A high-order pregnancy is always a challenge not only for the couple but also for the obstetrician, the pediatricians, the midwives, and the whole stuff of an obstetric clinic. The breakthroughs of infertility treatments have made more couples to postpone the birth of their children until they feel professionally and financially safe, many times after the age of 40. The advanced age of the mother puts extra pressure to the clinician for immediate success, leading to a rise of high-order pregnancies until the introduction of regulations and laws in many countries. The cost of a quadruplet and quintuplet pregnancy can be unbearable, not only financially but also psychologically. The management of such a pregnancy is also challenging since its beginning and to the end. Modern techniques and methods can also be difficult to be implemented on a quadruplet of quintuplet pregnancy because of the fear of losing four or five embryos at once. At the same time, the limited number of cases makes it almost impossible for studies to be made and guidelines to be established for most of the cases.
Part of the book: Multiple Pregnancy
An ectopic pregnancy implanted between the leaves of the broad ligament is a challenge to diagnose and manage. It can be found in almost any week of pregnancy, and it can present with a great spectrum of symptoms. This makes it necessary for the clinician to keep a high level of alertness and suspicion for this uncommon diagnosis and to be prepared when treating any ectopic pregnancy with poor response to medical treatment. The broad ligament surrounds a number of anatomical structures, structures necessary to be preserved when removing the ectopic pregnancy. This can be a challenge for the surgeon, especially when the patient presents with severe symptoms and the pregnancy is advanced. In these cases, even hysterectomies have been reported, a severe operation especially when the patient is young and without having completed her family planning. Finally, in the last three decades with the increasing widespread of laparoscopy and the added experience, there is a growing effort to manage these ectopic pregnancies with minimally invasive procedures, offering the patient a faster recovery, minimum blood loss, and lower surgical morbidity.
Part of the book: Non-tubal Ectopic Pregnancy