Quadruplet pregnancy with widespread Tenney-Parker changes: A case report

Abstract

Introduction: The incidence of multiple pregnancies has increased tremendously over the last 3–4 decades due to the advent of assisted reproductive technology treatment. Generally, multifetal pregnancy is associated with increase in maternal and perinatal morbidity and mortality, which are directly proportional with increasing numbers of fetuses in higher order multiple pregnancies. Case Report: We present a case of a 26-year-old G1P0104 female with a 3-year history of anovulatory infertility. After the third cycle of ovarian stimulation with clomiphene citrate, she became pregnant with quadruplets. She had no significant past medical or surgical history. The pregnancy was a tetrachorionictetraamniotic quadruplet and it was relatively uncomplicated during the first and second trimesters. However, the patient had prolonged antepartum admission from 25w6d due to symptomatic preterm uterine contractions. At 31w3d, the patient underwent primary cesarean section due to non-reassuring fetal heart tracing and biophysical profile of quadruplet A. Four viable neonates were delivered, three females and one male. All four quadruplets were admitted to the Neonatal Intensive Care Unit (NICU) with varying degrees of neonatal complications due to prematurity, but they were discharged home between 8 and 9 weeks of life. The placental pathology showed Tenney-Parker changes, but it did not adversely affect the outcome of these infants. Conclusion: Higher-order multifetal pregnancies can pose serious management challenges because of increased preterm delivery. Hence, management should be in a tertiary medical center with a multi-disciplinary team that includes an Obstetrician, Perinatologist, and Neonatologist.