+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Hospitalization vs. outpatient care in the management of triplet gestations



Hospitalization vs. outpatient care in the management of triplet gestations



International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics 77(3): 223-229



To compare the course and outcome of triplet gestations under a preventive care strategy that includes hospitalization, surveillance, bed rest, and daily specialized care from the beginning of the second trimester, with pregnancies managed according to the Croatian standard outpatient care protocol for multiplets. A retrospective study of 79 triplet pregnancies. Preventive hospitalization from the beginning of the second trimester, with complete bed rest and all necessary interventions, was chosen by 55 women (Group I). The remaining 24 women (Group II) elected the standard outpatient protocol for multiple pregnancies. Outpatient management with prophylactic bed rest was initiated at home as soon as the multiple pregnancy was diagnosed. After 28 weeks of gestation, all outpatients were hospitalized until delivery irrespective of symptoms. There was no difference between the groups regarding maternal age, race, pre-pregnancy weight and height, weight gain during the first 24 weeks of pregnancy, or the proportion of pregnancies achieved with assisted reproductive technology. Four out of 55 women (7.2%) from Group I and 4 out of 24 women (12.5%) from Group II had monochorionic triplet pregnancies (P=n.s.). Nulliparity was more frequent in Group I than in Group II (P=0.006). Elective cesarean delivery was significantly more frequent in Group I (46 out of 55 gestations, 72.7%) than in Group II (9 out of 24 gestations, 37.5%), P=0.024. Gestational age at delivery and mean birth weight were significantly higher in Group I than in Group II (P<0.001). Deliveries up to 28 weeks of pregnancy were infrequent in Group I (P=0.02). Thirty-three gestations in Group I (60%) and 6 (25%) in Group II had a duration of 33-36 weeks (P<0.001). Two out of 55 triplet gestations in Group I (3.6%) and 4 out of 24 in Group II (16.7%) ended in spontaneous abortion (P=0.053). The survival of the three triplets was more frequent in Group I than in Group II (P=0.048). For gestations reaching 24 weeks or more, the fetal and perinatal death rate was significantly lower in Group I (P<0.001). In Group I the intrauterine death rate for fetuses weighing 1500 g or less was also significantly lower (P=0.007), and the early neonatal death rate was almost half (15.8 vs. 28.9%, P=0.157). There were no differences in other pregnancy complications between the two groups except significantly more frequent preterm premature rupture of membranes and preterm labor requiring parenteral tocolysis in Group II (P=0.042 and 0.036, respectively), and significantly more frequent fetal growth retardation in Group I (P<0.001). Preventive hospitalization offers a better outcome for triplets even though prolonged hospitalization and all other procedures necessary to achieve optimal pregnancy outcome are also offered in the Croatian standard outpatient care protocol for multiplet pregnancies.

(PDF emailed within 0-6 h: $19.90)

Accession: 046273306

Download citation: RISBibTeXText

PMID: 12065133

DOI: 10.1016/s0020-7292(02)00060-7


Related references

Outcome of triplet pregnancy with prophylactic hospitalization vs outpatient perinatal care. American Journal of Obstetrics & Gynecology 176(1 PART 2): S55, 1997

Antepartum management of triplet gestations. American Journal of Obstetrics and Gynecology 167(4 Pt 1): 1117-1120, 1992

Comparison of birthweights of twin gestations resulting from embryo reduction of higher order gestations to birthweights of twin and triplet gestations using a novel way to correct for gestational age at delivery. American Journal of Obstetrics & Gynecology 174(1 PART 2): 346, 1996

Intensive antenatal care in triplet gestations reduces the cost of neonatal care for very low birth weight infants. Pediatric Research 49(4 Part 2): 417A, April, 2001

The effects of outpatient management on hospitalization for ambulatory care sensitive conditions associated with diabetes mellitus. Southern Medical Journal 101(8): 815-817, 2008

Contemporary management of triplet/quad gestations in a private practice setting. American Journal of Obstetrics & Gynecology 176(1 PART 2): S119, 1997

Outpatient triplet management: a contemporary review. American Journal of Obstetrics and Gynecology 161(3): 547-53; Discussion 553-5, 1989

Assessing psychiatric care settings. Hospitalization versus outpatient care. International Journal of Technology Assessment in Health Care 12(4): 618-633, 1996

The German Quality Management System for Outpatient Care (Q-M-A) Checklist--an instrument for assessing quality management systems in outpatient care. Gesundheitswesen ) 65(10): 585-592, 2003

Perinatal outcome associated with outpatient management of triplet pregnancy. American Journal of Obstetrics and Gynecology 178(4): 843-847, 1998

Cost savings and perinatal outcome associated with outpatient management of triplet pregnancy. American Journal of Obstetrics & Gynecology 176(1 PART 2): S120, 1997

Corticosteroids in triplet gestations. American Journal of Obstetrics & Gynecology 182(1 Part 2): S156, 2000

Causes of thrombocytopenia in triplet gestations. American Journal of Obstetrics & Gynecology 189(1): 177-180, July, 2003

Causes of thrombocytopenia in triplet gestations. American Journal of Obstetrics & Gynecology 185(6 Supplement): S184, December, 2001

Insurance parity and outpatient care following a psychiatric hospitalization. JAMA 301(18): 1880-1; Author Reply 1881, 2009