(541) Mode of delivery in triplet pregnancies, a retrospective cohort study over 20 years

We performed a retrospective cohort study including all women who delivered triplets from 26 weeks’ gestation onward in a tertiary care center in Amsterdam from 2000-2020. Exclusion criteria consisted of severe congenital abnormalities and antenatal death. We wanted to report the percentage of successful VD and indications for CD in women with an intended VD. Moreover, we compared women with an intention to VD to planned CD for maternal and neonatal outcomes. We calculated the odds ratio and 95% confidence intervals to determine significance.

Results:

A total of 71 women were included, 41% with an intended VD with a success rate of 90%. Three women with an intended VD had an emergency CD. Indications for emergency CD consisted of fetal distress, intra amniotic infection and severe vaginal blood loss. Of the planned CD 55% were on fetal indication, mostly for fetal growth restriction. Planned VD was associated with longer NICU admission (p=0.04), however the average gestational age at delivery with VD was 32+0 weeks compared to 33+0 weeks with CD (p=0.01). There were no significant differences between a planned VD and a planned CD in terms of neonatal mortality, Apgar scores and neonatal- or maternal morbidity.

Conclusion:

Women with a triplet pregnancy, who intended to have a VD, have a high probability of a successful VD. Furthermore, a VD is not associated with increased maternal or neonatal morbidity or mortality. These data can be used in the decision-making process regarding mode of delivery in women with triplet pregnancies.