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Invasive mole is a form of persistent or metastatic gestational trophoblastic disease presenting usually after hydatiform mole 6-10 times more common than choriocarcinoma. It is defined as molar gestation invading the myometrium or uterine vessels. Persistent vaginal bleeding after evacuation of molar pregnancy and persistent elevation of beta HCG [1] . The presentation of secondaries is after few months to years in choriocarcinoma but immediately in cases of invasive mole [2] . The following case is a spectrum showing a diagnostic dilemma between choriocarcinoma or invasive mole or a consistent finding of AV malformation in the ultrasonography because of lack of an initial histopathological evidence of molar pregnancy from the evacuated products of conception and also posed a difficulty in deciding the mode of treatment considering the age of the patient whether conservative or radical surgery.

Cervical fibroids are rare pelvic tumours with varying clinical presentations. Clinical and radiological evaluation of these fibroids help in deciding the treatment approach. There will be surgical difficulties due to their close proximity to pelvic organs like bladder, ureters and rectum. Hence proper intraoperative delineation is important. We present a series of four cases of cervical fibroid with different presentations and management. All these cases were evaluated and surgically managed without complications. The first and third case presented with huge mass per abdomen and pressure symptoms. Both underwent exploratory laparotomy where fibroid was enucleated followed by hysterectomy. The second and fourth case mimicked like a large polyp. In both the cases, cervical fibroid was excised vaginally and was followed by hysterectomy. Histopathological examination was suggestive of cervical leiomyoma. Therefore, cervical fibroid as a differential diagnosis should always be considered while evaluating any pelvic masses.

Background: Antepartum haemorrhage (APH) is an emergency obstetrical condition that accounts for 2-5% of pregnancies and contributes to high level of maternal and perinatal mortality and morbidity. The present study was undertaken to assess the incidence of APH and to determine the maternal and fetal outcome in women with APH.Methods: This study was conducted in 130 women diagnosed with APH (gestational age ≥28 weeks) admitted in the department of obstetrics and gynaecology, at tertiary care hospital in central India over a period of 18 months from January 2020 to June 2021.Results: The overall incidence of APH was 1.09% and majority of them had abruptio placentae (AP-53.08%) followed by placenta praevia (PP-38.46%) and unknown (UK-8.46%). Anaemia (90%) was the commonest maternal morbidity. A significant association found between APH type and HELLP infection (p<0.0001), PPH (p=0.028) and DIC (p<0.0001). Rate of maternal morality was 9.23% and commonest causes of mortality were renal failure and PPH (91.67% each). Most common neonatal morbidities were birth weight of <2.5 kgs (84.32%) and NICU admission (27.61%). APH type was significantly associated with birth weight (p<0.0001). Majority of neonates were born live (56.72%), 36.57% were IUDs, 6.72% were still born, and 14.18% were neonatal deaths. APH type was significantly associated with live births and IUDs, (p<0.0001).Conclusions: APH is still a leading cause of maternal morbidity and mortality. Most of the patients were booked at other centres and were presented late with complications at the time of admission. Both these factors have contributed significantly to the incidence of APH as well as maternal and perinatal morbidity and mortality.

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