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Background: Uterine inversion is an unpredictable entity, with more than one-half of cases reported without detectible precipitants. Hemorrhage can be rapid and life-threatening, requiring prompt recognition and aggressive management. Cases: Case 1: A 25-year-old female, para 1, with complete uterine inversion presented as a case of postpartum hemorrhage and this was managed successfully with intravenous (IV) nitroglycerine. Case 2: A second case involved partial uterine inversion, in a 22-year-old female, para 1, who had a retained placenta. The inversion was not corrected by anesthesia but was corrected by IV nitroglycerine without any sideeffects. Results: Both cases were treated successfully with the use of IV nitroglycerin. Both women had postpartum hemorrhage caused by uterine inversion. IV nitroglycerin was found to be effective and was not associated any adverse effects. Conclusions: General anesthetics are generally used for uterine relaxation in cases of uterine inversion but these agents are associated with serious side-effects. Nitroglycerin is a useful tool in the obstetrical armamentarium. Its short duration of action and rapid absorption make it ideal for expeditious uterine and cervical relaxation. Gynecologists and obstetricians should become familiar with the agents in the gynecology armamentarium so that major surgery can be prevented in cases like the ones described in this article. (GYNECOL SURG 31:104)

Background: Cesarean section-scar pregnancy (CSP) is a relatively rare form of ectopic pregnancy but is increasing in incidence with the increases in cesarean sections that are occurring. Case: A 26-year-old woman, gravida 2, para 1, was misdiagnosed as having a miscarriage when she presented with bleeding from her vagina. She underwent two dilatation and evacuation (D&E) procedures, both of which failed to stop her bleeding. After undergoing magnetic resonance imaging MRI, however, she was found to have a CSP. The CSP was treated successfully with a single dose of methotrexate. Results: The patient's pregnancy-related mass disappeared completely on day 72 post-treatement. She was counseled regarding contraception and was encouraged to come in early for her next pregnancy to undergo an early scan to determine the exact location of the new pregnancy. Conclusions: Massive bleeding after procedures such as D&E should raise the suspicion of CSP in high-risk cases. Sonographers should follow strict criteria to assess if any pregnancy is implanted at the site of a previous cesarean scar. MRI can play an adjunct role in evaluating a patient for CSP. Early diagnosis and treatment can prevent obstetric emergencies. CSP can be treated successfully with methotrexate. It is important to maintain a high level of suspicion for the diagnosis of CSP, as it can be easily misdiagnosed, which was what occurred in the current case. ( J GYNECOL SURG 31:92)

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Background: Ovarian pregnancy is one of the rarest form of ectopic pregnancy. Patients frequently present with abdominal pain and menstrual irregularities. Intrauterine devices have evolved as probable risk factors. Preoperative diagnosis is challenging but transvaginal sonography may be helpful. A diagnostic delay may lead to rupture, secondary implantation or operative difficulties. Therefore, awareness of this rare condition is important in reducing the associated risks. Case: Here, we report case of primary ovarian pregnancies presenting with acute abdominal pain which was diagnosed as ectopic tubal rupture pregnancy and on operation ovary were salvaged with wedge resection. Results: The patient was discharged after 5 days. On follow-up, it was noted that she conceived after 6 months. Conclusions: Medical conservative treatment is still myth in case of primary ovarian pregnancy as most are misdiagnosed and present as ruptured ectopic pregnancy and more awareness is needed in surgeons and radiologists for early diagnosis. ( J GYNECOL SURG 31:98)