Birth weight discordance and perinatal mortality among triplets

RADOVI

ЭЬяќѯѭЭѳЦлЦЬѭѳялЬѱЧѭЬЦѳлдяЦЬѸѯѭлѳѿЬлЧл

ќѯЭлѭдЭЦѯоѳялѭѯфќѳѸѳ

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ƭƳƢƵƢƭƴƢƧƳƩƢNJ

ƵǢǥǖǟǠǼǗǣǤǢǠǹǜǑǞǑǣǥǓǚǣǠǜǠǢǚǙǚǩǟǗǤǢǥǖǟǠǼǗǩǚǹǚǹǗǒǢǠǹǥǡǠǢǑǣǤǥǙǒǠǔǩǗǣǤǗǡǢǚǞǗǟǗǞǗǤǠǖǑǡǠǤǡǠǞǠǔǟǥǤǗǢǗǡǢǠ ǖǥǜǨǚǹǗƹǚǺǢǑǖǑǹǗǒǚǠǖǑǣǗǥǤǓǢǖǚǜǠǢǗǝǑǨǚǹǑǚǙǞǗdzǥǡǗǢǚǟǑǤǥǣǟǗ ǦǗǤǥǣǟǗǚǟǗǠǟǑǤǥǣǟǗǣǞǢǤǚǚǖǚǣǜǠǢǖǑǟǤǟǠǔǢǑǣǤǑ ǤǢǠǹǜǚƳǗǤǢǠǣǡǗǜǤǚǓǟǠǣǥǑǟǑǝǚǙǚǢǑǟǚǡǠǢǠdzǑǹǚǤǢǠǹǜǚǟǑƥǚǟǗǜǠǝǠǪǜǠǑǜǥǪǗǢǣǜǠǹǜǝǚǟǚǨǚDưǑǢǠǖǟǚǦǢǠǟǤEǥƣǗǠǔǢǑǖǥǥ ǡǗǢǚǠǖǥǠǖǹǑǟǥǑǢǑǖǠǖǗǨǗǞǒǢǑǔǠǖǚǟǗƧǚǣǜǠǢǖǑǟǤǟǚǢǑǣǤǹǗǖǗǦǚǟǚǣǑǟǜǑǠǢǑǙǝǚǜǑǥǡǠǢǠdzǑǹǟǠǹǞǑǣǚǓǗǼǑ ǠǖƶǡǠǣǝǗǖǻǚǧǡǗǤǔǠǖǚǟǑǖǠǪǝǠǹǗǖǠǡǠǢǑǣǤǑǒǢǠǹǑǤǢǚǔǗǞǚǟǚǧǤǢǥǖǟǠǼǑǙǑǙǑǧǓǑǺǥǹǥǼǚǚǩǗǪǼǠǹǡǢǚǞǗǟǚǞǗǤǠ ǖǑǑǣǚǣǤǚǢǑǟǗǢǗǡǢǠǖǥǜǨǚǹǗǤǠǜǠǞǝǗǩǗǻǑǚǟǦǗǢǤǚǝǚǤǗǤǑƫǟǨǚǖǗǟǨǚǹǑǤǢǚǔǗǞǚǟǑǒǚǝǑǹǗǪǗǣǤǟǑǡǠǢǠdzǑǹǑǑǥǩǗǣǤǑ ǝǠǣǤǖǚǣǜǠǢǖǑǟǤǟǠǔǢǑǣǤǑưǗǞǑǣǤǑǤǚǣǤǚǩǜǚǙǟǑǩǑǹǟǗǢǑǙǝǚǜǗǥǔǠǖǚǟǑǞǑǞǑǹǜǗǡǑǢǚǤǗǤǥǟǑǩǚǟǥǙǑǩǗǼǑǜǠǞǡǝǚǜǑǨǚǹǑ ǞǑǤǠǜǠǞǤǢǥǖǟǠǼǗǟǚǥǔǗǣǤǑǨǚǹǚǟǑǡǠǢǠdzǑǹǥƲǠǣǤǠǹǚǣǤǑǤǚǣǤǚǩǜǚǙǟǑǩǑǹǟǑǢǑǙǝǚǜǑ pǥǥǜǥǡǟǠǞǡǗǢǚǟǑǤǥǣǟǠǞǞǠǢǤǑ

