quadruplet pregnancy

New techniques, such as fetal reduction, have made possible a favorable outcome from a pregnancy with normally poor outcome.

When the splitting occurs soon after the fertilization, it results in a diamniotic-dichorionic pregnancy. In the study by Luke and Brown, the p-value was <0.0001 for diabetes mellitus, incompetent cervix, induction of labor, stimulation of labor, tocolysis, cesarean delivery, premature rupture of the membranes, infant death of ≥1 baby, birth at ≤29 weeks of pregnancy, and <0.05 for pregnancy-associated hypertension and eclampsia.

In the same study, they concluded that the average duration of reduced twin pregnancies with initially four sacs was 11 days shorter when compared to the duration of unreduced twin pregnancies (254 days–243 days, p < 0.001). In USA, in 2016, the 93% of quadruplets (217 cases) and the 100% of quintuplets and higher order pregnancies (31 cases) have been born before the 34th week of gestation [12].
Stelios Fiorentzis, Styliani Salta, Michail Pargianas, Artemis Pontikaki, Dimitrios P. Koutsoulis, Christodoulos Akrivis, Dimitrios Akrivis and Ioannis Kosmas (November 5th 2018).

A diamniotic-monochorionic pregnancy occurs when the fertilized egg splits between the third and the eighth day after fertilization and a monoamniotic-monochorionic when the splitting occurs between the ninth and twelfth day.

Serena's Quadruplet Pregnancy 104.

There was no difference between the groups in regard to the mode of delivery. The term “vanishing fetus” or “natural fetal reduction” is used to describe the loss, through miscarriage, of one or more fetuses during a multiple gestation. 104 deviations. There was no difference in regard to perinatal or obstetric complications. I began writing this post several months ago when the NICU director from Cook Children’s Hospital asked George and I to speak at an upcoming event about infant mortality.

We share our knowledge and peer-reveiwed research papers with libraries, scientific and engineering societies, and also work with corporate R&D departments and government entities. The average costs per child is about $233,680 in the USA (for a child born in 2015, data published by the U.S. Department of Agriculture), without the college education. “High-order pregnancy” is defined by the presence of three or more fetuses. We are a community of more than 103,000 authors and editors from 3,291 institutions spanning 160 countries, including Nobel Prize winners and some of the world’s most-cited researchers. Luke and Brown in 2008 [65] published a study in which they compared risk rates for maternal and neonatal complications among high-order pregnancies. Women between the ages of 35 and 41 are more likely to have a multiple gestation. Chow et al. Women with a BMI over 30 are more likely to conceive more than one babies compared to women with normal BMI [31, 32, 33, 34]. Modern fertility treatments are the most important reason for the increase in multifetal pregnancies. Quadruplet pregnancy occurs about once in 550,000 pregnancies. Anemia and iron deficiency are more prevalent among women with a multifetal pregnancy compared to women carrying singletons, so nutriments and supplements containing iron are highly recommended [93]. In the same study, the mean age for women with quadruplets and preeclampsia was 34 years and without preeclampsia was 28.6 years, with no statistical significance. For multiple pregnancies, Liem et al. Case report: The patient was a 34-year-old, G4 L2 Ab1.

Higher levels of FSH can be associated with the maturation of multiple follicles in natural cycles and consequently the occurrence of a multiple pregnancy [30].

Depp et al. The time of the elective delivery is also to be considered, with Elliot reporting choosing the 34 + 0 weeks for quadruplets [17]. The study by Luke and Brown in 2008 [45] also came to the same results that quadruplet pregnancies have greater chances for pregnancy-associated complications when compared to twin pregnancies. Multiple pregnancies present increased spontaneous loss rates, and these rates increase in parallel with the increase of the number of the fetuses. The management of such a pregnancy is also challenging since its beginning and to the end.
TNT-3D.

Tocolysis is also another method for the prevention or delay of preterm labor.

Liu in 2010 [19] reported a case of a monozygotic quadruplet pregnancy as a result of IVF, although the pregnancy ended in the ninth week of gestation due to chromosomal abnormalities. Ultrasonography plays an important role in the diagnosis of chorionicity and placentation of a pregnancy. A proposed fetal reduction can cause anxiety to the couple, but eventually the majority of patients accept to abort some fetuses in order to preserve the lives of the others [132].

Several researchers and clinicians used several different medicines, as prophylactic treatment.

Black women have the highest rate of dizygotic twins followed by Asian women and finally white women. It is estimated that about 25–30% of preterm labor is the result of preterm premature rupture of the membranes [78]. I abandoned it for fear of seeming lackluster or coming off as conceited. In cases of a quadruplet, quintuplet, or any high-order pregnancy, early diagnosis is crucial for the further management and treatment. In any case, more studies are necessary in order to have results that are more reliable. The rarity of quadruplet and quintuplet pregnancies makes further research necessary in order to confirm that the rise in gestational diabetes rates continues among quadruplet and quintuplet pregnancies. In the same study, however, they found that women who were drinking ≥15 alcohol units per week and those who were smoking ≥10 cigarettes per day were more likely to conceive a multifetal pregnancy.

