hospital designed comparative study. 31 subjects were studied for comparative study design with triplets obtained after infertility treatment (assisted post-IVF). Out of 31, 15 subjects were expectantly managed who refused reduction while 16 subjects chose reduction to twins. Outcomes like prematurity, complications in neonate, birth weight discordance, neonatal mortality and maternal complications were studied.Results: The fetal (triplet) reduction group was associated with significant (p

Key Clinical Message This case is extraordinary because it was never before described in English literature. The case describes a long‐standing debate about the safety of carrying this pregnancy to term. Some authors are for and some are against. The risks and benefits should be thoroughly reviewed before a decision is made.

Heterotopic pregnancy, simultaneous occurrence of both intra uterine and extra uterine pregnancy is on rise because of assisted reproductive technology and widespread usage of first trimester USG. However such pregnancies are rare following spontaneous occurrence. High degree of clinical suspicion is essential in such spontaneous conceptions to diagnose it in early pregnancy to maximize the outcome for intra uterine pregnancy. Here we are presenting a case of simultaneous occurrence of twin intrauterine pregnancy and co existing tubal abortion with good perinatal outcome from a remote area.