Quintuplet pregnancy: a case report from Pakistan

Introduction and importance: Quintuplet pregnancies are exceptionally rare outcomes of fertility treatments, that is clomiphene citrate therapy. These high-order multiple pregnancies carry significant risks for both maternal and neonatal health, necessitating specialized care to manage complications effectively.

Case presentation: A 26-year-old woman, gravida three para two, presented with preterm labor at 32 weeks gestation following clomiphene citrate self-medication. Diagnosed with quintuplets, she underwent an emergency cesarean section at Allied-1 Hospital, Faisalabad, delivering five neonates alive. Unfortunately, all five neonates succumbed to death due to perinatal asphyxia, three within 24 h and two on the third day.

Clinical discussion: Higher-order multiple pregnancies, such as quintuplets, are associated with increased risks of obstetric complications, including pre-eclampsia, gestational diabetes, and fetal growth restriction. Preterm birth further exacerbates the risk of neonatal complications like respiratory distress syndrome, perinatal asphyxia, and death. The patient's care highlights the challenges of managing such pregnancies in resource-limited settings, emphasizing the need for specialized antenatal and neonatal care facilities.

Conclusion: This case highlights the critical need for advanced medical care in managing high-order multiple pregnancies. The outcomes reflect the significant challenges posed by preterm labor and neonatal complications in quintuplet pregnancies. There is the need for enhanced antenatal care, healthcare infrastructure, and multidisciplinary teams for the efficient management of high-order multiple pregnancies in Pakistan, where neonatal and maternal mortality rates are surprisingly high.