A 26-year-old, gravida 2 abortion 1, unbooked case, presented to the labour ward at 36+5 weeks gestational age in active labour. Two years back, she had an induced abortion at 6 weeks of gestation by medical methods. During her present pregnancy, she had irregular antenatal check ups at a local hospital with no followup in the third trimester. She had no known history of any medical illnesses, drug intake or addiction. On examination, her pulse rate was 42/minute, while blood pressure was 110/80 mmHg. Cardiorespiratory system examination was unremarkable. Obstetric examination revealed term size uterus with fetus in longitudinal lie and cephalic presentation. There were regular uterine contractions, fetal heart rate was 140 beats/minute. On per vaginal examination, cervix was fully effaced, os was 4 centimetres dilated, vertex station was at -2 and membranes were intact.Cardiologist's opinion was sought in view of persistent bradycardia. Electrocardiogram (ECG) was done which showed sinus bradycardia with narrow QRS complexes suggestive of congenital Complete Heart Block (CHB) [Table/ Fig-1]. Echocardiography was normal. Routine blood investigations were within normal limit. Pulse rate settled to 70-76/minute with intravenous injection atropine. Plan was to proceed with temporary pacing if heart rate did not increase after injection atropine or any deterioration in haemodynamic status occurred.Labour was augmented with injection oxytocin. In the meantime, thick meconium stained liquor was detected on artificial rupture of membranes and cardiotocograph showed non-reassuring fetal heart rate pattern. The woman was taken up for caesarean section under emergent conditions without temporary pacing. However, injection isoprenaline and temporary pacemaker was kept on standby. She was preloaded with 750 mililitres of Ringer's lactate solution prior to spinal anaesthesia. Two mililitres of hyperbaric 0.5% Bupivacaine was injected into subarachnoid space at L3-L4 level with the woman in left lateral position. A sensory level upto T8 was achieved. A late preterm vigorous male baby with birth weight of 2400 grams (appropriate for date) was delivered. The average estimated total blood loss was approximately 600 mililitres. Monitoring included continuous ECG, pulse oximeter and both invasive and noninvasive blood pressure. During surgery, heart rate dipped to 50/minute once; it responded to atropine [Table/ Fig-2]. Intraoperative haemodynamics remained stable and surgery proceeded uneventfully.Postoperatively, continuous monitoring was done with pulse oximeter and invasive blood pressure. The woman's heart rate remained steady at 54-64 beats/minute. Analgesia was achieved with injection diclofenac 75mg intravenous 8 th hourly. Postpartum period was uneventful; she was discharged on the seventh postoperative day. The neonate did not have any rhythm disturbance. She was doing well on follow up at 6 weeks. She was prescribed progesterone only pill (desogestrel 75μg) for 3 months and advised to continue follow-up in cardiology. M...

We present a single institution case series of women who presented with acute urinary retention due to uterine leiomyomas and discuss the pathophysiology, diagnosis and management. The data of 4 women, who presented to our institute with acute urinary retention due to uterine fibroids from April 2014 to March 2015 were prospectively collected and retrospectively analysed. Women with urinary retention in the same period due to other causes like pregnancy, neurological disorders or psychosomatic illnesses were excluded from the analysis. Uterine leiomyomas are an extremely rare cause of acute urinary retention in women. The delay in diagnosing uterine leiomyomas presenting with acute urinary retention further complicates the management. The rarity of the condition makes it difficult to plan either prospective or retrospective trials. Hence, most of the evidence comes from case reports or series. We report a case series of acute urinary retention in women with uterine leiomyomas and discuss the pathophysiology, diagnosis and management options.were recorded. Any previous surgical and/or urological consultations for acute urinary retention were also documented. The location and size of the tumours were documented during the initial preoperative scans {ultrasound/Computed Tomography (CT)} and also at operation. Renal function tests including routine urine examination were recorded to document baseline renal function. Case details are presented in [Table/ Fig-1].