Quadruplets instead of fourth child

Sunday, July 9, will go down in history for East Tallinn Central Hospital (ITK) and for the whole country as the day when a miracle was born – quadruplets.

The four little girls were born Sunday afternoon, but prematurely, as it usually happens with multiple births. The children are stable, but they have to spend some time under the medics’ keen eye. This is why the doctors, who delivered the babies, were unwilling to describe the extraordinary event in detail.

“Quadruplets are a complicated problem even for nature, let alone for humans,” said Ralf Allikvee, the director of the hospital, asking for understanding and extra time.

The Sunday’s quadruplets could be reasonable called a miracle of nature, since they were conceived naturally. Many families all over the world have had multiple babies usually thanks to artificial insemination.

The hospital assures that the mother is well. The woman, who had already born three children, wanted a fourth one. But instead of a singly baby she had four.

The hospital had been prepared for the complicated birth and the delivery was assisted by a team of couple of dozen specialists – this was the first time for the hospital.

“In any case this is a rare event”, said Professor Katrin Õunap, head of the University of Tartu Clinic (UTC) center of clinical genetics. She admitted that she had no idea when quadruplets had been last born in Estonia.

This question made several top specialists think hard. Heili Varendi, senior researcher of the UTC children’s clinic, who had researched premature children, recalled that she had read a story about four sisters in a Soviet-era magazine. She had not heard of quadruple births in the later period, but knew that the ITK colleagues may soon release the news.

“This was really extraordinary”, Varendi commented.

The Statistical Office and the Institute of Health Development have no information about when quadruplets were last born in Estonia. The data of the institute’s register of births date back to 1992 and since then at least no such event has been registered.

According to ITK this was the first birth of quadruplets in half a century.

This is why newspapers and old church records are the only source of information about the frequency of quadruple births.

For example, the daily Postimees reported the birth of quadruplets in 1938. Newspapers also claimed that quadruplets had been born in 19598. According to church records, quadruplets may have been born in Antsla in 1789, in Viljandi in 1804, in Ambla parish in 1885 and in Kose parish in 1891.

Statistical data from elsewhere in the world for the latest period is also difficult to find and assess, since artificial insemination has made multiple births significantly more likely. Yet quadruplets are very rare and according to Wikipedia, there were only 3,500 sets of quadruplets known all over the world.

“Their number has increased in recent decades thanks to artificial insemination when the number of transplanted embryos was not limited. However, most countries (including Estonia) have by now set the limit at two embryos”, Õunap explained.

According to the same, dated, Wikipedia article, out of 700,000 natural pregnancies less than one leads to the birth of quadruplets.

Õunap added that multiple pregnancies, presumable also quadruple, happen more frequently, but the embryos need not survive until birth. “In the early stage of pregnancy one or more embryos may die so that one child could develop and be born. This is usually visible in ultrasound scan, since the dead embryo is usually covered with connective tissue,” the professor explained.

In most cases the mother cannot give birth to four embryos so that all would be born healthy; moreover, it also poses a threat to the mother’s health.

“One embryo during pregnancy means that the women’s weight increases by ten kilograms. If we multiply it by four – that is a lot of weight. The average term of pregnancy with quadruplets is approximately 30 weeks, since the women’s organism cannot endure it any longer”, the professor added. The timely birth occurs after 38-40 weeks of pregnancy.

Multiple births are becoming increasingly frequent in Estonia in recent years. For instance, a record 55 pairs of twins were born in ITK in the first half of 2017 and triplets – two boys and a girl – were born last month after a four-year pause.

Last year there were three births of triplets and 217 of twins in Estonia.

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