Rheumatoid arthritis (RA) is a lifelong, systemic autoimmune disease that affects women three times more frequently than men, often in their most productive and childbearing years. This chronic inflammatory disease occurs mainly due to immunological dysfunction and infiltration of T cells secreting cytokines causing inflammation and arthritis due to cartilage destruction and systemic symptoms. The primary feature being inflammatory synovitis which usually involves the peripheral joints. The mainstay of management of rheumatoid arthritis includes Disease Modifying Antirheumatic Drugs (DMARDs), most of which are contraindicated in pregnancy, thus causing a significant complexity in management during pregnancy. In our case, A 28 year old female, Primigravida with 26 weeks of gestation came to the OPD of department of Obstetrics and Gynaecology, MGM hospital with complaints of pain in the left knee joint for the past one year, aggravated two weeks back and diffuse swelling over the joint since 1 month. A diagnosis of monoarticular Rheumatoid arthritis was formed after ruling out other pathologies like reactive arthritis, tuberculosis of knee joint, referred pain due to pathologies in the neighbouring joints. Since the patient was pregnant, a decision based on level five evidence, was taken to avoid the DMARDs due to their potential teratogenicity and she was managed with an intra-articular injection of corticosteroid which showed no improvement in the patient's symptoms. Hence it was followed by an intra-articular injection of 8ml of Platelet rich plasma (PRP) which resulted in an improvement in VAS scores from 8 to 2, 4weeks after injection along with a clinical reduction in joint swelling and pain even at extremes of movements. The clinical benefits of PRP in RA can possibly be explained by its antiinflammatory effects.

Postpartum haemorrhage is dened as a blood loss of more than 500ml after delivery of the placenta. It is a clinical diagnosis that encompasses excessive blood loss after delivery of the baby from a variety of sites: uterus, cervix, 1 vagina and perineum

INTRODUCTION: The American College of Obstetricians and Gynaecology dene cervical incompetence as "the inability of the uterine cervix to retain a pregnancy in the second trimester in the absence of clinical contractions, labour, or both". HISTORY: Cervical cerclage was rst proposed by Dr. Vithal Shirodkar in 1955 and the 'Shirodkar technique' was rst described by him in Bombay in 1955. This technique was modied by the Australian Gynecologist and Obstetrician, I.A. McDonald. TYPES OF CERCLAGE: Depending on the route of insertion of the stitch, cerclage can be classied into – transvaginal and transabdominal (laparoscopy or laparotomy). Arobotic approach has also been introduced recently. TYPE OF SUTURE MATERIALS: Multiple suture materials have been used to perform cervical cerclage. They can be divided into – monolament and multilament (braided) sutures. Common monolament sutures used include Nylon (Ethilon) and polypropylene (Prolene) whereas braided sutures include silk and Mersilene tape. Commonly, Mersilene tape is used by physicians because of its strength, decreased possibility of tearing through tissues and ease of removal. However, braided sutures have been associated with an increased infection rate, especially when used in contaminated surgical areas CERVICAL CERCLAGE IN PLACENTA PREVIA: The rst randomized control trial for using cerclage for management of placenta previa was conducted by Arias et al,25 patients from 24-30 weeks of gestation with the result of Cerclage patients having a signicantly better perinatal outcome by more advanced gestational age at the time of delivery, larger birth weight and fewer neonatal complications also maternal bleeding was more frequent and severe for patients in the control group CERVICAL CERCLAGE IN MULTIFETALPREGNANCY: According to RCOG green top guideline no. 60, 2011, placement of history or ultrasound indicated cervical cerclage in multifetal pregnancy is not recommended as it is associated with an increased risk of pregnancy loss and preterm delivery