Analysis Of Maternal And Neonatal Outcomes Of Different Triplet Pregnancies With Conception Modes And Chorionicities

Objective:To investigate the clinical outcomes of different conception modes and different chorionicities in triplet pregnancies.Methods:A retrospective analysis was performed on the outcomes of 105 triplet pregnancies delivered in Hospital,from January 2010 to January 2023.They were divided into three groups according to the mode of conception,34 cases in the in vitro fertilization and embryo transfer group(IVF-ET),22 cases in the ovulation induction group and 49 cases in the natural conception group.The above total cases were divided into four groups according to chorionicity:21 cases in the trichorionic group,50 cases in the bichorionic group,11 cases in the monochorionic group and 23 cases in the group with unknown chorionicity.There was no significant difference in maternal age between the groups.We collected clinical information included age,gestational tiem,mode of conception,chorionicity,pregnancy complications(premature rupture of membranes,hypertensive disorders in pregnancy,gestational diabetes),gestational age,mode of delivery,and postpartum hemorrhage;information on neonatal outcome included:mean birth weight,Apgar score,NICU admission rate,tracheal intubation rate,length of hospital stay,and complications(infant respiratory distress syndrome(NRDS),pulmonary-related diseases,necrosis,sepsis,intraventricular hemorrhage,white matter injury,fetal malformations,twin-twin transfusion syndrome(TTTS),intrauterine fetal death).Based on the clinical data collected,study the relationship between pregnancy outcome and conception method(IVF-ET group,ovulation promotion group,and natural conception group);pregnancy outcome and chorionicity(monochorionic triplet,dichorionic triplet,trichorionic triplet,and unspecified-chorionic triplet)were analyzed separately.The results of the study were statistically analyzed using SPSS 26.0 software,and the measurement data were described by (?)±S or M(P25,P75),according to whether they obeyed normal distribution,and the count data were described in the form of number of cases(percentage).The measurement data were analyzed by ANOVA or Kruskal-Wallis H test according to whether they obeyed normal distribution.LSD-t test or Nemenyi test to compare every two group.Count data were tested by square test or Fisher’s exact probability method.P<0.05 was statistically significant.Results:1.Comparing among IVF-ET group,ovulation promotion group and natural conception group by different conception modes,the incidence of hypertensive disorders of pregnancy was significantly higher in IVF-ET group than in the natural conception group(23.5%vs 2.0%),and the incidence of hypertensive disorders in pregnancy was higher in the ovulation promotion group than in the natural conception group(18.2%vs2.0%).The IVF-ET group had the highest incidence of neonatal white matter injury,which was statistically different compared to the ovulation-promoting and natural conception groups(25.3%vs 10.0%vs 13.3%).Triplet pregnancies with concerned chorionicity were significantly different between the three groups(P<0.05).The highest percentage of triplets with dichorionic was in IVF-ET,with statistically significant differences compared to ovulation-promoted and spontaneous conception triplets,respectively(93.1%vs 33.3%;93.1%vs 47.4%).The remaining clinical data were not statistically different when compared.2.In the comparative analysis of different chorionic triplet pregnancies,trichorionic group,dichorionic group,monochorionic group,and chorionic unknown group,the incidence of dichorionic triplets was the highest in neonatal lung-related diseases,with a significantly difference compared to the trichorionic group;the incidence of dichorionic triplets was the highest in neonatal NICU admissions,with a statistically significant difference compared to the chorionic unknown group.There was no significantly difference among the comparison of the remaining perinatal maternal and child clinical data.Conclusion:IVF-ET conception has an increased incidence of hypertensive disorders in pregnancy and neonatal white matter damage in triplet pregnancies compared to spontaneous conception and ovulation-promoted conception,and the highest proportion of dichorionic triplets.This suggests that different conception modes affect maternal and child outcomes in triplet pregnancies.Chorionicity had no significant effect on the incidence of pregnancy complications in triplet pregnancies.It is suggested that different chorionicity affects the neonatal outcome of triplet pregnancies.To clarify the chorionicity of triplet pregnancies and to enhance monitoring with the aim of improving the perinatal prognosis.