Aplasia cutis congenita as a consequence of fetal reduction in a triplet pregnancy

Background: Aplasia cutis congenita (ACC) is a rare skin disorder characterized by a localized absence of skin at birth. It has been linked to both assisted reproductive technology (ART) and feto-reduction procedures. Group V ACC presents with a distinct, symmetrical distribution pattern. It is thought to result from an insult to the fetus after concomitant twin demise and is almost exclusively reported in monochorionic gestations.Case presentation: We report a rare case of Group V ACC in a dichorionic, triamniotic (di-Tri) triplet in-vitro fertilization (IVF) pregnancy subsequent to feto-reduction. The lesions were managed conservatively.Conclusion: ACC in multi-fetal pregnancies is a rare, but widely described complication. With increased incidence of ART-associated pregnancies and the use of feto-reduction for multiple pregnancies, this may become a more common phenomenon. Neonatologists and obstetricians should be aware of this complication and counsel their feto-reduction patients on the risks. This case is interesting because, to the best of our knowledge, there have been only nine reported cases of Group V ACC in triplet or higher order gestations.