Spontaneous quadruplet is rarely seen. Quadruplet pregnancy is accompanied with severe complications such as; abortion, premature Our patient was a 29- year old lady with history of first pregnancy twin that was aborted. In the second pregnancy at three months of gestation sonography showed quadruplet pregnancy so cerclage was performed for the patient. At 26 weeks gestation she was admitted to Alzahra hospital with diagnosed premature labor at 29 weeks plus 2 days of gestation the pregnancy was terminated by cesarean section, 4 newborns 2 healthy girls and one boy and the second boy expired after 24 hours due to RDS.

Ultrasound has revolutioned the care of women carring twins.First trimester evaluation is the best time to determine chorioniocity and amnioniocity in multiple gestations.First trimester diagnosis is based on the number of gestational sacs, amnions and yolk sacs.Growth rate in multiple multiple gestations during the fist and early second trimesters parallels the growth rate of singleton pregnancies, dropping off during the late second and third trimesters.Most cases of growth discrepancy are diagnosed at the second half of the pregnancy and twin to twin transfusion Syndrome is the main differentional diagnosis.Ultrasound is very important for evaluating complications of twin pregnancy some Complications are more frequent in twin than singleton gestations such as preterm delivery, IUGR, preeclampsia, PROM, Placenta previa, Abruptia placenta, post partom hemorrhage, umbilical and accidents and congenital anomalies and some are unique to twins: TTTS, twin emboliesation syndrome, Umbilical cord entanglement, Conjoined twin.

The rate of multiple pregnancy has dramatically increased during the past decades, along with the diffusion of assisted reproduction technology (ART). Multiple pregnancy entail an increased risk of, at times life threatening, maternal complications i.e. pre-eclampsia, eclampsia or abruptio placenta, of serious neonatal hazards, i.e. extreme prematurity or growth retardation, as well as deleterious impact on family and social life. It raises the ethical debate of fetal reduction. The international federation of gynaecologists and obstetricians (FIGO) recommendations on iatrogenic multiple pregnancy emphasizes the need for the transfer of a limited number of embryos during ART in order to secure a singleton pregnancy.

We report a case of a triple pregnancy after tubal ligation (TL) in a 24-year-old woman. The patient found out that she was pregnant about 2 years after TL. A live fetus and two other dead fetuses were reported in sonography at 17th week of pregnancy. In a determined time, Cesarean/Section and TL was done and the single term girl fetus and the two other dead fetuses in a papyrus form on the placenta were born.

During Assisted Reproductive Technology (ART) procedures, the transfer of a single embryo dramatically reduces the rate of multiple pregnancy. Proper information, therefore, should be delivered to patients before embryo transfer. In many countries, regulations limit, according to age of the patient, the number of embryos to be transferred. Selective fetal reduction should not be considered as a suitable alternative to a single embryo transfer policy. The international federation of obstetricians and gynaecologists (FIGO) recommendations on Multifetal reduction outline that the priority should be a careful planning and monitoring of infertility treatment for the reduction or avoidance of multiple pregnancy.