Postpartum hemorrhage (PPH), the loss of more than 500 mL of blood following childbirth, is a leading cause of maternal mortality worldwide. The current coronavirus disease 2019 (COVID-19) pandemic has strained health-care systems globally. Pregnant women are a vulnerable group at a high risk of severe infection with COVID-19 due to the physiological changes in their immune state. Although the infection can be asymptomatic, severe COVID-19 infection is associated with respiratory distress, fever and coagulopathies that can complicate an already hypercoagulable pregnancy state. There is a dearth of existing literature regarding the complications of COVID-19 infection during pregnancy, and much is yet to be known about this rapidly evolving pandemic. In our case report, we received a 23-year-old gravida 2 para 1 woman who was COVID-19 positive but asymptomatic; she presented to the obstetric department with labor pains which progressed to severe postpartum hemorrhage and development of mild respiratory distress.

Background: Coronavirus Disease 2019 (COVID-19) has been associated with adverse pregnancy outcomes including preeclampsia. COVID-19 and pre-eclampsia have overlapping clinical features therefore challenging to differentiate. Since COVID-19 is not routinely tested among pregnant women, it’s prudent to test it among patients presenting with Pre-eclampsia-Eclampsia. Case Presentation: A 23 year old female Gravida 1 Para 0 at 36 weeks and 5 days of amenorrhea presented at Mal Super Specialty Hospital as a referral in a semi-conscious state after a severe attack of tonic-clonic seizures. Detailed history from the husband was insignificant except for a persistent cough for the last 7 days. She had denied any visual changes, headaches or vaginal discharge. Physical examination revealed a tachycardia (150 bpm), elevated blood pressure (187/111 mmHg), a tachypnea (36 breaths/minute) and SPO2 of 94% at room air. Routine COVID-19 Rapid test turned positive, and the urine dipstick was +3. Additional tests revealed a leukocytosis and elevated liver enzymes. Chest radiograph revealed prominent interstitial markings and a bedside transabdominal ultrasonography showed a live single intrauterine fetus in cephalic presentation with normal cardiac activity and movements. A diagnosis of a prime gravida with eclampsia and COVID-19 was made. She was managed with intravenous labetalol, she had already received a loading dose of IV Magnesium sulphate and we administered two maintenance doses during monitoring. Within an hour of admission, she had a spontaneous rupture of the amniotic membranes, with meconium stained liquor (grade 2), and the fetal heart rate (148 beats per minute) was reassuring. She had an uncomplicated vaginal delivery of a live male newborn. Shortly after delivery, she developed slight respiratory distress and significant fluid overload that was managed with furosemide. A COVID-19 RT-PCR came back negative for the neonate and positive for the mother. She was shifted to the COVID-19 treatment unit and contact limited with the child. She was kept on a course of tablets Ivermectin, zinc, vitamin C, a montelukast, azithromycin, metronidazole and injectable pantoprazole. They were discharged on day 15 after recovery with a negative COVID nasopharyngeal swab. Conclusion: A diagnosis of pre-eclampsia-Eclampsia should prompt testing for COVID-19.

BACKGROUND Calcified chronic subdural hematomas (CCSDHs) are rare variants of chronic subdural hematomas (CSDHs) accounting to only 0.3–2.7% of CSDHs. Although the majority of the patients with CSDHs recover from surgery, there still is some doubt about its being applied to CCSDHs. OBSERVATIONS In this case report, the authors present a case of a 75-year-old male presenting with deterioration of motor function in his left limbs over the course of 18 months and acute neurological deterioration in the form of altered sensorium for 7 days. The patient experienced an episode of aspiration in the preoperative period that led to deterioration of pulmonary function in the postoperative period. A chest radiograph showed diffuse patches suggesting pulmonary compromise. Computed tomography and magnetic resonance imaging (MRI) documented a large subdural collection at the right frontal and parietal hemisphere with calcification, which was successfully and completely removed by surgery. LESSONS The chances of a subdural hematoma progressing to calcification is extremely rare. The presentation of this case was such that surgical intervention was the only option left for the patient. The presence of lacunar infarcts in the thalamus on MRI can also be attributed to the calcified hematoma.

The incidence of cancer among pregnancy, albeit rare, presents as a significant diagnostic challenge for clinicians especially with considerations for materno-fetal well-being. The double-edged sword of Renal Clear Cell Carcinoma and Gastrointestinal Stromal Tumor in near-term pregnant woman was encountered in our case and skillfully maneuvered via combination of advanced diagnostic techniques involving CT, MRI and endoscopy. A discussion board comprising of experts was set up and after extended consultation involving patient's relatives, elective cesarean was performed at 34 weeks after which surgical excision resulted in successful extraction of both the tumors, ensuring the survival of both mother and child.