Twin gestation is considered as high risk pregnancy due to associated high maternal morbidity and perinatal mortality in comparison with singleton pregnancies .Overall, the rate of twin gestation is on rise due to inadvertent use of ovulation induction drugs in assisted reproductive techniques. This observational study was carried out to find the maternal and perinatal outcome in 100 cases of twin gestation delivered at tertiary care referral hospital over a period of fifteen months. It was observed that the incidence of twins was 1.49 % .Seventy six percent cases were booked and attended antenatal clinic on regular basis .Preterm labour (84%) was the commonest obstetric complication ,whereas ,nutritional anemia (66%) and pregnancy induced hypertension (18%) were the commonest medical complications .The rate of caesarean section was 33%.There was no serious maternal morbidity or mortality .There were 35 perinatal deaths ,of which 20 were early neonatal deaths. Extreme prematurity (37%) and very low birth weight (33%) predisposed majority of perinatal deaths. Causes of neonatal deaths were respiratory distress, fulminant septicemia ,pulmonary hemorrhage and DIC. Judicious use of ovulation induction drugs can reduce the incidence of twin gestation. Early diagnosis of twin gestation with its chorionicity, careful monitoring for fetal wellbeing throughout the pregnancy ,regular antenatal checkups, adequate rest, good diet, cervical encirclage in selective cases, maternal gluco-corticoids therapy in preterm labour, short term tocolysis and institutional delivery having level III neonatal back up facilities can improve the maternal and perinatal outcome in twin gestation.

<p>The twin-to-twin transfusion syndrome (TTTS) is a severe complication of monochorionic twin pregnancies, caused by  inter-twin transfusion of blood from one fetus (the donor) towards the other fetus (the recipient) through placental anastomoses. Twin to twin transfusion complicates about 15-30% of monochorionic twin gestations and is responsible for 17% of the perinatal mortality in multiple pregnancies. The donor twin become anemic, hypovolemic and looses amniotic fluid where as the recipient becomes plethoric, hypervolemic and gains excess amniotic fluid .Both fetuses are at risk due to adverse hemodynamic changes following abnormal vascular communication . Severe TTTS has a 60-100% fetal or neonatal mortality rate. Mild-to-moderate TTTS is frequently associated with premature delivery. Fetal demise of one twin is associated with neurologic sequelae in 25% of surviving twins. We report a rare case of twin to twin transfusion syndrome in a primigravida ,who fulfilled the diagnostic criterias of the condition .Patient had miscarriage at 27 weeks of gestation due to severe uteroplacental insufficiency.Aetio-pathology ,hemodynamic alterations ,diagnostic modalities ,management options and prognosis is discussed in the report.</p>

Hysterectomy is one of the commonest major gynecological surgical procedures performed all over the world. It is performed either for benign or malignant gynecological conditions, through abdominal or vaginal route. Hemorrhage, accidental injury to the adjacent organs, wound dehiscence and sepsis are some of the major complications associated with this procedure. We report a rare case of a young woman, who presented with post coital rupture of vaginal vault and prolapse of bowel loop, three months following abdominal hysterectomy for benign condition. Her condition was stable at admission. A rent in the vaginal vault, measuring 4 to 5 centimeters was sutured by vaginal route, in two layers under general anesthesia, after reposition of bowel. She had uneventful postoperative period. She was followed up for a period of one year following repair, for re occurrence of this rare complication. Incidence, causative factors and preventive measures for this condition are discussed in the report.