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Table of Contents
LETTER TO EDITOR
Year : 2021  |  Volume : 18  |  Issue : 2  |  Page : 146-147

Diagnosis of quadriamniotic quadruplet gestation following spontaneous conception: Sonological appearance


Department of Radiology, St. John's Hospital, Kattappana, Kerala, India

Date of Submission30-Jan-2021
Date of Decision31-Jan-2021
Date of Acceptance01-Feb-2021
Date of Web Publication26-Feb-2021

Correspondence Address:
Reddy Ravikanth
Department of Radiology, St. John's Hospital, Kattappana, Kerala - 685 515
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_134_20

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How to cite this article:
Ravikanth R. Diagnosis of quadriamniotic quadruplet gestation following spontaneous conception: Sonological appearance. Apollo Med 2021;18:146-7

How to cite this URL:
Ravikanth R. Diagnosis of quadriamniotic quadruplet gestation following spontaneous conception: Sonological appearance. Apollo Med [serial online] 2021 [cited 2021 Jun 21];18:146-7. Available from: https://www.apollomedicine.org/text.asp?2021/18/2/146/310518



Sir,

A 29-year-old primigravida presented herself for an early gestation scan. According to Naegele's rule which calculates gestational age (GA) according to the last menstrual period date, her GA corresponded to 9 weeks 1 day. On ultrasonography, a gravid uterus demonstrating quadriamniotic quadruplet gestation with crown–rump length of all quadruplets corresponding to 9 weeks 1 day was noted. Chorionicity could not be assessed at this stage due to developing placentae, but in all probability. Ultrasonography images were in favor of a quadriamniotic quadrichorionic quadruplet gestation [Figure 1]. Further, transvaginal ultrasound was performed to determine chorionicity and amnionicity which confirmed four separate gestational sacs with chorion extending between them, consistent with features of quadrichorionic gestation; and yolk sac was visualized separately in all four gestational sacs, consistent with features of quadriamniotic gestation. She had no history of ovulation induction or use of assisted reproductive techniques. Before conception, her menstrual cycles were regular and her marriage was a nonconsanguinous one. She had no other relevant past and family history. The incidence of higher order (triplet or more) gestation ranges from 0.01% to 0.07% of all pregnancies.[1] Quadriamniotic quadruplet gestation following spontaneous conception is a rare entity with an incidence rate of 1 in 512,000–677,000 births.[2] Quadruplet and multiple pregnancies have been reported in cases following ovulation induction and assisted reproduction techniques postcessation of treatment with clomiphene citrate so-called “sustained effect.”[3] Quadruplet gestation is a high-risk pregnancy, and timely antenatal and intrapartum care is required for a successful fetal and maternal outcome. Elective cesarean section is the preferred mode of delivery of quadruplet pregnancies because of the increased risk of fetal malpresentation. Intrapartum fetal monitoring on ultrasonography in quadruplet gestation is generally difficult, and repeated follow-up scans are often mandatory to assess well-being of fetuses as death of one or more fetuses and intrauterine growth retardation are reported complications.
Figure 1: Ultrasonography image of a gravid uterus demonstrating quadriamniotic quadruplet gestation with crown–rump length of all quadruplets (A, B, C, and D) corresponding to 9 weeks 1 day. Note that chorionicity could not be assessed at this stage

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
1.Adegbite AL, Ward BS, Bajoria R. Perinatal outcome of quadruplet pregnancies in relation to chorionicity. J Perinatol 2007;27:15-21.  Back to cited text no. 1
    
2.
2. Rathod S, Samal SK, Singh S, Swain S. Quadruplet pregnancy following spontaneous conception: A rare case report. J Clin Diagn Res 2015;9:QD01-2.  Back to cited text no. 2
    
3.
3. Vikranth U, Borkar NV, Desai SK, Kania P, Rangoonwala NH.A quadruplet pregnancy. J Obstet Gynecol India 2007;57:439-41.  Back to cited text no. 3
    


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