Title: Quadruplet Pregnancy Following Spontaneous Conception: A Rare Case Report
Authors: Veena Meena, Khuteta Sushila, Amarawatin Kurre, Kalpana Bariha, Meena Shyam
DOI: http://dx.doi.org/10.18535/jmscr/v4i4.54
Higher order (triplet or more) multiple pregnancies occur when more than two fetuses are present in the uterus at the same time. Quadruplets are a set of four offspring born at one birth which can be fraternal (multizygotic), identical (monozygotic) or a combination of both. Multizygotic quadruplets occur from fertilisation of four different sets of ovum and sperm. Monozygotic multiples are the result of a fertilized egg that splits into two or more embryos. Multizygotic quadruplets can be all male, all female, or a combination of both while monozygotic quadruplets will always be of the same gender. Here we present a case of 26-year-old G2A1L0 with previous history of one spontaneous abortion at 8 wk of gestation. After evaluation, she was found to carry three live foetuses with an IUFD. She was managed conservatively till 35 wk of gestation with regular monitoring of coagulation parameters. Elective caesarean section was done at 35 wk; two male, one female live babies and one IUFD male baby were delivered. This case is unique due to the fact that our patient conceived a multizygotic quadruplet pregnancy spontaneously after an abortion. One fetus died in utero and the pregnancy continued successfully resulting in 3 live born healthy babies. Keywords: Multiple gestations, Quadriamniotic quadrichorionic placenta, intrauterine death 1. Fisk NM. Higher order multiples. In: Keith Edmonds (ed). Dewhursts textbook of obstetetrics and gyneacology for post graduates. Blackwell, Edinburgh.1999; 306. 2. Pernoll ML, Benson RC. Multiple pregnancy. In: Decheney AH (ed). Current obstetrics and gynaecologic diagnosis and treatment. Appleton and Lange, Connecticut. 1994; 357-367. 3. Marinho AO, Ilesanmi AO, Ladele AO, Asuni OH, Omigbodun AO, Oyejide CO. A fall in the rate of multiple births in Ibadan and Igbo-Ora Nigeria. Acta Genet Med Gemellol 1986; 35: 201-204. 4. Nkyekyer K. Multiple pregnancy. In: Kwawukume EY, Emuveyan EE (eds). Comprehensive obstetrics in the tropics. Asante and Hittscher, Accra. 2002; 162-172. 5. Spellacy WN. Multiple pregnancies (quadruplets or more). In: Scott JR (ed). Danforths obstetrics and gynaecology. Lippincott Williams & Wilkins, Baltimore. 2000; 293-300. 6. Goldman GA, Dicker D, Peleg D, Goldman JA. Is elective cerclage justified in the management of triplet and quadruplet pregnancy? Aust NZL J Obstet Gynaecol. 1989;29:9-11. 7. Doyle P. The outcome of multiple pregnancies. [4] Hum Reprod. 1996;11:110-20. 8. Hull MGR. Ovulation failure and induction. Clin Obstet Gynecol 8; 753. 9. Harshini V, Geethanjali, Vijaya R, Prajna. Outcome in twin pregnancy with intrauterine death of first twin- A case report. Int J Med Health Sci. 2012;1(4):7275. 10. Nnadi D, Ibrahim A, Nwobodo E. Spontaneous monochorionic tetra-amniotic quadruplet pregnancy at term. J Basic Clin Reprod Sci. 2013;2:57-59. 11. Vikranth U, Borkar NV, Desai SK, Kania P, Rangoonwala NH. A Quadruplet pregnancy. J Obstet Gynecol India. 2007;57(5):439-41. 12. Adegbite AL, Ward BS, Bajoria R. Perinatal outcome of quadruplet pregnancies in relation to chorionicity. Journal of Perinatology. 2007;27:15–21. 13. D’ Alton ME, Newton ER, Cetrulo CL. Intrauterine fetal demise in multiple gestations. Acta Genet Med Gemellol. 1984;33:43-49. 14. HHN Woo, SY Sin, LCH Tang. Single fetal death in twin pregnancies: review of the maternal and neonatal outcomes and management. HKMJ. 2000;6:293300.Abstract
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