Triplet Pregnancies and their Consequences

With the advent of assisted reproduction, the frequency of multiple births has grown dramatically. Though once rare, triplet births are now seen surprisingly often. Whereas twins have been the object of much important study, virtually nothing has been published focusing solely on triplets, until now. Triplet Pregnancies and their Consequences is unique: it is the first systematic, scientific review of the study of triplets. Covering the range of issues and complications possible in triplet pregnancies, the book includes ten distinct sections devoted to prenatal, intrapartum, and postnatal aspects of these pregnancies. It contains an analysis of a unique database of more than 3000 triplet pregnancies provided by Matria Healthcare of Marietta, Georgia. This is the first time there have been sufficient numbers of triplets in a data set to truly understand some of the unique biological circumstances associated with triplets. Topics include: Epidemiology and biology - including unique matched analyses of the entire French IVF registry Prenatal diagnosis with special attention to chorionicity Antepartum considerations with broad perspectives on treatment of preterm labor Delivery considerations The Matria Analysis - the largest triplet database in the world Short-term outcomes with special attention to low birth weight Long-term outcomes focusing on cerebral palsy and school performance Triplet Pregnancies and their Consequences is the first of its kind, a true landmark text. It will be indispensable to all healthcare providers dealing with the worldwide "epidemic" of iatrogenic triplets.

Table of Contents:
EPIDEMIOLOGY AND BIOLOGY The Frequency of Triplet Gestation, L.G. Keith, J.E. Fajardo, and J.J. Oleszczuk Spontaneous and Induced Triplets, I. Blickstein Triplet Zygosity and Chorionicity, G.A. Machin Ultrasound Evaluation of Unusual Triplet Gestations, I.E. Timor-Tritsch, A. Monteagudo, and A. Rebarber Triplet Pregnancies from French IVF Centers: 1986-98, E. Papiernik and J. de Mouzon for FIVNAT PRENATAL DIAGNOSIS Early Ultrasound and Triplet Pregnancy, S.T. Chasen and D.W. Skupski Screening for Chromosomal Abnormalities in Triplet and High-Order Multiple Pregnancy, R. Maymon and A. Herman Amniocentesis and Chorionic Villus Sampling in Triplet Pregnancies, R.A. Green, R.J. Wapner, and M.I. Evans Second-Trimester Sonographic Pitfalls and Caveats in Triplet Gestations, A. Kurjak Fetal Surveillance and Timing of Delivery in Triplet Gestations, R.B. Newman ANTEPARTUM CONSIDERATIONS A. PRETERM LABOR Routine Antepartum Care for Triplets, I. Blickstein Prediction of Preterm Triplet Birth by Clinical Assessment, B. Arabin, A. Merien, and J. van Eyck Tocolysis in Triplet Gestation, S. Rodts-Palenik and J.C. Morrison Aggressive Proactive Management of Triplet Preterm Labor, J.P. Elliott Subcutaneous Terbutaline Therapy in Triplet Gestations, F. Lam and P. Gill Aggressive versus Conservative Management in Triplet Pregnancies, Y. Oyelese, S. Poggi, and J.V. Collea B. MATERNAL COMPLICATIONS Maternal Complications Associated with Triplet Pregnancies, V.R. Klein Hypertensive Disorders During Triplet Gestations, M. Smith-Levitin C. FETAL COMPLICATIONS Complications of Monochorionicity in Triplet Gestations, G. Machin Fetal Growth in Triplet Pregnancies, I. Blickstein DELIVERY/BIRTH CONSIDERATIONS Delivery Route in Triplets, R.B. Kalish and D.W. Skupski Breastfeeding Triplets: Personal Reflections, J.L. Bleyl MATRIA DATABASE The MatriaTriplet Database: 1988-2000, I. Blickstein and D.L. Jacques SHORT-TERM OUTCOMES Neonatal and Long-Term Outcome in Triplets, E.S. Shinwell and S.E.-T. Friedman Morbidity and Mortality of the Extremely Preterm Infant, R.-A. deRegnier LONG-TERM OUTCOMES Cerebral Palsy in Triplets, B. Petterson, L. Watson, and J.J. Kurinczuk School Performance for Triplets, B. Alin Akerman Perinatal Management of the Triplet Family, K.S. Collopy Bereavement in Higher-Order Multiple Pregnancy, E. Bryan and J. Denton Familial and Psychological Reaction, J.L. Bleyl Diverse Factors Leading to Iatrogenic Multiple Pregnancies, S.C. Klock PREVENTIVE MEASURES Maternal nutrition: An Evidence-Based Approach for Triplet Gestations, J.J. Oleszczuk, A.K. Oleszczuk, K. Shelke, and L.G. Keith Avoiding Triplet Pregnancy in Assisted Reproduction, J.D. Fisch, P. Uzelac, and G. Sher Selective Reduction in Triplet Pregnancies, M.I. Evans, D.W. Britt, I.E. Zador, and R.J. Wapner MISCELLANEOUS Ethical Issues in Caring for Triplet Pregnancies, F.A. Chervenak and L.B. McCullough Cost-Effectiveness Analysisof One-, Two- and Three-Embryo Transfers in IVF, C. Jones and R. Ward Economic Implications of Multiple Births, J. Henderson and S. Petrou A Mother of Quads Speaks, D. Launslager Selective Clinical Experience a. Outcome of Twin and Triplet Gestations in a Spanish Center, R. Porta, M.C. Céspedes, V. Molina, J. Ruiz, A. Aurell, J.M. Mallafré, and J. Ríos b. Paying the Costs in the NICU, W. MacKendrick c. Bioethical Issues FUTURE DIRECTIONS Practical Guidelines for the Future, L.G. Keith, I. Blickstein, and J.J. Oleszczuk