abstract:Objectives: This study was undertaken to assess the degree of agreement amongst obstetricians regarding decisions to perform emergency Caesarean section (CS) procedures at a university hospital. Methods: This retrospective clinical audit was carried out on 50 consecutive emergency CS procedures performed between November 2012 and March 2013 on women with singleton pregnancies at the Sultan Qaboos University Hospital in Muscat, Oman. Data on each procedure were collected from electronic patient records and independently reviewed by six senior obstetricians to determine agreement with the decision. Results: Of the 50 women who underwent CS procedures, the mean age was 28.9 ± 5.1 years and 48% were primigravidae. A total of 65% of the CS procedures were category I. The most common indications for a CS was a non-reassuring fetal heart trace (40%) and dystocia (32%). There was complete agreement on the decision to perform 62% of the CS procedures. Five and four obstetricians agreed on 80% and 95% of the procedures, respectively. The range of disagreement was 4-20%. Disagreement occurred primarily with category II and III procedures compared to category I. Additionally, disagreement occurred in cases where the fetal heart trace pattern was interpreted as an indication for a category II CS. Conclusion: The majority of obstetricians agreed on the decisions to perform 94% of the emergency CS procedures. Obstetric decision-making could be improved with the implementation of fetal scalp pH testing facilities, fetal heart trace interpretation training and cardiotocography review meetings.

rate of 44 per minute and blood pressure of 80/40 mmHg. There was tenderness and guarding on abdominal palpation. The initial hemoglobin was 4.1g/dl. Vigorous resuscitation was started; a bedside ultrasound showed a viable intrauterine pregnancy equivalent to seven weeks gestation with a left-sided adnexal mass and significant amount of free fluid in the pelvis. The patient was taken immediately to the operating room for exploratory laparotomy which revealed a hemo-peritoneum of 2.2 liters of blood and blood clots, a left ovarian mass of 9x10 cm, twisted twice around the ovarian pedicle with a ruptured capsule and actively bleeding from the base (Figure 1). There was soft and velvety tissue inside the ruptured cyst (Figure 2). The left tube was twisted at the cornu and stretched over the mass. The left ovarian pedicle was clamped to control the bleeding and as there was no suspicion of malignancy macroscopically, left salpingo-oophorectomy was performed.

The study of Histocompatibility Locus Antigen (HLA) frequencies in 48 cases with congenital heart disease (CHD) in children in Cairo showed high incidence of A10. Cases with atrial septal defect have shown a significant association with A3 besides A10. There is also a significant association between B12-45 and right loop anomalies (Fallot's and pulmonary stenosis) together with A10. On the other hand, children with rheumatic heart disease have shown strong positive association with HLA group B8 and negative association with A28.

Eclampsia is an Obstetric emergency. It is uncommon in early second trimester and an early diagnosis will aid in preventing complications. We report an unusual case of eclampsia at an 18 weeks gestation with a good maternal outcome.