A few days ago, a delayed-interval delivery in a quadruplet pregnancy was successfully conducted by Prof. Ma Yuyan’s team at the Department of Obstetrics and Gynecology in Qilu Hospital, which is rare world-widely.
On February 25th, an expectant mother of quadruplets transferred to our hospital. According to previous test results, her cervix had expanded, and the diagnosis was 22 weeks and 2 days pregnancy, quadruplets, threatened abortion, and cervical incompetence. Prof. Ma Yuyan immediately admitted the mother to the second inpatient ward of obstetrics. After communicating with family members of the patient, treatments like inhibition of premature uterine contractions were used, however, results were not satisfactory. The cervix was expanding, and babies might be born prematurely at any time. Considering babies were still premature, Prof. Ma Yuyan performed cervical ligation for the expectant mother to prolong gestational weeks and increase the probability for the fetus to live. After the surgery, treatments including inhibitions of uterine contractions and prevention of infection were given.
The first baby was born at March 22th, weighing only 735 grams, and the gestational age of it was only 25 weeks and 6 days-an extremely preterm infant. Due to the anatomical and physiological characteristics of premature infants, the incidence of some diseases and mortality rate are relatively high for them. To increase the chance of survival for the unborn, Prof. Ma conducted urgent cervical ligation for the patient again with the consent of her and her family members. Therapies including the prevention of infection were given, and contractions, fetal heart rates, and fetal movements were closely monitored.
After 4 days, the patient had PROM (premature rupture of membranes), and the second baby was born with a gestational age of 26 weeks and 3 days, weighing 870 grams. The patient did not have obvious uterine contractions after delivery, and the team performed the third cervical ligation for her. “We have done many cases of delayed-interval delivery in twin pregnancy. However, this time we are facing the quadruplet pregnancy: with two fetuses delivered naturally and the other two remaining in the womb.”, said Prof. Ma. Delayed-interval delivery and miscarriage prevention in quadruplet pregnancy is rare world-widely. Delayed-interval delivery has risks such as infection. Once it happens, it can be fatal to both the mother and fetuses. Therefore, the medical team carefully evaluated the treatment and monitored the mother and fetuses closely.
On April, 1st, on the 6th day after the third cervical ligation, the patient had vaginal discharge again, accompanied by uterine contractions. Fetal heart monitoring showed one of the fetuses had abnormal fetal heart rate, showing suspicious fetal distress. The gestational age of fetuses is 27 weeks and 2 days. After communicating with the patient and family members, the team decided to perform cesarean to terminate the pregnancy. The third and fourth babies were born safely, weighing 1050 and 1030 grams respectively. They were transferred to NICU after the surgery.
