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Feto–Fetal Transfusion Syndrome in Monochorionic Quadruplets

O'Brien, Barbara M. MD1,2; Feltovich, Helen M. MD3; Carr, Stephen R. MD1,2; Luks, Francois I. MD1

doi: 10.1097/AOG.0b013e3181b190ee
Case Reports

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.

A case of feto–fetal transfusion syndrome in monochorionic tetramniotic quadruplets was treated by endoscopic laser ablation of placental communications between two of the four fetuses.

From the 1Fetal Treatment Program and 2Division of Maternal–Fetal Medicine, Alpert Medical School of Brown University, Providence, Rhode Island; and 3Minnesota Perinatal Physicians, Allina Hospitals and Clinics, Minneapolis, Minnesota.

Corresponding author: Barbara M. O'Brien, MD, Division of Maternal–Fetal Medicine, Women & Infants' Hospital, 101 Dudley Street, Providence, RI 02903; e-mail:

Presented at the Annual Meeting of the International Fetal Medicine and Surgery Society (IFMSS), Athens, Greece, September 12–16, 2008.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2010 The American College of Obstetricians and Gynecologists