{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T05:02:05Z","timestamp":1785214925555,"version":"3.55.0"},"reference-count":12,"publisher":"Georg Thieme Verlag KG","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This study aimed to describe a contemporary cohort of triplet pregnancies from two tertiary centers in a middle-income country and evaluate the association between gestational age (GA) at birth and perinatal death. We developed and internally validated a GA-based risk model.<\/jats:p>\n                  <jats:p>Retrospective cohort from two tertiary hospitals (2015\u20132024). The unit of analysis was the fetus\/neonate, with cluster-robust standard errors at the mother level. Primary outcome: Perinatal death (stillbirth \u2265230\/7 weeks or neonatal death \u226428 days). GA was modeled with logistic regression using restricted cubic splines; Firth penalization addressed separation where applicable. Internal validation used 200 bootstrap resamples.<\/jats:p>\n                  <jats:p>The cohort included 150 neonates; perinatal death occurred in 23 (15.4%). Median GA was 33 (31\u201334) weeks overall, 34.0 (32.0\u201334.0) in survivors, and 25.0 (24.0\u201328.0) in perinatal deaths. In the adjusted spline model, GA was the dominant predictor (overall Wald \u03c72\u2009=\u20091,473.66, df\u2009=\u20093, p\u2009&lt;\u20090.001; non-linearity \u03c72\u2009=\u2009424.92, df\u2009=\u20092, p\u2009&lt;\u20090.001), while severe preeclampsia was not significant (\u03c72\u2009=\u20090.10, p\u2009=\u20090.750). The category-based Firth model showed markedly elevated odds of perinatal death at earlier gestations versus \u226534 weeks: &lt;28 weeks; adjusted odds ratio (aOR)\u2009=\u2009871.15 (95% confidence interval [CI]: 81.25\u2013124,006.80, p\u2009&lt;\u20090.001); 28 to &lt;32 weeks, aOR\u2009=\u200950.22 (5.45\u20136,682.53, p\u2009&lt;\u20090.001); 32 to &lt;34 weeks, aOR\u2009=\u20095.34 (0.26\u2013804.14, p\u2009=\u20090.278); and severe preeclampsia, aOR\u2009=\u20091.02 (0.09\u20137.17, p\u2009=\u20090.984). The internally validated model demonstrated excellent discrimination (optimism-corrected area under the receiver operating characteristic curve [AUROC], 0.972) and good overall performance (Brier score, 0.047), with a calibration intercept of \u22120.129, a slope of 0.696, and a maximum absolute calibration error (E\n                  max) of 0.104.<\/jats:p>\n                  <jats:p>In triplet pregnancies, GA at birth is the dominant determinant of perinatal death, with a steep risk gradient at earlier gestations. A GA-based model demonstrates excellent discrimination and acceptable calibration following bootstrap internal validation, supporting its use in informing counseling and timing-of-delivery decisions in this high-risk population.<\/jats:p>","DOI":"10.1055\/a-2781-7542","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T23:54:57Z","timestamp":1768002897000},"page":"1486-1492","source":"Crossref","is-referenced-by-count":0,"title":["Perinatal Death in Triplets by Gestational Age: A Retrospective Cohort from Two Tertiary Hospitals"],"prefix":"10.1055","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1325-7249","authenticated-orcid":false,"given":"Oswaldo","family":"Tipiani-Rodriguez","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Alberto Sabogal Sologuren National Hospital (EsSalud), Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1186\/s12884-024-06599-5","article-title":"Perinatal outcomes and growth discordance of triplet pregnancies based on chorionicity: A retrospective cohort study","volume":"24","author":"Q Hu","year":"2024","journal-title":"BMC Pregnancy Childbirth"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"e145","DOI":"10.1097\/AOG.0000000000004397","article-title":"Multifetal gestations: Twin, triplet, and higher-order multifetal pregnancies: ACOG Practice Bulletin, Number 231","volume":"137","author":"American College of Obstetricians and Gynecologists","year":"2021","journal-title":"Obstet Gynecol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"e256","DOI":"10.1055\/s-0040-1709489","article-title":"The maternal impact, health burden, and postpartum sequela in triplet pregnancies: A retrospective cohort","volume":"38","author":"D S Lambers","year":"2021","journal-title":"Am J Perinatol"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1111\/aogs.14281","article-title":"Short-term and long-term outcomes of trichorionic triplet pregnancies with expectant management","volume":"101","author":"J Y Lee","year":"2022","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1002\/uog.26256","article-title":"Perinatal outcome of monochorionic triamniotic triplet pregnancy: Multicenter cohort study","volume":"62","author":"F G Sileo","year":"2023","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1186\/s12887-025-05933-w","article-title":"Global inequities in the survival of extremely preterm infants: A systematic review and meta-analysis","volume":"25","author":"T Getaneh","year":"2025","journal-title":"BMC Pediatr"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"178","DOI":"10.17843\/rpmesp.2022.392.10629","article-title":"Desigualdad en la mortalidad neonatal del Per\u00fa generada por la pobreza y educaci\u00f3n, 2011-2019. [In Spanish]","volume":"39","author":"J G \u00c1vila Vargas-Machuca","year":"2022","journal-title":"Rev Peru Med Exp Salud Publica"},{"key":"ref9","first-page":"128","article-title":"Maternal, pregnancy and neonatal outcomes in triplet pregnancies in Sweden - a nationwide cohort study","author":"M M Ekstr\u00f6m","year":"2023","journal-title":"Ups J Med Sci"},{"issue":"38","key":"ref10","doi-asserted-by":"crossref","first-page":"e44500","DOI":"10.1097\/MD.0000000000044500","article-title":"Comparison of maternal and perinatal outcomes of multifetal pregnancy reduction versus conservative management in triplet pregnancies","volume":"104","author":"H Cetin Arslan","year":"2025","journal-title":"Medicine (Baltimore)"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1002\/uog.29166","article-title":"ISUOG Practice Guidelines (updated): Role of ultrasound in twin pregnancy","volume":"65","author":"A Khalil","year":"2025","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"06","key":"ref14","doi-asserted-by":"crossref","first-page":"e237","DOI":"10.1097\/AOG.0000000000003891","article-title":"Gestational hypertension and preeclampsia: ACOG Practice Bulletin, Number 222","volume":"135","author":"American College of Obstetricians and Gynecologists","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"05","key":"ref15","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1038\/sj.jp.7210950","article-title":"Triplet morbidity and mortality in a large case series","volume":"23","author":"S Barr","year":"2003","journal-title":"J Perinatol"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2781-7542.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:51:01Z","timestamp":1785214261000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2781-7542"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,9]]},"references-count":12,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,7,27]]},"published-print":{"date-parts":[[2026,8]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2781-7542","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1,9]]},"published":{"date-parts":[[2026,1,9]]}}}