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In triplet pregnancy, cesarean section is usually recommended as a mode of delivery. However, we have tried vaginal delivery in women with triplet pregnancy who are candidates for and want trial of labor (TOL). We have already experienced over one thousand cases of vaginal delivery in twin pregnancy. We undertook this study to determine whether TOL is an alternative option in triplet pregnancy.
The study population consisted of triplet pregnancies born in Seoul National University Hospital (≥24 weeks). The “women who are candidates for TOL” were those with cephalic presentation of the first fetus and without any contraindication for vaginal delivery. We compared maternal and neonatal outcomes between triplet pregnancies with attempted vaginal delivery and those with planned cesarean delivery.
Out of total 358 triplet pregnancies, 152 cases were defined as candidates for TOL. Of them, 47 (31%) women attempted vaginal delivery and 105 women chose planned cesarean delivery. The success rate of attempted vaginal delivery was 78.7% (37/47). The cause of failed vaginal delivery was induction failure in all 10 cases and there was no case of combined delivery. The rate of maternal and neonatal morbidities were not different between cases with attempted vaginal delivery and those with planned cesarean delivery, even if the median birthweights of fetus were smaller in cases with attempted vaginal delivery. And duration of hospital stay after delivery was shorter in cases with attempted vaginal delivery than in those with planned cesarean delivery. (Table)
In triplet pregnancies, attempted vaginal delivery did not increase the risk of maternal and neonatal morbidities and resulted in shorter postpartum hospital stay. Our data support that vaginal delivery of triplet pregnancy can be tried in the hospital which has experience in vaginal birth of twin pregnancy.