Background: The most crucial period of intra uterine life are the first twelve weeks of gestation, where history and clinical examination may often be inconclusive. Ultrasonography plays an important role in confirming the pregnancy, its site and viability. The objective of this study was to determine the first trimester ultrasonographic findings of a normal intrauterine pregnancy, early pregnancy failure and to have a comparative evaluation of transvaginal with transabdominal ultrasonography in the diagnosis of early pregnancy failure.Methods: Cross sectional study done in the Department of Obstetrics and Gynaecology, Silchar Medical College and Hospital from 1st June 2019 to 31st May 2020. Data were collected from 80 patients presenting to the Antenatal and Gynaecology OPD of Silchar Medical College, with positive urine beta HCG test with signs and symptoms suggestive of early pregnancy. The study was conducted during the said study period. General physical and pelvic examination done for in the cases provisional clinical diagnosis and subjected to ultrasound. Sonography by both abdominal and transvaginal method was done and findings were compared.Results: 70% of cases in this study came out to be of normal pregnancy while 30% of the total cases were of abnormal pregnancy. Various fetal developmental markers such as gestational sac, yolk sac, fetal pole, fetal heart motion, double decidual sac sign were visualised in better number of cases by transvaginal sonography than by abdominal. Amongst cases of abnormal pregnancy, parameters such as detection of abnormality in shape of gestational sac, abnormality in yolk sac were found to be better seen with transvaginal sonography than with transabdominal sonography. Measurements of mean sac diameter, crown rump length were found to be similar by both the methods.Conclusions: Combination of abdominal sonography and transvaginal sonography complements the defects of two methods and thus improves the accuracy of diagnosis. Thus it can be said that transvaginal sonography should not be used as a substitute but as a conjunct with abdominal sonography for better visualization, improved diagnosis thereby leading to better management of the patients.

Conjoined twins or Siamese twins are identical twins that are joined in utero. The original Siamese twins were born in Siam (now Thailand) in 1811. They were males and lived for about 62 years. Incidence being 1 in 49,000 births to 1 in 1,89,000 births, this phenomenon is very rare. Approximate half are stillborn and one- third die within 24 hours of birth. Five types of conjoint twins are classically described, thoracopagus, omphalopagus, pygopagus, ischiopagus and craniopagus. With a reported incidence of 74-75% of all conjoint twins, Thoracopagus is the most common type. Omphalopagus with an incidence of 0.5% is the least common. Here we are reporting a case of thoraco-omphalopagus twin pregnancy with intra uterine death delivered by hysterotomy.

Heterotopic pregnancy refers to condition where two pregnancies are present simultaneously at different implantation sites mostly manifested as intrauterine and ectopic pregnancies. First heterotopic pregnancy after in vitro fertilization was reported in 1972. Mostly it is a sporadic condition. The most common ectopic site is the fallopian tube, both in spontaneous and assisted reproductive technology (ART) heterotopic pregnancies. Almost 60-70% of heterotopic cases result in live childbirth with outcomes similar to that of singleton pregnancies. Spontaneous heterotopic pregnancy is a rare and potentially dangerous condition in which intrauterine (IU) and extrauterine pregnancies occur at the same time. It can be a life-threatening condition and can be missed, with the diagnosis being overlooked. A high suspicion is needed in women with risk factors for an ectopic pregnancy and in low-risk women with an intrauterine gestation who have free fluid with or without an adnexal mass or in those presenting acute abdominal pain and shock. The ectopic component is usually treated surgically and the intrauterine one is expected to continue normally.