Sextuplets: management of a higher order pregnancy in a medium-resource setting

A 28-year-old gravida 1 para 0 was referred to the Mt. Hope Maternity Hospital, a tertiary teaching institution at 8 weeks of gestation with excessive vomiting in pregnancy secondary to a sextuplet pregnancy. She was given empirical clomiphene citrate 100mg for 10 days after having difficulty conceiving with know polycystic ovarian syndrome. She conceived after the first course of clomiphene citrate. After being counseled on the many maternal and fetal complications with higher-order pregnancy and a clear road-map for the management of the pregnancy, which included multifetal pregnancy reduction (MFPR), this was declined due to socio-cultural and ethical grounds. Cervical cerclage was inserted at 12 weeks gestation and thromboprophylaxis commenced. Urgent Caesarean delivery was arranged at 31 weeks of pregnancy secondary to worsening symptoms of overdistension. This study aims to outline management of a higher order pregnancy when the standard approach of MFPR is unacceptable to the patient. Central to this cause was circumventing risks of higher order gestations such as preterm labor, pre-eclampsia, thrombosis and anaemia.