Case Report Of Radiofrequency Fetal Reduction In Monozygotic Triplet And Quadruplet Pregnancy And Literature Review

Compared with monocyesis,multiple pregnancies,especially monozygotic pregnancies,can increase the risk of maternal and fetal Pregnancy-related complications and severity in different degree,which cause poor pregnancy outcome.Radiofrequency fetal reduction has been used to treat monozygotic twins widely.However,since monozygotic triplets and quadruplets are rare,and the placental allocation and vascular anastomosis is complex,the methods and cliinical outcome of fetal reduction needs to be investigated.In this study,we researched and followed 8 monozygotic triplets and quadruplets radiofrequency fetal reduction cases in recent years,and summarized literature report aiming at providing certain reference for clinical treatment.From Mar.2014 to Jan.2017,Shandong Provincial Hospital treated eight cases,including seven monozygotic triples and one monozygotic quadruplet.In these cases,gestational age was 24-34 years old.Patients all kept in good health before pregnancy,and developed smoothly in the first trimester without abdominal pain or vaginal bleeding.Six cases was spontaneous pregnancy and two cases were IVF-ET pregnancy.There was not obvious family aggregation in these cases.At 16-18 weeks of gestation,they chose radiofrequency fetal reduction.Pregnancy outcome:seven cases delivered by cesarean successfully,including two preterm premature rupture of membranes,one severe preeclampsia and four term labors.One case was infected and aborted on the 6th day after operation.One minute and five minutes Apgar of the newborns were above 7.Three newborns treated in hospital,in which one appeared pathologic jaundice,and one appeared laryngeal stridor.The patients did not get any complications after delivery and kept in good health.The spontaneous occurrence of monozygotic triple and quadruplet is rare.Since the wide use of artificial assisted reproductive technology recently,the incidence increased obviously.However,the mechanism is still debatable,which may be related to gestational age,zona pellucida operation,ovary stimulation,culture time and heredity,ect.And monozygotic triple and quadruplet can add the danger of abortion,hypertensive disorder complicating pregnancy,selective fetal growth restriction,premature rupture of membrane,fetal distress,intrauterine fetal death,and premature labor,ect.Twin-twin.transfusion syndrome is the distinctive complication of monozygotic multiple pregnancy.It is effective to implement fetal reduction and laser photocoagulation timely.