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Key content Hysteroscopy is a common surgical procedure in gynaecology. Fluid distension media is needed to undertake the procedure. The common fluid distension media available are discussed, along with their properties and role in undertaking operative hysteroscopic procedures. Some inherent complications can occur when there is excessive fluid absorption during hysteroscopic procedures. The monitoring of the fluid distension medium used and how to avoid complications is discussed. Learning objectives To gain a better understanding of the fluid media are available for hysteroscopic surgery. To understand the risks associated with the use of different distension fluid media. To understand the difference between the various fluid distension media and their effect when excessive absorption occurs. To recognise, manage and prevent complications associated with excessive fluid absorption. To understand the different monitoring systems available during surgery.

Spontaneous heterotopic pregnancy is a rare clinical condition in which intrauterine and extra uterine pregnancies occur at the same time. It can be a life threatening condition and can be easily missed with the diagnosis being overlooked. We present the case of a 40 year old patient who was treated for a heterotopic pregnancy. She had a transvaginal ultrasound because of a previous ectopic pregnancy and an intrauterine gestational sac was seen with false reassurances. The patient presented acutely with a ruptured tubal pregnancy and this was managed laparoscopically. The ectopic pregnancy was not suspected at her initial presentation. A high index of suspicion is needed in women with risk factors for an ectopic pregnancy and in low risk women who have free fluid with or without an adnexal mass with an intrauterine gestation.

Introduction:Bacterial cellulitis post-Cesarean section is rare. Negative pressure wound therapy (NPWT) is widely used in various medical specialities; its effectiveness in obstetrics however remains the topic of debate—used predominantly as an adjunct to secondary intention specific to high-risk patient groups. Its application in the treatment of actively infected wounds post-Cesarean is not well documented. Here, we document NPWT in the treatment of an unusually severe case of bacterial cellulitis with abdominal abscess postpartum. We provide a unique photographic timeline of wound progression following major surgical debridement, documenting the effectiveness of 2 different NPWT systems (RENASYS GO and PICO, Smith & Nephew). We report problems encountered using these NPWT systems and “ad-hoc” solutions to improve efficacy and patient experience.A 34-year-old primiparous Caucasian female with no prior history or risk factors for infection and a normal body mass index (BMI) presented with severe abdominal pain, swelling, and extensive abdominal redness 7 days postemergency Cesarean section. Examination revealed extensive cellulitis with associated abdominal abscess. Staphylococcus aureus was identified in wound exudates and extensive surgical debridement undertaken day 11 postnatally due to continued febrile episodes and clinical deterioration, despite aggressive intravenous antibiotic therapy. Occlusive NPWT dressings were applied for a period of 3 weeks before discharge, as well as a further 5 weeks postdischarge into the community.NPWT was well tolerated and efficacious in infection clearance and wound healing during bacterial cellulitis. Wound healing averaged 1 cm2 per week before NPWT withdrawal; cessation of NPWT before full wound closure resulted in significantly reduced healing rate, increased purulent discharges, and skin irritation, highlighting the efficacy of NPWT. Five-month follow-up in the clinic found the wound to be fully healed with no additional scarring beyond the boundaries of the original Cesarean incision. The patient was pleased with treatment outcomes, reporting no lasting pain or discomfort from the scar.Conclusions:This report represents the first documented use of NPWT to aid healing of an actively infected, open wound following extensive surgical debridement 10 days post-Cesarean section, confirming both the efficacy and tolerability of NPWT for the treatment of severe bacterial cellulitis in obstetric debridement.

Leiomyomas (fibroid) arise from the smooth muscle of the myometrium and are benign in nature. Intavascular leiomyomatosis is an unusual and rare condition where the fibroid grows into the pelvic veins and inferior vena cava and sometimes extends into the heart chambers. We present a case where a woman presented to us with multiple fibroids and underwent an abdominal hysterectomy. The diagnosis was not suspected before the surgery but diagnosed on histopathology. The patient underwent further surgery to remove the fibroids from the pelvic veins and the inferior vena cava. This condition has been reported in only few case reports around the world. In view of the rarity of this condition, the diagnosis can be easily missed. We suggest an increased vigilance in women who have large fibroids with unusual features in symptoms or during surgery. Pre-surgical imaging will help to make diagnosis, and good surgical outcomes can be achieved by a multidisciplinary surgical approach.