Noteworthy, a higher BMI increases the probability of multizygotic pregnancies but not monozygotic ones. They concluded that women with triplets and more were in greater risk for pregnancy associated hypertension, eclampsia, anemia, diabetes mellitus, placental abruption, premature rupture of the membranes, and cesarean delivery, even after the adjustment for important confounding factors. There was statistically significant higher incidence for almost all complications considered within the trichorionic group. Finally, for quadruplets and high-order pregnancies, Caucasian race was a common aggravating factor, and premature rupture of the membranes in multifetal gestations increased with gestational plurality and occurred at earlier gestational age. Since the early 1970s, maternal age was considered an important factor that could influence the conception of a multiple pregnancy, with a reported fourfold increase of dizygotic twinning rate between the ages of 15 and 37 [28]. Many studies, since the 1970s [39, 40, 41, 42], have denoted an increase in twin pregnancies after the cessation of oral contraceptive pills.

Altogether, the reduction of a high-order pregnancy with more than four fetuses to twins holds the best outcome.

Since placenta plays an important role in preeclampsia [82], the increased mass of the placenta in multifetal pregnancies is probably associated with the occurrence of preeclampsia. Nnadi in 2013 [20] described a case of monozygotic quadruplet pregnancy conceived naturally that ended in an elective cesarean section of a set of monochorionic tetra-amniotic quadruplets at 37 weeks of gestation. Quadruplets and Quintuplets, Multiple Pregnancy - New Challenges, Julio Elito Jr., IntechOpen, DOI: 10.5772/intechopen.80338. Licensee IntechOpen.

15 Comments. Delivery of small, premature infants of a multiple pregnancy can usually be accomplished through the pelvic canal. in 2004 [112] in a series of 313 multiple pregnancies showed that fetal reduction can reduce the risk of pregnancy loss and severe prematurity in quadruplets and higher order pregnancies and result, in most cases, in at least one live neonate. Quadruplets and quintuplets have higher neonatal and perinatal mortality compared to triplets. Quadruplet bellies. On the other hand, premature rupture of the membranes for late preterm gestational ages (34–37 weeks of gestation) contributed to 10% of quadruplets, 12.2% of triplets, 11% of twins, 10.2% of singletons, while no high-order pregnancies could reach that gestational age (p < 0.001).

According to their results, quadruplet pregnancies are more likely to be diagnosed with preterm premature rupture of the membranes (10.64% compared to 9.61% for triplets and 6.17% for twin pregnancies, p < 0.001).

Hypertensive disorders of pregnancy are more common among multiple pregnancies, in particular quadruplet pregnancies have a reported incidence of pregnancy-associated hypertension up to 40% with earlier and more severe onset [80]. Superfetation has not yet been proven possible in humans, although it exists in animals [26]. Since 75% of monozygotic twins are also monochorionic [61], women who have undergone such treatments and have a multifetal gestation must be suspected for monochorionicity. On the other hand, they observed a statistically significant difference when they compared neonatal deaths (p = 0.02), the “Discharged Alive” (76.3% for triplets, 54.9% for quadruplets and quintuplets, p = 0.003), early neonatal mortality for ≥1000 g (p = 0.04), and perinatal mortality for >24 and ≥28 weeks of pregnancy (both p = 0.005). Check out the Illustrated Guide to Pregnancy Photography! Copyright © 2020 Elsevier B.V. or its licensors or contributors. Malpresentations are common, while the babies often require intensive care and special treatment, considering that more than 90% of high-order pregnancies are born prematurely. 20 Comments. The same study showed that the rates for severe pregnancy-associated hypertensive disorders were 1.1, 3.1, 1.6, and 0.5% for quadruplet, triplet, twin, and singleton pregnancies, respectively. Straus in 2002 compared a group of quadruplet and quintuplet pregnancies with cerclage and one without and found that the birth weight was higher in the cerclage group (p < 0.001). 19 Comments. When all pregnancy complications were compared, no statistically significant difference was found between the two groups, except for premature labor (p = 0.046). This case reported was correctly diagnosed at approximately 17 weeks of gestation, by a combination of clinical and x-ray findings, apparently the earliest diagnosis on record. Neubecker in 1962 [21] and Rau in 1940 [22] reported two cases of monozygotic quintuplet pregnancies, indicating the possibility of a quadruplet and quintuplet pregnancy arising from a single ovum.

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