{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T01:03:15Z","timestamp":1790643795894,"version":"4.1.0"},"reference-count":17,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T00:00:00Z","timestamp":1696291200000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2023,10]]},"abstract":"ABSTRACT<\/jats:title>Objective<\/jats:title>Monochorionic (MC) triplet pregnancies are extremely rare and information on these pregnancies and their complications is limited. We aimed to investigate the risk of early and late pregnancy complications, perinatal outcome and the timing and methods of fetal intervention in these pregnancies.<\/jats:p><\/jats:sec>Methods<\/jats:title>This was a multicenter retrospective cohort study of MC triamniotic (TA) triplet pregnancies managed in 21 participating centers around the world from 2007 onwards. Data on maternal age, mode of conception, diagnosis of major fetal structural anomalies or aneuploidy, gestational age (GA) at diagnosis of anomalies, twin\u2010to\u2010twin transfusion syndrome (TTTS), twin anemia\u2013polycythemia sequence (TAPS), twin reversed arterial perfusion (TRAP) sequence and or selective fetal growth restriction (sFGR) were retrieved from patient records. Data on antenatal interventions were collected, including data on selective fetal reduction (three to two or three to one), laser surgery and any other active fetal intervention (including amniodrainage). Data on perinatal outcome were collected, including numbers of live birth, intrauterine demise, neonatal death, perinatal death and termination of fetus or pregnancy (TOP). Neonatal data such as GA at birth, birth weight, admission to neonatal intensive care unit and neonatal morbidity were also collected. Perinatal outcomes were assessed according to whether the pregnancy was managed expectantly or underwent fetal intervention.<\/jats:p><\/jats:sec>Results<\/jats:title>Of an initial cohort of 174 MCTA triplet pregnancies, 11 underwent early TOP, three had an early miscarriage, six were lost to follow\u2010up and one was ongoing at the time of writing. Thus, the study cohort included 153 pregnancies, of which the majority (92.8%) were managed expectantly. The incidence of pregnancy affected by one or more fetal structural abnormality was 13.7% (21\/153) and that of TRAP sequence was 5.2% (8\/153). The most common antenatal complication related to chorionicity was TTTS, which affected just over one quarter (27.6%; 42\/152, after removing a pregnancy with TOP <\u200924\u2009weeks for fetal anomalies) of the pregnancies, followed by sFGR (16.4%; 25\/152), while TAPS (spontaneous or post TTTS with or without laser treatment) occurred in only 4.6% (7\/152) of pregnancies. No monochorionicity\u2010related antenatal complication was recorded in 49.3% (75\/152) of pregnancies. Survival was apparently associated largely with the development of these complications: there was at least one survivor beyond the neonatal period in 85.1% (57\/67) of pregnancies without antenatal complications, in 100% (25\/25) of those complicated by sFGR and in 47.6% (20\/42) of those complicated by TTTS. The overall rate of preterm birth prior to 28\u2009weeks was 14.5% (18\/124) and that prior to 32\u2009weeks' gestation was 49.2% (61\/124).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Monochorionicity\u2010related complications, which can impact adversely perinatal outcome, occur in almost half of MCTA triplet pregnancies, creating a challenge with regard to counseling, surveillance and management. \u00a9 2023 The Authors. Ultrasound in Obstetrics & Gynecology<\/jats:italic> published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.26256","type":"journal-article","created":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T16:34:54Z","timestamp":1684514094000},"page":"540-551","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Perinatal outcome of monochorionic triamniotic triplet pregnancy: multicenter cohort study"],"prefix":"10.1002","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7380-0576","authenticated-orcid":false,"given":"F. G.","family":"Sileo","sequence":"first","affiliation":[{"name":"Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust University of London London UK"},{"name":"Prenatal Medicine Unit, Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult University of Modena and Reggio Emilia Modena Italy"},{"name":"Department of Biomedical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental Medicine University of Modena and Reggio Emilia Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Accurti","sequence":"additional","affiliation":[{"name":"Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1927-2084","authenticated-orcid":false,"given":"A.","family":"Baschat","sequence":"additional","affiliation":[{"name":"Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics Johns Hopkins University Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5725-9270","authenticated-orcid":false,"given":"J.","family":"Binder","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Feto\u2010Maternal Medicine Medical University of Vienna Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3471-7248","authenticated-orcid":false,"given":"E.","family":"Carreras","sequence":"additional","affiliation":[{"name":"Maternal\u2013Fetal Medicine Unit, Department of Obstetrics and Reproductive Medicine, Grup de Recerca en Medicina Materna I Fetal, Vall d'Hebron Institut de Recerca (VHIR) Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus Barcelona Spain"},{"name":"Universitat Aut\u00f2noma de Barcelona Bellaterra Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Chianchiano","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Bucchieri