Abstract : First trimester transvaginal embryo reduction is an effective alternative for the management of multifetal
pregnancy in assisted reproduction and is done by performing an intracardiac embryo puncture until a
systole is verified.
A 32-year-old G2 A1 conceived through in vitro fertilization (IVF) at 10 weeks of gestation.
Ultrasonography confirmed quadruplet pregnancy with viability of all four fetuses with minimal sub
chorionic hemorrhage. The couple was counselled about all potential complications and were counselled
to undergo fetal reduction of quadruplets to twins. She underwent fetal reduction and pregnancy was
uneventful in first and second trimesters with regular antenatal check-ups. In third trimester the woman
with 35 weeks of gestation with twin breech presented with premature preterm rupture of membranes
(PPROM), delivered by emergency lower section caesarean section (LSCS) with first twin as breech and
second twin as vertex. First twin was delivered with birth weight 1.75 kg and second twin with birth weight
Keywords: Total reduction, Multifetal pregnancy, IVF, Transvaginal embryo reduction, PPROM.