Objective: To study the pregnancy outcome of antenatal women diagnosed with single umbilical artery (SUA) in singleton pregnancy in tertiary medical center and its association with intrauterine growth restriction (IUGR), renal and cardiac anomalies. Materials and methods:We performed a prospective study of 6,711 singleton pregnancies at Sri Ramachandra Medical College, Chennai, between July 2009 and June 2011 and the pregnancies diagnosed with SUA were followed. The primary outcomes were renal anomalies, cardiac anomalies and IUGR.Results: Of the 6,711 pregnancies there were 59 (0.88%) cases of SUA diagnosed at anatomic survey. Thirty seven pregnancies had isolated SUA (62.7%) and 22 singleton pregnancies had associated malformations (37.2%). Conclusion:Our data suggests that the prevalence of SUA and associated anomalies seems to be similar to that reported in other countries. Evaluating cord vessels is important and fetuses with isolated SUA need more detailed assessment and monitoring 1 including Doppler study in the presence of IUGR. SUA with multiple anomalies need further evalution with fetal echocardiogram and invasive tests like amniocentesis for karyotyping.

Posterior reversible encephalopathy syndrome (PRES) is a clinical-neuroradiological entity characterized by headache, vomiting, confusion, seizures and blurred vision along with images suggesting white gray matter edema in posterior regions of the brain as shown by magnetic resonance imaging (MRI). 1 The term PRES describes a potentially reversible imaging appearance and may occur in diverse situations, including hypertension, eclampsia, pre-eclampsia, immunosuppressive medications, such as cyclosporine, various antineoplastic agents, severe hypercalcemia, thrombocytopenic syndromes, Henoch-Schönlein purpura, hemolytic uremic syndrome, amyloid angiopathy, systemic lupus erythematosus (SLE), renal failure, post-transplantation, infection and sepsis 4 (Gram-positive organisms predominate). We report two cases of acute PRES who had eclampsia and presented with recurrent episodes of seizures and hypertension. The authors emphasize that even though PRES is usually reversible, the early recognition and management of this syndrome is important to prevent permanent neurological sequelae. Treatment of PRES needs to be early and aggressive with rapid control of convulsions and arterial hypertension. Although prognosis is favorable, delay in treatment can sometimes lead to cerebral ischemia and infarct.

Amniotic fluid embolism (AFE) is a rare and often fatal obstetric condition, characterized by sudden cardiovascular collapse, altered mental status, and disseminated intravascular coagulation (DIC). The disease is rare, with an incidence ranging from one in 600 to one in 80,000, perhaps because there is no established laboratory marker diagnostic suitable for both survivors and fatalities alike. We present a case of AFE in a low-risk primigravida which was successfully managed by a multidisciplinary team.

Cesarean scar pregnancy (CSP) is the rarest type of ectopic pregnancy implanted in the myometrium at the site of the previous cesarean section scar. It may lead catastrophic complications like uterine rupture and uncontrollable hemorrhage.4 Early diagnosis can offer treatment options of avoiding uterine rupture and hemorrhage, thus, preserving the uterus and future fertility. The conservative treatment can be by local and/or systemic administration of methotrexate, dilatation and curettage, excision of trophoblastic tissues (laparoscopy/laparotomy), bilateral internal artery ligation with trophoblastic evacuation and uterine artery embolization7 combined with curettage and/ or methotrexate. We did successful treatment of a viable CSP by systemic injections of methotrexate followed by selective uterine artery embolization in combination with dilatation and curettage. How to cite this article Mehta P, Vishwanath U, Joseph S, Anitha M. Successful Management of a Scary Case of Cesarean Scar Pregnancy with Combined Treatment using Methotrexate, Uterine Artery Embolization and Suction Evacuation. J South Asian Feder Obst Gynae 2015;7(3):143-147.