ǝǚǤǗǤǥǚǙǞǗdzǥǖǓǗǔǢǥǡǗǚǣǡǚǤǑǟǚǜǑǥǔǢǥǡǚǣǜǠǟǜǠǢǖǑǟǤǟǚǞǢǑǣǤǠǞǥǠǖǟǠǣǥǟǑǥǔǢǥǡǚǣǑǖǚǣǜǠǢǖǑǟǤǟǚǞǢǑǣǤǠǞ ƱǖǟǠǣǓǗǢǠǓǑǤǟǠǼǑǙǑǡǢǠǨǗǟǤǟǚǚǟǤǗǢǓǑǝǡǠǓǗǢǗǻǑ odds ratioǡǠǜǑǙǥǹǗǤǢǚǡǥǤǑǓǗǼǚǢǚǙǚǜǙǑǟǑǣǤǑǟǑǜǟǗǡǠǓǠǺǟǠǔǡǗ ǢǚǟǑǤǥǣǟǠǔǚǣǧǠǖǑǥǔǢǥǡǚǣǖǚǣǜǠǢǖǑǟǤǟǚǞǢǑǣǤǠǞ ǥǠǖǟǠǣǥǟǑǔǢǥǡǥǣǜǠǟǜǠǢǖǑǟǤǟǚǞǢǑǣǤǠǞ ǑǝǚǠǓǑǢǑǙǝǚǜǑǟǚǹǗ ǣǤǑǤǚǣǤǚǩǜǚǙǟǑǩǑǹǟǑ pƵǢǥǖǟǠǼǗǣǤǢǠǹǜǑǞǑǜǑǠǓǚǣǠǜǠǢǚǙǚǩǟǗǤǢǥǖǟǠǼǗǙǑǧǤǗǓǑǹǥǚǟǤǗǟǙǚǓǑǟǚǜǠǟǣǤǑǟǤǑǟǟǑǖǙǠǢǑ ǡǠǣǤǑǓǺǑǻǗǥǝǤǢǑǙǓǥǩǟǗǖǚǹǑǔǟǠǙǗǖǚǣǜǠǢǖǑǟǤǟǠǔǢǑǣǤǑǙǑǧǤǗǓǑǖǠǖǑǤǟǚǠǡǢǗǙǥǖǠǟǠǪǗǻǥǠǖǝǥǜǑǠǡǣǤǗǤǢǚǩǜǗǡǢǚǢǠǖǗ

ƭǺǥǩǟǗǢǗǩǚǤǢǠǹǜǗǖǚǣǜǠǢǖǑǟǤǟǚǢǑǣǤǡǗǢǚǟǑǤǥǣǟǚǞǠǢǤǑǝǚǤǗǤ

UVOD

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ǜ¿¨ÒÑʶÀÒ¨§Î¿ÊѸ¨ÊœÊ»ÎÃʿ廨ÓÒѴѵÒεœ Ԝ¤¨¶ÎÃÒÎÀ¶ÒѵœÃÒÎɸÎÃҜ¨¾¸¨ÓÑÒÑ´»œÊ¿¶ÃÒÎ ¤œ£¸¨Êœ¿Ñʶ¿¨ÀœÒÑÔÎÜÉÎÃÑ®¨ÃѵœÒÑÉ¿¨§œ¿ ²ÎèҜÀ§¿ÊÒÎÀÊʿ廨¾¨¸ÑÔ¨¼œÒœ²ÎÃÔÎ ÀÊ¿¶»ÎԜ¤Ñ¶ÎÃÒÎÀ¶ÒѾ¸¨ÓÑÒ®œÑÜÀœÊɶÊÑԜ¤Ñ¶ ÎÃÒÎÀ¶ÒѵœÃÒÎɸÎÃҜʿ¶ÃÒԜ#%ÇÎԜ¤ÑÒ¿¨Ó¨»

za nastanak perinatusne smrti za trojke uglavnom se

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CIQ RADA

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šwi period i ispita uticaj diskordantnog rasta

