Raheela Mohsin.
Triplet Gestation - Arrest of preterm labour.
J Coll Physicians Surg Pak Jan ;9(5):241-2.

The main pregnancy complication in triplet gestation are prematurity (including premature rupture of membranes), pregnancy induced hypertension, anaemia, antepartum and postpartum haemorrhage. A case of triplet gestation is presented in which zygosity was determined at eighteen weeks of gestation.

CASE REPORT: A 30 years old house wife of lower middle class, married to her first cousin for last 7 years, presented with second pregnancy and a strong family history of twin pregnancy. The earlier pregnancy was also a spontaneous twin pregnancy with death of one fetus in utero at 30 weeks and preterm vaginal delivery of other fetus at 32 weeks of gestation at home, after a short labour. The baby died one week after birth due to the respiratory distress syndrome. Now after the six months of first delivery she gave history of gestational amenorrhoea of about 18 weeks and experienced exaggerated symptoms of pregnancy plus the early perception of fetal movement. There was no history of fertility drugs. On examination she was pale with blood pressure of 120/70 mmHg and fundal height of about 26 weeks. High resolution ultrasound examination revealed the presence of three fetuses, a thick membrane was seen between each sac and widely separated placental sites indicating a trizygotic trichorionic pregnancy. No congenital anomaly was detected and fetal sizes corresponded to the gestational age. At 28 weeks of gestation she reported in emergency with painful uterine contractions. On examination mild uterine contractions were palpable. Pelvic examination revealed intact cervical cerclage and high vaginal swab culture yielded no growth. After one hour observation it was decided to use tocolytic agent alongwith corticosteroids with careful monitoring of maternal pulse, blood pressure, blood glucose, serum urea, electrolyte, ECG and fetal heart rate. An infusion with ritodrine hydrochloride (Yutopar), a beta agonist, 150mg (3x5 ml ampoules) diluted in 500 ml of 5% dextrose solution was prepared. Initially the drip rate was 20 drops/min i.e. 0.1 mg/min and gradually increased by 10 drops/min every 10 min till the uterus was relaxed at 40 drops/min i.e. 0.2 mg/min of ritodrine hydrochloride. The infusion was continued for 12 hours after the last uterine contraction and oral therapy started as one tablet (10mg) at approximately 30 min before the termination of intravenous administration every 6 hours for 3 days and maintained at 10mg twice daily thereafter. Along with ritodrine infusion patient also received intramuscular injection of betamethasone 12 mg B.D for 2 days.

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