**8. Conclusion**

In cases of a quadruplet, quintuplet, or any high-order pregnancy, early diagnosis is crucial for the further management and treatment. The international literature concerning pregnancies with more than three fetuses is still limited, and it is not going to be any better in the future. The prevalence of high-order pregnancies after the rise until 1996 is tending to normalize, making—again—unique and rare such cases. The lack of cases and the diversity of these cases make it difficult to manage the complications, which will probably arise during a high-order pregnancy. New treatments used for singleton or twin pregnancy complications cannot always be considered as options for treating a high-order pregnancy, especially when no data are available. Beside the scientific interest for these cases and the challenge they pose to anyone dealing with them, it is always important to remember that the couple suffers the greater burden. The psychology of the couple should never be underestimated. Even by the beginning of the pregnancy, the possibility of a result not favorable is always in mind, so additional support is necessary. Fetal reduction is a method that improves the outcome of these pregnancies and could be offered as an option when there is experience with the procedure and no other limitations are present (e.g. religious).
