**5. Conclusions**

Hyper-prolificacy challenges the performance of the sow in terms of parturition, colostrum production, neonatal survival, and fertility. Birth complications, piglet mortality, and puerperal disease need to be prevented. Before parturition, we recommend that sows are allowed to move freely and that nest-building materials, e.g., straw, hay, sawdust, or paper sheets, are provided. Modifying the sow's late gestation diet in order to prevent constipation and high body condition will also have beneficial effects. During parturition, timely application of birth assistance is highly important. The exact cause of dystocia must be diagnosed and treated. Hyper-stimulation of the uterus with excessive oxytocin must be avoided. Close attention and assistance needs to be given to weak-born piglets, small piglets, and piglets without teats. New technologies, such as the use of Brix refractometer and infrared cameras, can help in the assessment of the status of colostrum and the newborn. After parturition, sows at risk of PDS need to be identified and checked within the first 3 days postpartum. Hungry and noisy piglets making vigorous nursing efforts indicates PDS. The exact cause of PDS should be determined for proper treatment. Acute endometritis is indicated by large amounts of vaginal discharge and diagnosed best using ultrasonography. Inspection and palpation of the mammary gland and evaluation of the sow's behavior best diagnose mastitis. Cystitis can be diagnosed by performing a macroscopic evaluation of urine and urine stix testing. If needed, samples of urine and vaginal discharge can be sent for bacteriological examination. If no signs of mastitis, cystitis, and endometritis around, the cause may be constipation.
