BACKGROUND: Endoscopic laser ablation of placental vessels is now the preferred treatment for severe feto–fetal transfusion syndrome in twin gestations, and has been well-documented in triplet gestations as well.
CASE: Stage IV feto–fetal transfusion syndrome was diagnosed at 20.3 weeks of gestation between two of a set of monochorionic, tetramniotic quadruplets. Endoscopic laser ablation occurred at 20.4 weeks. Feto–fetal transfusion recurred at 22 weeks between the initial donor and the two previously unaffected fetuses. Delivery occurred at 24.9 weeks. The donor and one of the corecipients died shortly after birth. The sole survivor was doing well.
CONCLUSION: Treatment of feto–fetal transfusion syndrome in higher-order gestations is challenging because of the increased pregnancy risks, the difficult angioarchitecture and the risk of recurrence.