Rupture of a gravid uterus is a surgical emergency. Predisposing factors include a scarred uterus. Spontaneous rupture of an unscarred uterus during pregnancy is a rare occurrence. We hereby present the case of a spontaneous complete uterine rupture at a gestational age of 35 weeks 01 day in a 25 years old patient. The case was managed at the Civil Hospital Bahawalpur. She had past history of one uterine curettage for endometrial polyp one year back. She presented with mild abdominal pains of sudden onset. After conservative management for 10 hours in hospital she suddenly developed severe abdominal pains with P/V bleeding. On ultrasound scan, uterine rupture was diagnosed and an emergency laparotomy was done. The ruptured amniotic sac with baby and placenta were found in the peritoneal cavity with rupture of the uterine funds. Spontaneous uterine fundus rupture usually occurs when there is an upper segment uterine scar. This case report shows that past history of curettage is a risk factor for the presence of uterine scar.

Introduction: Due to the anatomical proximity of the urogenital organs, reproductive and obstetrical procedures have been intrinsically linked to urological damage. The connection of the genital and urine tracts anatomically and during embryologic development makes the urinary system particularly vulnerable to damage during surgical procedures in the female. Urinary bladder and ureter injuries are a common post-gynecological or obstetrical surgery complication. Objectives: To determine the frequency of urological injuries in obstetrical and gynaecological surgery. Materials & Methods: A total of 142 women who are undergoing obstetric and gynecologic surgeries, 25 to 55 years of age were included. Patients having urological injury from other than obstetric and gynecologic surgeries were excluded. In this study all patients were included who are fulfilling inclusion criteria undergoing obstetric (cessarean section) & gynaecologic (laprotomies & hysterectomies) were enrolled after taking written informed consent. Risk factors for urological injuries were assessed in terms of indication (risk for surgery), site of ureteric injury, location of bladder injury was noticed. Results: Age range in this study was from 25 to 55 years with mean age of 40.20 ± 6.92 years. Majority of the patients 77 (54.23%) were between 41 to 55 years of age. Mean duration of surgery was 62.16 ± 14.52 minutes. Mean time interval after surgery was 37.51 ± 13.89 hours. In this study, frequency of ureteral injury, urinary bladder injury and mixed injury in obstetrical and gynaecological surgery was found in 20 (14.08%), 14 (9.86%) and 07 (4.93%) patients. Conclusion: This study concluded that understanding pelvic anatomy, detailed dissection, and patience in challenging cases are the essential elements to predict and reduce damage. Keywords: obstetrical and gynaecological surgery, ureteric injury, bladder injury.

Twin reversed arterial perfusion sequence (TRAP sequence) is a condition that occurs only in identical twins that share a placenta (monochorionic), in which one twin lacking a functioning cardiac system "acardiac monster" receives blood from the normally developing twin called the "pump twin". This places an enormous demand on the heart putting the pump twin at risk for cardiac failure. Left untreated, the pump twin will die in 50 percent to 75 percent of cases. Here we present the case report of a 20 years old G2P1at 32 weeks POG with a monochorionic twin pregnancy. One of the twins was "acardiac acephalous" and the other a "pump twin" with mild hydrocephalous.

Rupture of a gravid uterus is a surgical emergency. Predisposing factorsinclude a scarred uterus. Spontaneous rupture of an unscarred uterus during pregnancy is arare occurrence. We hereby present the case of a spontaneous complete uterine rupture at agestational age of 35 weeks 01 day in a 25 years old patient. The case was managed at theCivil Hospital Bahawalpur. She had past history of one uterine curettage for endometrial polypone year back. She presented with mild abdominal pains of sudden onset. After conservativemanagement for 10 hours in hospital she suddenly developed severe abdominal pains with P/Vbleeding. On ultrasound scan, uterine rupture was diagnosed and an emergency laparotomywas done. The ruptured amniotic sac with baby and placenta were found in the peritoneal cavitywith rupture of the uterine funds. Spontaneous uterine fundus rupture usually occurs whenthere is an upper segment uterine scar. This case report shows that past history of curettage isa risk factor for the presence of uterine scar.

Twin reversed arterial perfusion sequence (TRAP sequence) is a condition thatoccurs only in identical twins that share a placenta (monochorionic), in which one twin lackinga functioning cardiac system “acardiac monster” receives blood from the normally developingtwin called the “pump twin”. This places an enormous demand on the heart putting the pumptwin at risk for cardiac failure. Left untreated, the pump twin will die in 50 percent to 75 percentof cases. Here we present the case report of a 20 years old G2P1at 32 weeks POG with amonochorionic twin pregnancy. One of the twins was “acardiac acephalous” and the other a“pump twin” with mild hydrocephalous.