Women undergoing pregnancy termination for foetal abnormalities in the early second trimester should be informed of possible higher chance of incomplete abortion.

Pregnancy termination for trisomy 21 is associated with a higher risk of incomplete abortion. Fetal diagnosis affects the outcome of pregnancy termination.

A 31-year-old primiparous women with haemoglobin H disease complained of epigastric pain one day after giving uneventful vaginal birth to a 2.0kg boy at 38 weeks. Epigastric pain temporarily settled with oral antacid, she became dizzy and sweaty associated with back pain. She was pale and hypotensive, abdomen distended. Ultrasound showed free fluid inside the abdomen. Diagnostic tapping yielded blood. Haemoglobin was 6.4g/dl. Emergency laparotomy was performed. Splenomegaly (20cm in span) with rupture and 2.5L hemoperitoneum was found. Splenectomy was done. The total blood loss was 3.5L. Seven units of pack cells and 4 units of fresh frozen plasma were transfused. Histology showed congestive splenomegaly (605gm). Further investigations showed normal G6PD activity, negative blood smears for malaria parasites, normal red cell morphology and negative monospot test. This is the first report of postpartum splenic rupture related to thalassemic splenomegaly.

Objectives When the first twin is in cephalic presentation without other contraindications for vaginal delivery, vaginal birth is an option. Information on how women choose is scant. In this pilot study, we attempted to identify factors influencing women's choice on mode of delivery when twin I is presenting by vertex. Methods This is a retrospective review of all the twin pregnancies with twin I presenting vertex delivered in a regional hospital between April 2006 and March 2009. Without other contraindications for vaginal delivery, women carrying such twin pregnancies were allowed a choice between vaginal and caesarean birth in our unit. Results A total of 98 sets of twins fulfilled our inclusion criteria, 47 (48%) attempted vaginal delivery and 51 (52%) opted for cesarean section. On univariate analysis, education level below tertiary, history of vaginal birth, spontaneously conceived twin pregnancy, monochorionicity and second twin presenting vertex as well were statistically significantly associated with attempted vaginal birth, while maternal age and gestational age (>= 34 weeks versus <34 weeks) were not. On logistic regression, only spontaneous conception and second twin in cephalic presentation remained statistically significant factors associated with an attempt at vaginal delivery. The adjusted odds ratios were 6.16 (p=0.013) and 13.21 (p<0.001) respectively. Conclusion Mothers carrying spontaneously conceived twin pregnancy with both fetuses in cephalic presentation were more willing to opt for vaginal birth.

Objective The common types of compression sutures are less effective with abnormal placentation. In this study, we reported our experience with the use of two parallel vertical compression sutures over the lower uterine segment for cases of major placenta previa and accreta. This is the largest series reported on the use of this type of compression sutures. Methods Clinical details for cases of major placenta previa with parallel vertical compression sutures applied during caesarean section were collected and reviewed. Results Twenty-eight women with major placenta previa (including 2 with accreta) had parallel vertical compression sutures inserted during caesarean delivery. It was successfully applied for both term and preterm uterus (from 30 to 39 weeks) and in both elective (15 cases) and in emergency settings (13 cases). Bleeding immediately decreased and all successfully had their uterus conserved. In 17 cases, major postpartum haemorrhage (>=1000ml) was prevented. In 79% of cases (22/28), it was performed by trainee under supervision, 45% (10/22) without assistance by consultant. B-lynch sutures were applied in addition in three cases and uterine artery embolisation for the two cases of accreta. All had normal return of menstruation. Conclusion In women with major placenta previa or accreta, two vertical compression sutures placed in the lower uterine segment are an easy and effective way for rapid control of massive bleeding, and should be considered first-line surgical measure.