LAUSR

We report a 37-year-old, Afro-Caribbean lady, G6P3 with a spontaneous quadruplet pregnancy and successful outcome of four male babies. She had previous history of three full term vaginal deliveries. The first two pregnancies were complicated with pregnancy induced hypertension and gestational diabetes. Her booking BMI was 40 kg/m (height-1.58 m, weight-102 kg) with a blood pressure of 120/80mmHg. She conceived while on the contraceptive implant which was inserted about 6 months ago. The diagnosis was made on an early pregnancy ultrasound at 10 weeks’ gestation. She was counselled regarding the risks associated with multiple pregnancies by our Foetal Medicine Consultant. The option of selective foeticide to twin pregnancy was discussed, but she was keen to continue this quadruplet pregnancy. She was commenced on folic acid, Aspirin, and micronized progesterone pessaries. First trimester ultrasound and screening were reported to be normal and it was identified as dichorionic quadra-amniotic pregnancy based on two placentas and four amniotic sacs seen. Glucose tolerance test was done at 16weeks and repeated at 26weeks, which were normal. Delivery by elective caesarean section was planned at 32weeks. She presented to our labour ward at 28weeks and 6 days with threatened preterm labour. She was given a course of corticosteroids and she remained as an inpatient until delivery. Regular foetal surveillance was done with fortnightly growth scan and weekly liquor volume and foetal doppler measurements which was normal. An elective caesarean section was performed at 32weeks and 2 days of gestation, four male babies were delivered with birth weights of 1640 g, 1500 g, 1605 g and 1655 g, respectively. Placenta was confirmed to be dichorionic quadra-amniotic. All the four babies were transferred to neonatal unit and discharged in good condition 3 weeks after delivery. The mother was discharged home on thromboprophylaxis for 6 weeks.