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Acute fatty liver of pregnancy (AFLP) is a rare condition with an incidence rate of 1 to 20 000 that mostly occurs in the third trimester of pregnancy. There is no specific treatment for AFLP thus a conservative treatment is usually applied in this regard. This case report is related to a 28-year-old G3 P1 Ab1 L1 woman at 29 weeks of pregnancy who was referred to our emergency ward from a primary setting with an epigastric pain, a mild hypertension, and the suspicion of HELLP [Hemolysis, elevated liver enzymes, and low platelet count] syndrome. The lab exams ruled out viral infections including hepatitis B virus (HBV), hepatitis C virus (HCV), and Human immunodeficiency virus (HIV). In addition, the urine protein was 40 mg/600 cc. AFLP was diagnosed and a cesarean was performed under spinal analgesia because of elevated liver enzymes, proteinuria in the normal range for pregnancy, the presence of viral infections that involved the liver, and lack of pruritus. A 29-week girl with a weight of 1115 g was born and the patient was discharged with a good condition. At 5 days postpartum, she referred with abdominal pain, fever, as well as incisional redness and discharge. The ultrasound scan showed a hematoma in the depth of the subdermis point of the cesarean incision. Thus, antibiotics and one unit of fresh frozen plasma were infused. On 14-day postpartum, the patient was discharged with a good condition. The purpose of this study was to focus the attention of physicians to the point that AFLP may improve after childbirth but it may predispose the patient to coagulation disorders and hematoma.

Introduction: Cesarean rate increased in recent decades worldwide. One of the consequences of the increased cesarean rate and repeat cesarean is the significant increase in cesarean scar pregnancies (CSPs). Diagnosis of a CSP is more difficult when there is a heterotopic pregnancy in a non-assisted pregnancy. Case Presentation: The patient was a 34-year-old G5P2L2Ab2 referred for spotting in Shahidan Mobini hospital, Sabzevar, Iran in 2016. She had a history of 2 cesareans and 2 abortions. Three ultrasounds were performed showing a gestational sac in the lower segment of the uterus with different diagnoses: 1) with hemorrhage over it, 2) with the 2nd gestational sac over it, which was diagnosed as missed abortion, and 3) with an echo-free and irregularly region supporting the 2nd sac or a clot in the lower part of the uterus. The increased local vascularity suggested a level of placenta accreta, partial mole, or trophoblastic reaction. Since the first diagnosis was missed abortion, curettage was performed. Due to the continuation of severe bleeding, abdominal hysterectomy was performed. The patient was discharged in good condition after 3 days. Conclusions: Heterotopic CSP does not have any specific symptoms, which caused it to be easily misdiagnosed. Physicians should use precise diagnostic tests in case of controversial test results.

Introduction: A complete heart block is a cardiac electrical conduction disorder with a very rare occurrence in pregnancy, which may be asymptomatic. There are no specific guidelines for the management of asymptomatic complete heart block in labor, vaginal delivery, and cesarean with only a few reports of cesarean management of patients with complete heart block. Case report: A 30-year-old woman, Gravida 4, abortion 3, gestational age of 41 weeks without any specific problems, was referred to our maternity hospital. The pulse rate and blood pressure were 68 and 60/110, respectively. Labor was induced with oxytocin and, after three hours, was discontinued due to late decelerations of fetal heart rate. Electrocardiography confirmed a maternal pulse rate of 42. Cardiac consultation led to the diagnosis of a complete heart block. Due to the frequent late decelerations of fetal heart rate and no response to atropine therapy, the patient was a candidate for a cesarean. Before cesarean, the pacemaker was installed. Cesarean was performed with general anesthesia, and the infant was delivered in good condition. In Postpartum, the pacemaker was removed (PR=55, BP=125/80), and the mother was discharged the next day. Due to the lack of specific guidelines, fetal indication for an emergency cesarean, mother poor obstetrics history, and none response to atropine therapy, we chose to incorporate pacemakers and remove it after cesarean safely. Conclusion: Vital signs assessment during pregnancy and childbirth is recommended to detect cases of complete heart block and provide optimal care.