ÒѧοÊѸ¨ÊœÊ֜ʶÀѨÒÎÔοαœÒ´Ñè

METOD RADA

ŜʿÎÀɜ»Ê¨ÔÒÎ À¶ ÑÒѸ¨Ó¨¿ÑÒ¨ Éοαѵ¨ ʿε »¨ÒÑ·¨Òœ»Î¸Î¼»ÎÑ»¶¼œ¿À»Îµ»¸¨Ò¨®¨<šÑ¿ÎÃÒ¨

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dentovogtʜÀÊÑËÑÒº¨ÊÒ¨µœÔβ Mann-Whitneyʜ ÀÊѨÑÒѸ¨ÓΧÔÑ¿¨µÑÒÀœ ANOVA

REZULTATI

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TABELA 2.ưǑǩǚǟǡǠǢǠdzǑǹǑǞǑǣǗǤǢǠǹǜǚǟǑǢǠdzǗǻǥǚǡǗǢǚǟǑǤǥǣǟǚǞǠǢǤǑǝǚǤǗǤǤǢǠǹǜǚǥǠǖǟǠǣǥǟǑǖǚǣǜǠǢǖǑǟǤǟǚǢǑǣǤ TABLE 2. The manner of delivery, birth weight, and perinatal mortality associated with birth weight discordance.

ƳǑǙǝǚǜǑǥǞǑǣǟǚǟǑǢǠdzǗǻǥ

Difference in birth weight

ƶǜǥǡǟǠ

Total (%) p

ưǑǩǚǟǡǠǢǠdzǑǹǑ=ǨǑǢǣǜǚǢǗǙ

The manner of delivery – Caesarean (%)

ƯǑǣǑǟǑǢǠdzǗǻǥ g

Birth weight (g)

<0.05

<0.05

ƲǗǢǚǟǑǤǥǣǟǚǞǠǢǤǑǝǚǤǗǤ

Perinatal mortality

ƴǞǢǤǦǗǤǥǣǑ

Foetal death

ƴǞǢǤǟǗǠǟǑǤǥǣǑ

Neonatal death

ƶǜǥǡǟǠ

Total <0.05

OR (95% CI)

OR=ǠǖǟǠǣǓǗǢǠǓǑǤǟǠǼǑCI=ǚǟǤǗǢǓǑǝǡǠǓǗǢǗǻǑ

OR – odds ratio; CI – confidence interval

TABELA 1.ƱǒǗǝǗǘǹǑǤǢǥǖǟǠǼǑǣǤǢǠǹǜǑǞǑǥǠǖǟǠǣǥǟǑǖǚǣǜǠǢǖǑǟǤǟǚǢǑǣǤ TABLE 1. Characteristics of triplet pregnancies by birth weight discordance.

ƳǑǙǝǚǜǑǥǞǑǣǚǟǑǢǠdzǗǻǥ

Difference in birth weight <20% >20% p ƣǢǠǹǤǢǠǹǜǚ

Number of triplets (%)

ƴǤǑǢǠǣǤǞǑǹǜǗ ƴƤjƴƧ

Maternal age (MV±SD) j j

ƲǑǢǚǤǗǤ ƴƤjƴƧ

Parity (MV±SD) j j

ƣǢǠǹǤǢǥǖǟǠǼǑǟǑǣǤǑǝǚǧǣǡǠǟǤǑǟǠ

Spontaneous conception (%)

ƣǢǠǹǤǢǥǖǟǠǼǑǟǑǣǤǑǝǚǧǡǠǤǡǠǞǠǔǟǥǤǠǞǢǗǡǢǠǖǥǜǨǚǹǠǞ

Infertility treatment (%)

ƵǢǥǖǟǠǼǗǣǜǠǞǡǝǚǜǑǨǚǹǑǞǑ

Disorders complicating pregnancy (%)

ƲǠǢǠdzǑǹǟǑǔǗǣǤǑǨǚǹǑ ƴƤjƴƧ

Gestational age at delivery (MV±SD) j j

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LITERATURA

1. MacDorman MF, Atkinson JO. Infant mortality statistics from 1997 period linked birth/infant death data set. Natl Vital Stat Rep 1999; 47(23):1-23.

