Spontaneous Quintuplets Born to a Woman Without Fertility Treatment in Riyadh Saudi Arabia
Spontaneous Quintuplets Born to a Woman Without Fertility Treatment in Riyadh Saudi Arabia
Dr Ayesha Kamal Nasir1, Dr Sara H Dobal2, Dr Shumaila Jabeen3
2,3. Dallah hospital Namar Riyadh KSA
Corresponding Author: Dr Ayesha Kamal Nasir, MBBS MCPS FCPS SRGS ARDMS, Hod Ob/Gyne, Dallah hospital Namar
Copy Right: © 2022 Dr Ayesha Kamal Nasir, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received Date: March 23, 2022
Published Date: April 01, 2022
Spontaneous Quintuplets Born to a Woman Without Fertility Treatment in Riyadh Saudi Arabia
Introduction
Multiple gestations are usually iatrogenic by use of assisted reproductive techniques (ART), but it is extremely rare in spontaneous conception with a chance of one in a 55 millon births. Muliple prehgnancy can result in maternal, fetal and neonatal morbidity.
Multiple gestations have higher risk of complications in mother and babies like pre-eclampsia, gestational diabetes and pretem labor. Discordance of fetal growth is also very common and Perinatal loss is inversely related to birth weight.
Case report
This female patient was 33 yrs old P5+0 ago all svd, last delivery 6 yrs ago, There was no history of infertility but she was hepatits B positive. Her expected date of delivery by her earliest scan of 7 weeks showed Quintuplets babies (5 fetuses).
This was a spontaneous conception and she had cervical cerclage at 12 weeks. She was taking oral dedrogesterone (Duphaston) tid . Her blood group was O positive with low hemoglobin (9.4) . She came to Dallah Hospital Namar on 22.09.2021 at 28+ weeks quintuplet pregnancy and was in distress, unable to walk due to enlarged abdomen and was suffering.
Her first ultrasound here showed 5 alive fetuses seen largest weighing 1322gm and smallest 1121gm. 5 placentas were seen on anterior and lateral walls. Patient was a high risk pregnancy in severe need of monitoring and care around the clock with hospital admission. She was started on Iron injections and plan was to continue pregnancy as much possible within hospital setting as considering the condition of patient, she may have needed earlier LSCS if she developed pains.
She also needed simultaneous NICU cover for the 5 preterm babies accommodated. She was offered admission in Dallah Hospital Namar on 06.10.2021 at 29+ weeks pregnancy. Monitoring was done with serial ultrasound scans and growth recorded for the next 3 weeks.
The plan was to continue the pregnancy till at least 32 weeks were completed to reduce the risk of fetal mortality and morbidity.She was started on rectal miconized progesgterone ( Cyclogest) and daily low molecular heparin injections (clexane) in addition to the oral progesterone .Five NICU beds were kept empty and reserved for her throughout her stay. She was assessed daily for any risk of developing premature labor pains as well as serial ultrasound measurements.
On 22.10.2021 when she was 31+ 5 she complained of mild pains off and on so after steroid cover and mgso4 cover for neuroprotection she was planned for elective LSCS at 32 weeks and a day before surgery we assembled a team of 20 specialized physicians consultants in Ob Gynae, Paediatrics and Anesthesia with senior nursing staff and all participated in an experimental trial run carried out before surgery for everyone to be prepared for the birth of the quintuplets. Positions and roles were assigned to everyone,5 incubators were numbered ,and one of our doctor tied 4 dolls to her belly and we carried out a mock surgery trial .
ON 24.10.2021 LSCS at 0755H surgery was carried out. : Cervical cerclage was removed before anesthesia, 5 alve babies were delivered: 1st breech girl, 1.7 kg, A/S 5/7 2nd breech boy, 2.039 kg, A/S 7/9 3rd cephalic boy, 1.65 kg, A/S 8/9 4th cephalic girl, 1.79 kg, A/S 7/9 5th cephalic boy 2.1 kg, A/S 8/9,
All the babies were managed in NICU till stable. Mother was discharged in stable condition with no complaints.
Discussion
Quintuplets are a rare occurrence. This is even rarer if they are born to a woman without fertility treatment . The incidence decreases as the number of fetuses increases. According to Hellins law, incidence of twin is 1:80, triplet is 1:6400 , for quadruplets is approximately 0.000142 i.e. less than 1/700,000 singleton births but Quintuplets conceived spontaneously , occurs once in 55 million births.
Quintuplets are a set of 5 babies born in one birth . As compared with singleton pregnancies, quintuplets are associated with high rates of obstetric complications and significant prenatal morbidity and mortality. The first case in the world was reported on 28th May 1934 in Canada where the babies survived. Details of less than three cases of quintuplets after infertility treatment have been found in KSA where the babies survived. Our case in Dallah Hospital Namar is the first case of spontaneous quintuplet conception with HBS antigen positive and 100 percent survival of the babies at 32+weeks.
Conclusion
The mothers should be counseled about regular ANC check-ups for early identification of multiple pregnancies so that proper care can be given to prolong the gestational age and reduce the complications associated with multiple pregnancies. Here we want to highlight the proper management along with good counselling and adequate preparation for a good outcome.
References