Multifetal Pregnancy Reduction in Quadruplets: Perinatal Outcome—Analysis of 20 Consecutive Cases

Abstract

High order multiple pregnancy (HOMP) is defined as presence of three or more fetuses in utero. These pregnancies are often met with increased maternal and perinatal complications. The incidence of HOMP has been rising considerably with increasing usage of assisted reproductive techniques (ART). Multifetal pregnancy reduction (MFPR) is a standard procedure aimed to minimise maternal–fetal complications by converting high order multiples into twins or singletons. While the procedure has been well researched in triplets, literature is sparse for quadruplets. This is a case series of 20 consecutive cases of MFPR followed up till delivery. All procedures were performed between 11 and 14 weeks of gestation (mean 11.9+/- 0.94) in a dedicated fetal medicine unit by a single operator through transabdominal route. The primary outcome measure was to assess procedure related miscarriage. The study also looked at neonatal outcomes at delivery and various maternal complications like antepartum hemorrhage (APH) and prelabour premature rupture of membranes (PPROM). There was no pregnancy loss before 24 weeks but the rate of preterm delivery was very high (90%). Only two out of 20 women were delivered after 37 weeks. All (100%) ended in live births. There were two cases of neonatal deaths where one twin died from each pair. The mean birthweight (+/- SD) was 1754.75 (+/- 514.75) g (range 700–2600 g). Quadruplet pregnancies can happen with fertility treatment. Transabdominal MFPR in the first trimester is a safe procedure for quadruplets.

Keywords

Quadruplets - Multifetal pregnancy reduction - Multiple pregnancy - Fetal reduction

Publication History

Received: 16 February 2021

Accepted: 28 May 2021

Article published online:
05 May 2023