A 41-year-old lawyer of black African origin booked at 26 weeks of gestation at our antenatal clinic. Her early antenatal care had been undertaken in Nigeria. A cervical stitch had been inserted at 20 completed weeks of gestation after the ultrasound finding of a shortened cervix. Her gravidity was 21 and parity 0. She had undergone 20 surgical terminations of pregnancy at gestations ranging from 3 to 4 months, carried out in Nigeria and the USA. In addition, it was noted on ultrasound scan that she had multiple uterine fibroids, the largest of which was fundal, measuring 5 cm. Her first obstetric ultrasound scan in our unit was at 29 weeks of gestation. The placental site was reported to be posterior and high, and fetal growth measurements were within normal limits.Apart from the cervical cerclage, the antenatal course was uneventful, and at 36 weeks of gestation, the cervical stitch was removed. She presented to the labour ward at 39 weeks of gestation with spontaneous labour. She made slow progress, and the labour was augmented with oxytocics. The decision was made to proceed to emergency caesarean section under spinal anaesthesia at 5-cm dilatation as the cardiotocograph was suboptimal and there was now fresh meconium.Initially, the caesarean section was straightforward. A 2.375 kg male infant was delivered, with Apgar scores of 9 at 1 minute and 10 at 5 minutes. The surgeon did not anticipate any problems with the third stage and hence proceeded to deliver the placenta. This could only be partially removed; the placenta was found to be morbidly adherent to the posterior wall of the uterus and there was no clear plane of separation between the placenta and the uterus and accreta was diagnosed. At this point, she had begun to bleed heavily. The consultant was informed and attended immediately. He removed the remaining placenta. Five international units of syntocinon was administered intravenously, followed by an infusion of 40 iu syntocinon in 500 ml of normal saline in accordance with the labour ward guidelines. The uterus was well contracted, but she continued to bleed from the placental bed. Haemostatic sutures, interrupted figure of eight sutures, were placed at the bleeding points, with no effect. The placental bed was very friable and the bleeding uncontrolled. Compression methods were attempted using packs, with no success, as bleeding continued through the packs. The large fundal fibroid precluded the use of a B-Lynch suture.At this point, the consultant opted to try a technique he had successfully used to stop life-threatening bleeding in two cases of placenta praevia in the Sudan (unpublished; personal communication). He inserted his hand through the uterine incision into the cervix, which he then grasped, pulled through and inverted into the uterine cavity. The posterior lip of the cervix was then sutured onto the posterior wall of the uterus over the bleeding areas of the placental bed. In all, three interrupted stitches with a 2/0 vicryl, taper, curved bodied 30-mm needle were placed deep into th...

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The prevalence of Leiomyomas with pregnancy is reported as 0.3-2.9%1.They usually remain asymptomatic during pregnancy, if they are small.In symptomatic one, management is generally expectant and surgical removal is particularly delayed until after delivery. Symptomatic myoma, which does not respond to conservative management need antenatal myomectomy. Second trimester is preferable for its better outcome8,12.We present a case of symptomatic multiple uterine fibroids which include a huge one, diagnosed during pregnancy clinically & ultrasonography confirmed it. The casewas managed successfully by antenatal myomectomy due to failure of conservative management.Totalweight of fibroids was 1500gms. The pregnancy progressed to term uneventfully & elective caesarian section was done on 28/04/2019 for transverse lie. A healthy female baby weighing 03Kg was delivered. The patient was discharged in good condition on 05/05/2019. J Bangladesh Coll Phys Surg 2021; 39(1): 59-61

A patient with suspected ectopic pregnancy was managed successfully with expectant approach using serial serum ²hCG monitoring. Expectant management can be a useful form of treatment for ectopic pregnancy in selected patients. Introduction:Ectopic pregnancy is a disaster in human reproduction. It is one of the most important causes of death during the first trimester of pregnancy. Ectopic pregnancy is more threatening for women than normal vaginal delivery and induced abortions 1 . If it is not diagnosed and treated expeditiously, it may also take the life of the mother or at the very least, compromise her future ability to reproduce.