Comparison of singleton, twin and triplet pregnancy outcomes of preterm infants delivered before 34 weeks of gestation

Yıl 2014, Cilt: 45 Sayı: 1, 38 - 43, 01.03.2014

Sevilay Topcuoğlu Dilek Yavuzcan Öztürk Tuğba Gürsoy Güner Karatekin H.Fahri Ovalı

https://doi.org/10.16948/zktb.83454

Öz

Objective: We aimed to compare the perinatal characteristics, neonatal morbidity and mortality of singletons, twins and triplets born before 34 weeks of gestation and admitted to our neonatal intensive care unit.Method: Singleton and multiple-birth infants born before 34 weeks of gestation and admitted to our unit between January 2012 and January 2013 were compared in terms of demographic features, natal and neonatal problems. Data were collected from medical records. Results: Five Hundred Forty-Four infants were enrolled to the study. Among these, 435 (80%) there were singletons, 92 (17%) twins and 17 (3%) triplets. There was no difference between groups according to maternalage, chorio amnionitis, oligohydramniosis, and diabetes. While all triplet pregnancies had antenatal care, only 43.2% of twin pregnancies and 32.2% of singletons had antenatal care (p<0.0001). As expected, antenatal steroid administration rate was higher in triplets (p<0.01). Although there was no difference between incidence of major morbidities, durations of parenteralnutrition and hospitalization were longer in singleton infants. Mortality was 21.2 % in singletons, 21.3% in twins. All triplet infants were discharged without any complication.Conclusions: There was no adverses hortterm outcome in multiple-birth infants, comparing with singletons. More over, it was found that neonatal outcome was better in multiple-birth group who had higher antenatal care rate.

Anahtar Kelimeler

Newborn, singleton, triplets, twins.CİLT: 45 YIL: 2014 SAYI: 1ZEYNEP KAMİL TIP BÜLTENİ

Otuz Dört Hafta Altı Tekil, İkiz ve Üçüz Gebelik Sonuçlarının Karşılaştırılması

Öz

Amaç: Yenidoğan kliniğimizde izlenen 34 haftadan küçük, tek, ikiz ve üçüz gebelik sonucu doğan bebeklerin erken neonatal sonuçlarının karşılaştırılması amaçlandı.

Yöntem: Ocak 2012-Ocak 2013 tarihleri arasında servisimizde yatarak izlenen, tekil ve çoğul gebelik sonucu doğan, gebelik yaşı 34 haftadan küçük bebekler demografik özellikler, doğum ve yenidoğan problemleri açısından retrospektif olarak karşılaştırıldı. Veriler hasta dosyalarından elde edildi.

Bulgular: Beş yüz kırkdört hasta çalışmaya alındı. Hasta grubunun 435’ini (% 80) tek, 92’sini (%17) ikiz, 17’sini (%3) üçüz bebekler oluşturmaktaydı. Anne yaşı, koriyoamniyonit, oligohidramniyoz, diyabet açısından gruplar arasında fark yoktu. Üçüz gebeliklerin hepsi antenatal dönemde takipli iken ikiz gebeliklerin %43.2’si, tekil gebeliklerin ise %32.2’sinin antenatal takipli olduğu görüldü (p<0.0001). Bununla ilişkili olarak antenatal steroit yapılma oranı üçüz gebeliklerde daha yüksekti (p<0.01). Majör neonatal morbiditelerin sıklığı açısından anlamlı fark saptanmamakla birlikte parenteral nutrisyon ve yatış süresi tekil bebeklerde daha uzundu. Mortalitenin tekil bebeklerde %21.2, ikizlerde %21.3 olduğu görüldü. Bütün üçüz bebekler sağlıklı olarak taburcu edildi. 

Yorum            : Çoğul gebeliklerde kısa dönem neonatal sonuçlar açısından tekil gebeliklere göre olumsuz bir sonuç saptanmamıştır. Buna ek olarak, gebeliğinde antenatal izlem oranı daha fazla olan çoğul gebelik grubunda neonatal sonuçlar daha olumlu bulunmuştur.

Anahtar Kelimeler

İkiz, tekil, üçüz, yenidoğan.Comparison of singleton, twin and triplet pregnancy outcomes of preterm infants delivered before 34 weeks of gestation.

