Assisted reproductive techniques have proved to be a boon for infertile couples. With advent of newer techniques, the incidence of successful multiple pregnancies has also risen. Considering the emotional and financial aspects of the treatment and the risk of preterm delivery in such cases, our intent is not only to salvage one of the twins in case of unfortunate preterm delivery of the other but also to deliver a viable second twin with better chance of survival and favourable neonatal outcome. The current case describes a 34-year woman with previous 2 failed IVF conceptions, on external progesterone support, carrying a twin gestation in preterm labour. Upon the inadvertent delivery of the first twin, a cervical cerclage was done, and she was given conservative management, including bed rest and head low position in view of short cervix, with an aim to delay the delivery of the other. An interval of 66 days was achieved with surgical as well as medical management, following which a healthy second twin was born.

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Background Cervical ectopic pregnancies account for less than 1% of all pregnancies. It may present with abnormal and occasionally heavy bleeding. Aim To understand the challenges associated with management of cervical ectopic pregnancies and learn to individualize the available treatment modalities for a successful outcome. Case report A 42-year-old woman, G6P2L2MTP3 with amenorrhea of 2 months, was diagnosed with cervical ectopic pregnancy of 9 weeks on ultrasonography. She was a known case of dilated cardiomyopathy with type II diastolic dysfunction and an ejection fraction of 25%. The patient was given systemic methotrexate followed by intra-amniotic methotrexate and fetal intracardiac potassium chloride. She was followed up with serial β-human chorionic gonadotropin (hCG) reports. However, she developed abdominal pain with bleeding per vaginum and ultrasonography suggestive of a hematoma. The patient was then taken up for a bilateral uterine artery embolization followed by an immediate suction evacuation. The products of conception sent for histopathology confirmed the microscopic diagnosis of cervical pregnancy. Conclusion It is a challenging clinical situation to diagnose and manage. It needs to be diagnosed early, and management needs to be individualized. Clinical significance Even with advanced diagnostic modalities and reduction in current mortality rates, cervical pregnancy remains a life-threatening condition. It is of utmost importance to be thorough with the emerging trends in its management, as it comes with the promise of being unpredictably catastrophic. How to cite this article Raza N, PaiDhungat NP. Successful Conservative Management of a Case of Cervical Ectopic Pregnancy complicated with Preexisting Cardiomyopathy. J South Asian Feder Obst Gynae 2017;9(4):356-359.

Morbidly adherent placenta can lead to catastrophic obstetric hemorrhage accounting for between 1/3rd and ½ of emergency peripartum hysterectomies. When recognized antenatally, a multidisciplinary team approach with careful peripartum planning, can reduce complications. We compared 2 patients with morbidly adherent placenta who underwent obstetric hysterectomy with IIA ligation only and the other with IIA balloon catheter with ligation. The intra & postoperative course was compared and has been described. IIA ligation is a valuable procedure to control intractable obstetric haemorrhage. It is cost effective, doesn't require any prior extensive setup, safe and simple in practiced hands & can be of immense help in immediate control of bleeding. Balloon catheters prophylactically in the internal iliac arteries before delivery can be done to allow obstruction of blood flow to the uterus when necessary. With balloon catheter occlusion, the balloons are in place and need only to be inflated, utilizing less than a minute's time; this can be crucial in a moment of massive hemorrhage.

The occurrence of oligohydramnios complicating a pregnancy is seen in 0.8 to 5.5 % of pregnancies. Severe Oligohydramnios, though not clearly defined, but clinically with an AFI of less than 5 cm appears to be an important predictor for an abnormal fetal outcome. In general, the prognosis of mid trimester oligohydramnios is still poor. Hence we report a case with a very favourable neonatal outcome following severe oligohydramnios documented in early pregnancy. The aim of this case report is to add our experience to the currently limited literature regarding the best treatment of this unique obstetrical problem.