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Triplet heterotopic pregnancy with an intrauterine monochorionic diamniotic twin pregnancy and an interstitial pregnancy following in vitro fertilisation and transfer of two embryos

Fetal wastage among pregnant women with liver cirrhosis is said to occur in 18 per cent of cases and is related to the severity of maternal disease. The risk of spontaneous abortion is greatly increased even when there is no apparent deterioration in hepatic function (Cheng, 1977). Prematurity is regarded as the most common cause of neonatal death and even where the baby survives, intrauterine growth retardation occurs in up to 50 per cent of offspring born to mothers with cirrhosis (Pajor and Lehoczky, 1994). One of our patients (case 1) had an intrauterine death at 30 weeks while in another patient (case 2) the baby died soon after delivery. The gestational age by ultrasound in this latter case (case 2) consistently lagged behind the gestational age by dates (using the last menstrual period). At the time of delivery, there was a difference of 5 weeks, which was suggestive of intrauterine growth retardation. Prematurity was the probable cause of the baby’s death. These case reports show that delayed diagnosis and a dearth of facilities for variceal sclerotherapy and emergency haemostatic support are important problems the Nigerian woman with liver cirrhosis may face if she becomes pregnant.