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This retrospective cohort study reviews the patients who underwent cervical resistance index (CRI) study and cervical cerclage in a tertiary referral centre. The authors included patients in a period of 5 years, with 42 cerclages and 30 CRIs. The elective cervical cerclages were inserted in the late first or early second trimester of pregnancies. A few emergency rescue cerclages were inserted after 24 weeks. 89% of patients with elective cerclages delivered beyond 33 weeks gestation. 58% of rescue cerclages delivered after 32 weeks gestation. 2 patients had rescue cerclages, after the initial elective cerclages in the same pregnancies. CRI produced variable results from 0 to more than 40. The group of CRI result 15 to 19 had the most patients. CRIs up to 22 were offered cerclages. There were inconsistencies in the recommendation for equivocal CRIs from 22 to 29. All CRIs beyond 29 had subsequent term pregnancies without cervical cerclage. Patients who had term pregnancies, and subsequently spontaneous abortions or preterm deliveries can be diagnosed with cervical incompetence from CRIs. In conclusion, majority of patients had pregnancies beyond 32 weeks with cervical cerclages. CRI can be a useful tool to diagnose cervical incompetence and for recommending cervical cerclages in subsequent pregnancies.

INTRODUCTION:This report describes a unique case of concurrent chronic and acute ectopic pregnancies in an ipsilateral tube. CASE HISTORY:A 33-year-old woman presented with symptoms suggestive of miscarriage that resolved on conservative management, resulting to normal ßhCG level. However, she was readmitted 5 weeks later with vaginal spotting, right iliac fossa pain and slightly elevated ßHCG. A diagnosis of pregnancy of unknown location was made and she was managed conservatively. Four weeks later the patient presented once again with vaginal bleeding and a positive pregnancy test. Her serum ßhCG level was elevated and her pelvic ultrasound scan showed an adnexal mass. The patient therefore underwent laparoscopic salpingectomy. Histopathological examination showed two ectopic pregnancies within the same tube; an older (chronic) ectopic positioned within proximal end of the tube and a more recent one at the distal end.CONCLUSION: This case highlights the difficulty in diagnosing chronic ectopic pregnancy and the increased risk of recurrence after conservative management.

We describe the obstetric care delivered to a woman over the course of three pregnancies during which time she and her partner were diagnosed as carriers of a rare autosomal recessive disorder: Donohue syndrome. She went on to deliver two affected children and one child who was unaffected. The first baby was growth restricted in utero and had many classical clinical and biochemical features of the syndrome. This infant died at the age of five months. The mother declined prenatal testing in her subsequent pregnancies. Fortunately, she was to deliver a healthy baby in her second pregnancy. However, her third pregnancy was again complicated by severe intrauterine growth restriction. She was delivered of the second affected baby who again demonstrated many of the features and abnormalities associated with Donohue syndrome. This baby died at thirteen months of age. The process leading to the diagnosis, the ultrasound growth charts related to affected and unaffected fetuses and the implications for subsequent management are described.