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Epic Fetus. I just don't like it.
It gets boring quick and Repentance didn't do enough to make it more interesting. Gello&Mom's Knife is pretty much the highlight (because of the sprite) and most other fun synergies are also busted even w/o it, like C-Section or just The Keeper's melee attack. I usually only pick it up if i have to.
I'll take Brimstone, Revelation (Holy Brim), and Tech X, obviously, but...
Mom's Knife? Lil Brim? Choco Milk? Cursed Eye? Monstro's Lung? Lil Monstro? Kidney Stone? Sulfur? Nerfed Void Maw? Yeah nah, brah.
I have enough to pay attention to in this game without babysitting my fire-rate.
Spirit Sword just hurts my fingers. And my keyboard. Same with Choco Milk.
quality 4 is tech x before and after nerf.
edit: dr fetus is a close 2nd for quality 4 as well
It was way OP though. High DPS ring, DMG-up and way more Black Hearts than you'd realistically ever need. And it still gets really OP as you get high a DMG stat, thanks to the high tickrate.
Though i'd probably still given the ring "Vampirism"-properties, if i had to choose. Most nerfs weren't bad, but just rather boring.