Low-dose oral misoprostol solution (20 micrograms) administered every 2 hours seems at least as effective as both vaginal dinoprostone and vaginal misoprostol, with lower rates of cesarean delivery and uterine hyperstimulation, respectively.

Oral misoprostol is as effective as intramuscular oxytocin in the prevention of PPH. Shivering and transient pyrexia were specific side effects of misoprostol. Misoprostol has potential in reducing the high incidence of PPH in developing countries.

A 34-year-old para 3þ0 with no significant medical history was admitted at 30 weeks gestation with sudden onset of chest pain, tightness of the chest, shortness of breath and left calf pain. She had an unproductive cough with no haemoptysis. Reassessment for risk factors for venous thromboembolism was unremarkable.On examination, she was haemodynamically stable, apyrexial with a normal O 2 saturation in air of 98%. Chest examination was normal. Based on clinical symptoms a provisional diagnosis of pulmonary embolus was made. Therapeutic LMWH (enoxaparin) was commenced and objective testing with ventilation/perfusion (V/Q) scan arranged. Chest X-ray done showed clear lung fields and perfusion scan revealed an area of decreased uptake at the left lower lung base with a high probability of a pulmonary embolus. Doppler scan of the left leg was not done as it would not add any further information. Therapeutic enoxaparin was continued and the patient made good clinical recovery. She was discharged on treatment dose of enoxaparin and arrangements for follow-up in the anticoagulant clinic made.She was readmitted 4 days later complaining of severe cough productive of greenish sputum. Repeat chest X-ray showed lower left zone shadowing suggestive of a chest infection. Broad spectrum intravenous antibiotics were commenced and therapeutic enoxaparin was continued. On the second day of admission, she developed sudden onset of sharp constant left iliac fossa pain exacerbated by coughing and movement. She had no history of fibroids or ovarian masses and denied having recently experienced fever, chills, contraction pains, vaginal bleeding, trauma or falls.On examination, all vital signs were normal. Abdominal examination revealed a gravid uterus consistent with 32 weeks gestation and an exquisitely tender, immobile mass measuring 10 6 10 cm 2 diameter in the left lower quadrant of the abdomen, with no bruit on auscultation. There was rebound tenderness and guarding. Speculum examination showed a long cervix and closed os. A reassuring CTG with no signs of uterine activity was obtained on monitoring. Initial FBC done was normal. An urgent USS performed showed appropriately grown fetus, cephalic, normal AFI and end diastolic flow and a posterior upper segment placenta. A cystic septated area with internal echoes was noted in the left iliac region thought to be intraperitoneal. Differential diagnosis of placental abruption, ovarian mass accident and rectus sheath haematoma (RSH) were entertained.During emergency ultrasound scan, she collapsed after experiencing severe abdominal pain. The abdomen became tense and efforts to detect fetal heart were unsuccessful. She was hypotensive and tachycardic and urgent FBC showed a 30% drop in the haemoglobin. Resuscitation was immediately commenced and patient transferred to theatre. At laparotomy through a midline incision there was a large retroperitoneal RSH to the left of the midline incision of *1000 ml. Bleeding from the left inferior epigastric vessels was controlled by ligation and an ...