Successful pregnancy outcome after fetal reduction in a woman with quadruplet pregnancy to twin pregnancy

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 1.75 kg. Keywords: Total reduction, Multifetal pregnancy, IVF, Transvaginal embryo reduction, PPROM.