Acute colonic pseudo-obstruction syndrome, also known as Ogilvie's syndrome, is a rare condition associated with significant morbidity and mortality. We report a case that developed very rapidly after emergency caesarean section. A 20-year-old woman underwent an emergency caesarean section for failure to progress in the first stage of labour and a healthy male infant was delivered without incident. However, soon afterwards the patient developed significant abdominal distension and pain. Ogilvie's syndrome was diagnosed following an abdominal x-ray which revealed a gross large bowel obstruction without mechanical cause. To prevent caecal rupture, the patient underwent successful emergency colonic decompression.

Key content Nerve injuries are a common complication of gynaecological surgery, occurring in 1.1–1.9% of cases. Patient mal‐positioning, incorrect placement of self‐retaining retractors, haematoma formation and direct nerve entrapment or transection are the primary causative factors in perioperative nerve injury. Nerves most commonly injured during surgery include the femoral, ilioinguinal, pudendal, obturator, lateral cutaneous, iliohypogastric and genitofemoral nerves. The majority of neuropathies resolve with conservative management and physiotherapy. Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants and gamma‐aminobutyric acid (GABA) antagonists are of significant benefit in managing painful neuropathies. Learning objectives To gain an overview of the spectrum of different neuropathies that may occur following pelvic surgery. To learn about safe surgical techniques in the prevention of postoperative neuropathies. To review the clinical anatomy of the lumbo‐sacral and brachial plexuses. Ethical issues Neuropathies can cause considerable postoperative morbidity. Should neuropathies following gynaecology surgery be discussed routinely during consent taking? Neuropathies following surgery may have considerable medico‐legal implications.

Should regional analgesia be offered on request to women who are at or near full dilatation? Should all women with a raised body mass index be encouraged to have an early epidural in labour? What is an acceptable time to wait for an epidural in labour?

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Key content In pregnancy, fibroids can lead to complications such as placental abruption and increased caesarean section rates. Surgical intervention of fibroids within the first two trimesters is possible in selected women. Increasing evidence suggests that myomectomy can be performed concurrently with caesarean section without an increased risk of blood transfusion or hysterectomy. Adverse outcomes are associated with subsequent pregnancies following uterine artery embolisation. Learning objectives To outline the complications of fibroids and treatment options in pregnancy. To determine pregnancy outcomes in those previously treated for uterine fibroids, including with uterine artery embolisation and ulipristal acetate. To discuss the mode of delivery in women with a previous myomectomy. Ethical issues With the provision of informed consent, should women with a previous myomectomy be encouraged to proceed with vaginal delivery? A greater rate of certain complications has been observed in pregnancies that follow uterine artery embolisation. Should this information be provided routinely?