2. Gaudino JA, Blackmore-PrinceC, Yip R, Rochat RW. Quality assessment of fetal death records in Georgia. A method for improvement. Am J Public Health 1997; 87:1323-7.

3. Facts about triplet and high-order births. Atlanta: Centers for Dis-ease Control and Prevention, Office of Communication, Division of Media Relations; 2000. Available at: http://www.cdc.gov/od/oc/ media/pressrel/r2ko623.htm. Accessed 2002 Dec. 16.

4. Mordell N, Benshushan A, Zajicek G, Laufer N, Schenker JG, Sadovsky E. Discordancy in triplets. Am J Perinatol 1993; 10:224-5.

5. Demissie K, Ananth CV, Martin J, Hanley ML, MacDorman MF, Rhoads GG. Fetal and neonatal mortality among twin gestations in the United States: The role of intrapair birth weight discordance. Obstet Gynecol 2002; 100:474-80.

ƴƳƲƴƭƫƢƳƸƫƤƪƢƹƨƮƱƭƶƲưƱƮƨƭƢƳƴƵƤƱ

INTRODUCTION

The incidence of multiple births has increased in the last decade. Perinatal mortality in triplets is significantly greater than in twin and singleton births.

OBJECTIVE

The objective of this study was to describe the extent of birth weight discordance among triplets and to identify its association with an increased risk of perinatal mortality.

METHOD

A retrospective analysis of triplet births, for the period 1993-2003, was conducted at the Gynaecological-Obstetric Clin-ic “Narodni Front” in Belgrade. Birth weight discordance was defined as the difference in birth weight between the largest and the smallest triplet’s weight of more than 20%.

RESULTS

The rate of triplets has increased by almost 75% between the first (7.7%) and the last (29.6%) 5-year period of the last decade. Triplets are becoming more common because of the frequent use of assisted reproductive technology as a treat-ment for infertility. In the period 1993-2003, there were a total of 40 triplet live births (24 weeks and greater) with incidence of 0.06%. There was no clear association between maternal age, parity, method of conception, birth gestational age, and dis-orders complicating pregnancy with birth discordance more

than 20%. Regarding birth weight groups, statistical signifi-cance occurred only in the <999 grams group for discordant and in the 2000-2499 grams group for concordant triplets. Overall, the perinatal mortality rate in the group was 10.8%, the foetal mortality rate was 1.7% (2/120), and the neonatal (0-28 days) mortality rate was 9.1% (11/120). An odds ratio of 95% con-fidence interval shows 3 times greater risk for adverse perina-tal outcome in the discordant group. However, the difference was not significant.

CONCLUSION

Increasing birth weight discordance may increase the risk of adverse perinatal outcome. Triplet pregnancies, being high risk, require intensive antenatal care in order to prevent preterm delivery and ultrasound in order to diagnose foetal growth abnormality and discordance, which increase foetal surveil-lance, through the use of biophysical profiles, non-stress tests, and Doppler velocimetry, thus assessing foetal well-being and the appropriate moment for obstetric intervention.

Key words: triplets; birth weight discordance; perinatal mor-tality

Amira EGIĆ

Župana Vlastimira 6A, 11000 Beograd Tel: 011 660 714

E-mail: egicam@eunet.yu

BIRTH WEIGHT DISCORDANCE AND PERINATAL MORTALITY AMONG TRIPLETS

Amira EGIĆ, Željko MIKOVIĆ, Dejan FILIMONOVIĆ, Anka ĆIROVIĆ Clinic for Gynaecology and Obstetrics “Narodni Front”, Belgrade