PERINATAL OUTCOME ASSOCIATED WITH OUTPATIENT MANAGEMENT OF TRIPLET PREGNANCY

OBJECTIVE: Our goal was to compare the lengths of hospitalization and the perinatal outcomes of triplet pregnancies managed with either outp atient or inpatient third-trimester bed rest. STUDY DESIGN: Thirty-two triplet pregnancies in which outpatient bed rest was prescribed (Apri l 1993 to April 1996) were compared with a historic cohort of 34 tripl ets (January 1985 to March 1993) in which routine hospitalization was undertaken in the third trimester, Length of hospitalization and mater nal and neonatal outcome parameters were compared between groups. RESU LTS: Maternal inpatient hospital days were significantly reduced for t he group managed as outpatients, but combined maternal and neonatal ho spitalization was similar between groups. The mean gestational age at delivery was 1 week greater in the hospitalized cohort (33.5 +/- 2.8 v s 32.5 +/- 2.8, respectively; p = 0.16), and average birth weight was correspondingly greater in hospitalized cases (1942 gm vs 1718 gm, p < 0.005). Neonatal lengths of stay were similar between groups, reflect ing earlier postnatal discharge in the outpatient era of this study. P reeclampsia occurred with greater frequency in the outpatient group (3 1.3% vs 8.8%, p = 0.02), and the neonatal complication of intraventric ular hemorrhage occurred more commonly in this cohort as well (10/96 v s 1/102, p = 0.004). All other maternal and neonatal complications wer e similar be tween groups. CONCLUSION: Reduction in the length of hosp italization attributable to outpatient management was limited to the m aternal length of stay. It is possible that the observed maternal and neonatal complications in the outpatient group may have been related t o less rigorous bed rest. We would suggest that the differences noted in preeclampsia, birth weight, and intraventricular hemorrhage support prospective evaluation of bed rest in triplet pregnancy.