La Ferla\u2010Fatebenefratelli Hospital Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Cruz\u2010Martinez","sequence":"additional","affiliation":[{"name":"Fetal Surgery Center, Instituto Medicina Fetal M\u00e9xico Queretaro\/Guadalajara Jalisco Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5178-3354","authenticated-orcid":false,"given":"F.","family":"D'Antonio","sequence":"additional","affiliation":[{"name":"Center for Fetal Care and High\u2010Risk Pregnancy, Department of Obstetrics and Gynecology University \u2018G. d'Annunzio\u2019 of Chieti\u2010Pescara Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.","family":"Gielchinsky","sequence":"additional","affiliation":[{"name":"Fetal Medicine Center, Helen Schneider Hospital for Women Rabin Medical Center Petach Tikvah Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Hecher","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Fetal Medicine University Medical Center Hamburg\u2010Eppendorf Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, The Fetal Center at Children's Memorial Hermann Hospital University of Texas Health Science Center, McGovern Medical School Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Lopriore","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Leiden University Medical Center Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Massoud","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Fetal Medicine, Centre Hospitalier Lyon Sud Hospices Civils de Lyon Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. N.","family":"N\u00f8rgaard","sequence":"additional","affiliation":[{"name":"Center of Fetal Medicine and Pregnancy, Department of Obstetrics Copenhagen University Hospital Rigshospitalet Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1789-3808","authenticated-orcid":false,"given":"G.","family":"Papaioannou","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology National and Kapodistrian University of Athens Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7793-714X","authenticated-orcid":false,"given":"F.","family":"Prefumo","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences University of Brescia Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3650-5751","authenticated-orcid":false,"given":"G.","family":"Salsi","sequence":"additional","affiliation":[{"name":"Obstetric Unit, Department of Medical and Surgical Sciences University of Bologna and IRCCS Azienda Ospedaliero\u2010Universitaria S.Orsola\u2010Malpighi Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Sim\u00f5es","sequence":"additional","affiliation":[{"name":"Department of Maternal\u2013Fetal Medicine and Maternity Dr. Alfredo da Costa Nova Medica School Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Umstad","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Melbourne Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Vavilala","sequence":"additional","affiliation":[{"name":"Department of Fetal Medicine Fernandez Hospital Hyderabad Telangana India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0702-370X","authenticated-orcid":false,"given":"Y.","family":"Yinon","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"},{"name":"Department of Obstetrics and Gynecology Sheba Medical Center Tel Hashomer Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2802-7670","authenticated-orcid":false,"given":"A.","family":"Khalil","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust University of London London UK"},{"name":"Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute St George's University of London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"MCTA Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,3]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-3-4"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0037-1603917"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2005.00627.x"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2010.08.002"},{"issue":"36","key":"e_1_2_7_6_1","first-page":"e1","article-title":"Perinatal death of triplet pregnancies by chorionicity","volume":"209","author":"Kawaguchi H","year":"2013","journal-title":"AJOG"},{"key":"e_1_2_7_7_1","unstructured":"National Institute for Health and Care Excellence.Twin and triplet pregnancy. NICE Guideline [NG137] 2019.https:\/\/www.nice.org.uk\/guidance\/ng137[Accessed 2 October 2022]."},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.24887"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1017\/thg.2016.92"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.21987"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1017\/thg.2014.69"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.15042"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1159\/000527030"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.18834"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13348"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.03.050"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-022-04617-y"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22054"}],"container-title":["Ultrasound in Obstetrics & Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.26256","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T12:03:30Z","timestamp":1747224210000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.26256"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10]]},"references-count":17,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1002\/uog.26256"],"URL":"https:\/\/doi.org\/10.1002\/uog.26256","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10]]},"assertion":[{"value":"2022-11-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}