Kaynakça

• Loraine E, Wilkins I. Epidemiology and biology of multiple gestations. Clin Perinatol 2005; 32: 301-14
• Yayla M, Baytur Y. Çok Merkezli Çoğul Gebelik Çalışması 1 – Epidemiyoloji. Perinatoloji Dergisi 2008; 16: 1-9
• Powers WF, Kiley JL. The risks of confronting twins: a national perspective. Am J Obstet Gynecol 1994; 170: 456-61
• Ray B, Ward Platt MP. Mortality of twin and singleton live birth under 30 weeks’ gestation: a population-based study. Arch Dis Child Fetal Neonatal Ed 2009; 94: 140-143.
• Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163:1723.
• International committee for the classification of retinopathy of prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 2005; 123(7): 991-9.
• Papile LA, Burstein J, Burstein R. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 g. J Pediatr 1978; 92(4): 529-34.
• Walsh MC, Kliegman RM. Neonatal necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986: 33; 179.
• Garg P, Abdel-Latif ME, Bolisetty S, et al. Perinatal characteristics and outcome of preterm singleton, twin and triplet infants in NSW an the ACT, Australia (1994-2005). Arch Dis Child Fetal Neonatal Ed 2010; 95: 20-24.
• Blondel B, Kogan MD, Alexander GR, et al. The impact of increasing number of multiple births on the rates of preterm birth and low birth weight: an international study. Am J Public Health 2002; 92: 1313
• Nakhuda GS, Sauer MV. Addressing the growing problem of multiple gestations created by assisted reproductive therapies. Semin Perinatol 2005; 29: 355-62.
• Sibai BM, Hauth J, Caritis S, et al. Hypertensive disorders in twin versus singleton gestations. Am J ObstetGynecol. 2000; 182: 938
• Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlleds tudies. BMJ 2005; 330:565.
• Romero R, Shamma F, Avila C, et al. Infection and labour. Prevalence, microbiology, and clinical significance of intra-amniotic infection in twin gestations with preterm labor. Am J Obstet Gynecol 1990; 163: 757-61
• Sela HY, Simpson LL. Preterm premature rupture of membranes complicating twin pregnancy: management considerations. Clin Obstet Gynecol. 2011; 54: 321-9.
• Mercer BM. Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am 2005; 32: 411.
• Mizrahi M, Furman B, Shoham-Vardi I, et al. Perinatal outcome and peripartum complications in preterm singleton and twins deliveries: a comparative study. Eur J Obstet Gynecol Reprod Biol. 1999; 87: 55-61.
• Gardner MO, Goldenberg RL, Cliver SP, et al. The origin and outcome of preterm twin pregnancies. Obstet Gynecol 1995; 85: 553-7
• Hayes EJ, Paul D, Ness A, et al. Very-low-birth weight neonates: do outcomes differ in multiple compared with singleton gestations. Am J Perinatol 2007; 24: 373-6
• Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006; :CD004454.
• Gyamfi C, Mele L, Wapner RJ. The effect of plurality and obesity on betamethasone concentrations in women at risk for preterm delivery. Am J Obstet Gynecol. 2010; 203: 219
• Report on the Consensus Development Conference on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes. U.S. Department of Health and Human Services, Public Health Service, NIH Pub No. 95-3784, November 1994
• Ombelet W, Martens G, De Sutter P, et al. Perinatal outcome of 12021 singleton and 3108 twin births after non-assisted reproduction: a cohort study. Hum Rep 2006; 21: 1025-1032.
• Donovan EF, Ehrenkranz RA, Shankaran S, et al. Outcomes of very low birth weight twins cared for in the National Institute of Child Health and Human Development Neonatal Research Network's intensive care units. Am J Obstet Gynecol 1998; 179:742.
• Bastek JA, Srinivas SK, Sammel MD, et al. Do neonatal outcomes differ depending on the cause of preterm birth? A comparison between spontaneous birth and iatrogenic delivery for preeclampsia. Am J Perinatol 2010; 27: 163-169
• Engineer N, Kumar S. Perinatal varibles and neonatal outcomes in severely growth restricted preterm fetuses. Acta Obstet Gynecol Scand 2010; 89: 1174-81
• Mathews TJ, Menacker F, MacDorman MF. Infant mortality statistics from the 2000 period linked birth/infant death data set. Natl Vital Stat Rep 2002; 50: 1.
• Kayıkçıoğlu F, Koçak M, Pata Ö, et al. İkiz gebeliklerde perinatal sonuçlar: 268 vakanın değerlendirilmesi. MN-GORM 2001; 7: 13-6.
• Kamacı M, Zeteroğlu Ş, Şahin HG. Çoğul gebeliklerde doğum yöntemleri: Obstetrik komplikasyonlar ve perinatal mortalite. Jinekoloji ve Obstetrik Dergisi (Logos) 2004; 18: 135-9.
• Yayla M, Ergin RN, Baytur Y. Çok Merkezli Çoğul Gebelik Çalışması III - Üçüz Gebelikler. Perinatoloji Dergisi 2010; 18: 1-7