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.

Spontaneous quuadruplet pregnancy is a very rare condition.1.2 A 29 year-old female patient with G2 with the previous experience of loosing twins in the 22nd week of pregnancy admitted in the Alzahra hospital with the detection of preterm labor. She terminated in the 29th week &2 days. Of the four children born two girls & one boy are in good health & the other boy becauuse of the respiratory distress syndrome has died.

Objective: Triplet or higher-order multiple pregnancies are often caused due to ovulation induction. Spontaneous quadruplet pregnancy is a rare phenomenon which is associated with maternal and fetal complications. Here in, we report a spontaneous quadruplet pregnancy with no family history and as a result of an unwanted pregnancy. Case report: The patient was a 34-year-old, G4 L2 Ab1. She noticed being pregnant during breastfeeding, a spontaneous quadruplet pregnancy. There was no case of multiple pregnancies in her or her husband's family. In week 29 she was hospitalized due to the diagnosis of preterm labour. At 32 weeks and 4 days of gestation, because of the restart of labour contractions and dilatation development, she underwent a cesarean section. The outcome was the birth of 4 healthy neonates weighing between 1800 to 2100 gram and normal Apgar score. Conclusion: Quadruplet pregnancy can rarely occur spontaneously even unintentionally, and can reach the third trimester without prophylactic cerclage.

To describe the social and historical impact of ART on multiple gestations and to discuss psychological issues unique to these families.At the time of the birth of the Dionne quintuplets in 1934, only 33 cases of quintuplets had been reported in the literature and none of the quintuplets survived more than 50 days. Spontaneous higher order multiple gestation is still rare but the number of iatrogenic multiple pregnancies has dramatically increased as a result of assisted reproduction. Despite pretreatment counseling about the medical and emotional risks of having multiples, many infertile couples continue to want that experience and their religious affiliation, education and knowledge of multiple gestation outcomes were not predictors of that desire. The transition to parenthood of multiples can be difficult and couples often find themselves overwhelmed by the social, psychological and financial pressure of raising multiples. Mothers of multiples may experience social stigma, isolation, stress and depression. On the positive side, couples report increased marital solidification as a result of dealing with the stress of raising multiples.In conclution, though raising multiples may provide unique rewards, couples are often unprepared for the stresses and challenges involved in raising them.

Introduction: Uterine rupture in pregnancy is rare and often catastrophic with high incidence of fetal and maternal morbidity and mortality. The most common cause of uterine rupture is separation of previous cesarean hysterotomy scar. Other common predisposing factors to uterine rupture are previous traumatizing operations or manipulations such as curettage, perforation, myomectomy and excessive or inappropriate uterine stimulation with oxytocin.Case Report: In this case, spontaneous rupture of uterine at 25-26 weeks gestation (twin pregnancy) in a 36 year old woman has been reported (G5P2A2Ll). She was hospitalized so that preeclampsia can be rule out for her. She underwent laparoscopic removal of myoma and 3 months later IVF was done for her because of secondary infertility. During hospitalization, suddenly she had mild vaginal bleeding and decreased fetal movement. Emergency sonography reported that the two fetuses died and severe oligohydramnius and myomatosis uterine with the biggest size was 90mm.Conclusion: Try of labor was done for her but she didn't respond to induction and the patient was qualified for cesarean section. During the operation, the rupture of the uterine wall was seen in the site of the previous myomectomy and the two dead fetuses were observed in the abdomen without myoma in the uterin. The myoma that was reported by the sonologist was hematoma and omentoma. Uterine wall was repaired.

Acute fatty liver of pregnancy (AFLP) is a rare entity and a potentially fatal disorder. It is reported to be more common in multiple than singleton pregnancies. Sometimes it coincides with preeclampsia but the exact etiology is not yet understood. A 31-year-old G2 P1 patient admitted at 33 weeks of pregnancy with signs and symptoms of jaundice, gastroenteritis, hypertension, malaise, urinary incontinence and preterm contractions. She had history of idiopathic hypothalamic amenorrhea and by a recent trial with gonadotropins, she had got triplet gestation. After admission her general condition deteriorated. She underwent Cesarean section at once and all fetuses survived. She had severe postpartum hemorrhage. The results of laboratory tests indicated coagulopathy and liver function abnormalities. The AFLP was diagnosed on the third day of hospital stay. She was discharged one week later. Again she returned with complaint of severe sustained headache. Computed tomography showed subdural hemorrhage and drainage of hematoma was performed immediately. Finally the patient recovered from all of these critical conditions. This is the first report of AFLP in a patient with history of idiopathic hypothalamic amenorrhea. AFLP should be suspected in every pregnant patient with preeclampsia and gastroenteritis symptoms in the third trimester of pregnancy.

A 32 year-old multigravid patient with 10 weeks of pregnancy was referred to the emergency ward with massive vaginal bleeding and preshock state. Suction curettage, laparotomy, uterine artery ligation, Macdonald cerclage, and hysterectomy was done, in that order.After hysterectomy and massive transfusion she recovered. When a diagnosis of cesarean scar pregnancy is made in the emergency state and especially in the presence of underlying disease, morbidity is high and fertility lost.