Trichorionic Quadruplet Delivered Beyond 36 Weeks of Gestation: A Case Report and Literature Review

As a parent, there are few moments more joyous than seeing a positive pregnancy test. But when that positive pregnancy test is followed by news of having quadruplets, the joy, surprise, and excitement of the announcement is amplified. For the expectant mother, the news of having quadruplets brings a unique set of challenges, both physical and emotional. For the parents, the journey of being pregnant with quadruplets can bring a unique set of obstacles and concerns that are not present in singleton pregnancies. This blog post will explore the unique and sometimes arduous journey of being 40 weeks pregnant with quadruplets. We will discuss the physical and emotional changes that can occur during a multiple pregnancy, as well as the unique concerns that come with being pregnant with quadruplets. Additionally, we will provide resources and tips to help make the journey more manageable.

Of the 17 embryos, 10 had reached the 8-cell stage by day 3, one had reached the 7-cell stage, and 6 were still in the 2- to 4-cell stage. The couple decided to have 3 embryos transferred back into the uterus after receiving extensive counseling; they were aware of the risk of multiple pregnancy and its potential negative effects. Three very good quality 8-cell embryos (with grade 3. Later that day, at roughly 72 hours after oocyte recovery, the most suitable embryos (5 to 4 out of 4) were transferred. The Sydney IVF embryo transfer catheter (Catalogue number K-JETS-6019-SIVF, Cook, Limerick, Ireland) was successfully used for the embryo transfer. The remaining 8 embryos of good quality (7 8-cell and 1 7-cell embryos with grade 3 to 3 5 out of 4) underwent cryopreservation using vitrification technique.

The couple underwent an ultrasound at 11 weeks of pregnancy, which determined that all four fetuses were viable. The intersac membranes were examined for chorionicity, and it appeared that the pregnancy was trichorionic quadramniotic because the dividing membrane between two of the foetuses displayed a “T” sign rather than a “lambda” sign in the other dividing membranes between the foetuses. This was anticipated because it was the most likely cause for those three embryos developing into four foetuses. The couple received fresh counseling regarding all risks associated with this type of pregnancy, as well as information on the benefits, drawbacks, and debates surrounding cervical cerclage and nuchal translucency measurement in high-order multiple pregnancies. They made the decision to continue this pregnancy regardless of the results, so they declined to have their nuchal translucency measured. Only if all four fetuses were still alive after two weeks did the couple decide to have a cervical cerclage. After determining that all four fetuses were viable at 13 weeks’ gestation, the McDonald cervical cerclage was performed without any issues.

TTTS is a devastating complication that can affect 10%E2%80%9330% of monochorionic twins [6, 7] and is associated with up to 80% mortality rate in untreated cases [17] As early as 11 weeks into a trichorionic quadruplet pregnancy that resulted from IVF-ICSI, TTTS has been documented [18]. She avoided developing this complication in our case, which is fortunate. The same positive outcome has also been reported by other people in two sets of monochorionic twins in a quadruplet pregnancy [10].

Multiple pregnancies are regarded as high-risk pregnancies, with more complications appearing as the number of fetuses rises. Mothers of triplets and quadruplets had a higher risk of being diagnosed with preterm premature rupture of the membranes, experiencing excessive bleeding, giving birth earlier than 29 weeks, and losing one or more babies than mothers of twins [8]. In various reports, the gestational age at delivery for quadruplets ranged from 28 weeks to 31 weeks [1, 2]. Only a few reports stated that the gestational age at which delivery occurred was 34 weeks [9, 10]. In contrast to the examples above, our case was unusual in that none of the complications were present, and delivery wasn’t done until 36 weeks and 3 days into the pregnancy.

In a review that included over 158000 multiple pregnancies, other complications like gestational diabetes mellitus, abruptio placenta, and premature rupture of membranes were significantly higher in women who had triplet pregnancies, quadruplet pregnancies, and higher-order multiple gestations than in women who had twin pregnancies [15]. Other smaller reviews observed the same finding [4, 8]. Our case did not sustain any of those complications.

Compared to single newborns, quadruplets and other multiples typically weigh less at birth and grow more slowly. Problems with the umbilical cord and placenta are among the many causes.

Compared to a single premature baby of a similar gestational age, preterm multiples have a higher risk of developing cerebral palsy.

A C-section is the procedure of choice for quadruplets and higher multiples to help ensure your safety and the safety of your babies.

It’s incredibly exciting to be expecting quadruplets, but it’s also completely normal to feel a little anxious. Quadruplets are very rare and can present some unique challenges. Continue reading for Flo’s advice on what to do if you are expecting quadruplets.

Occasionally, women over 30 release two eggs during their menstrual cycle, increasing their likelihood of having quadruplets.

The news that you are expecting four babies or more will probably come as a HUGE surprise. You may feel delighted, scared and shell-shocked all at once! But the good news is there’s plenty of support available from the NHS and specialist organisations like Twins and Multiple Birth Association (Tamba).

At your first ultrasound, you’ll learn the details, including the number of fetuses you’re carrying, the number of placentas, and whether or not they’re in separate or shared amniotic sacs. At the first ultrasound, it might be beneficial to see a picture of your babies to help the news sink in.

You’re going to be super busy when your gorgeous babies finally arrive, plunging you into a new stratosphere of happy chaos. So read up beforehand on everything from multiple births to sleep routines. And why not get down to your local twins club to meet mums with twins, triplets or more to meet mums in the same boat?

FAQ

Can you carry quadruplets to full term?

A normal pregnancy lasts 40 weeks. The average length of a pregnancy for triplets is 32 weeks. For quadruplets, the average length is 30 weeks. Continuing a multiple pregnancy past 36 weeks can be risky for you and your babies.

How many weeks do you deliver quadruplets?

Twin pregnancies occasionally progress to 40 weeks but almost always deliver early. As the number of fetuses increases, the expected duration of the pregnancy decreases. The average duration is 35 weeks for twins, 33 weeks for triplets, and 30 weeks for quadruplets.

What to expect when you have a quadruplet pregnancy?

The majority of women experience sleep discomfort with a multiple pregnancy. You may be struggling with back pain, heartburn, breathing problems, and constipation. And if you’re pregnant with quadruplets, you’re probably noticing these issues well before your third trimester.

Can you naturally give birth to quadruplets?

Two minutes later, he said there was a fourth. I was speechless.” The couple conceived quadruplets naturally, an extremely rare occurrence that happens in just 1 in 700,000 pregnancies. Approximately 90 percent of quadruplets are conceived with the assistance of medical technology.

Mother Delivers Quadruplets at Sharp Mary Birch Hospital for Women & Newborns

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