Successful intrauterine management of severe feto-fetal transfusion in a monochorionic triplet pregnancy using bipolar umbilical cord coagulation

Triplet-to-triplet transfusion is a rare clinical complication of monochorionic pregnancies. We present such a case in a monochorionic triamniotic triplet gestation. After a single fetal demise an ongoing twin-to-twin transfusion continued in the surviving triplets. The donor triplet had ultrasound evidence of secondary structural brain damage. The pregnancy was successfully managed with bipolar umbilical cord coagulation of the donor triplet and spontaneous vaginal delivery of the recipient triplet. The case highlights the clinical spectrum and diagnostic and management options that present themselves in these high-risk pregnancies.