1Department of Child Health, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
2Department of Child Health, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
3Division of Neonatology, Department of Child Health, Dr. Ramelan Navy Central Hospital, Surabaya, Indonesia
4Department of Obstetrics and Gynecology, Dr. Ramelan Navy Central Hospital, Surabaya, Indonesia
5Department of Child Health, Universitas Hang Tuah, Surabaya, Indonesia
6Department of Obstetrics and Gynecology, Universitas Hang Tuah, Surabaya, Indonesia
Spontaneous monozygotic quadruplet pregnancies are among the rarest forms of human multiple gestation, with an estimated incidence of approximately 1 in 11–15 million pregnancies. Monochorionic quadramniotic (MCQA) configurations represent only a subset of these cases and are reported almost exclusively as isolated case reports. Published literature on MCQA quadruplet pregnancies largely focuses on antenatal findings, with limited reporting of postnatal outcomes and early neonatal follow-up. We report a spontaneously conceived MCQA quadruplet pregnancy in a 32-year-old Indonesian woman that reached late preterm gestation. The pregnancy was antenatally diagnosed as triplets, with a fourth fetus unexpectedly identified during emergency caesarean section at 35+5 weeks of gestation. Post-delivery placental examination, including colored-dye vascular injection, confirmed a single monochorionic quadramniotic placenta with superficial vascular anastomoses. Birth weights ranged from 1,190 g to 1,816 g, with a maximum inter-twin discordance of 34.5%. There was no clinical or hematological evidence of twin-to-twin transfusion sequence. All four female neonates achieved spontaneous cardiorespiratory adaptation requiring only brief free-flow oxygen. None required positive pressure ventilation, continuous positive airway pressure, intubation, or surfactant therapy. All neonates tolerated enteral feeding, were discharged in stable condition during the early postnatal period, and demonstrated appropriate early postnatal growth and normal early sensory screening findings. This case demonstrates that spontaneous MCQA quadruplet pregnancies can achieve favorable early neonatal outcomes when gestation is prolonged into the late preterm period, even in the presence of significant growth discordance. These findings add objective neonatal outcome data to the limited existing literature for this exceptionally rare pregnancy configuration.
Keywords: monochorionic quadramniotic quadruplets; spontaneous quadruplets; neonatal outcomes; late preterm birth; multiple pregnancy.
How to cite this article: Erick E., Harahap A., Sudiarta KE. Neonatal Outcomes in Spontaneous Late Preterm Monochorionic Quadramniotic Quadruplets Delivered at 35+5 Weeks: A Case Report. Int J Drug Deliv Technol. 2026;16(16s): 273-278. DOI: 10.25258/ijddt.16.16s.29
Source of support: Nil.
Conflict of interest: None