A 29-year-old woman elected to terminate her pregnancy at 21 weeks due to severe fetal hydrops. Feticide was carried out, mifepristone (200 mg) was given and 48 h later misoprostol 200 mg was administered per vaginam and repeated 3-hourly until five pessaries had been given. There was no cervical dilatation after the administration of 1,000 mg of misoprostol. The following day, a further five misoprostol 200 mg pessaries were given with still no cervical change. The same regimen was tried orally the next day. Over 3 days, 3,000 mg of misoprostol had been administered, with no cervical change. As the placenta was low lying, rather than attempting an intrauterine installation technique with the risk of haemorrhage, a different prostaglandin was given. Five doses of 1 mg gemeprost were given 3-hourly, yet the cervix remained 2 cm long.An ultrasound revealed an empty, well-contracted upper uterine segment, with a clear midline echo. The pregnancy sac was intact and was markedly distending the lower segment of the uterus. The decision was made to proceed to surgery; a laparotomy and hysterotomy were performed. The findings at operation matched those seen on ultrasound.

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We report a three-variable simplified model of excitation fronts in human atrial tissue. The model is derived by novel asymptotic techniques from the biophysically realistic model of Courtemanche et al. [11] in extension of our previous similar models. An iterative analytical solution of the model is presented which is in excellent quantitative agreement with the realistic model. It opens new possibilities for analytical studies as well as for efficient numerical simulation of this and other cardiac models of similar structure.

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