Abnormal Low Lying Implantation of Ectopic Pregnancy (LLIEP) may occur in cervix, cervico isthmic region or caesarean scar. Cervicoisthmic pregnancy remains the rarest form of LLIEP, a life threatening cause of maternal morbidity and mortality with an incidence of 1 in every 2400 to 4500 pregnancies. In isthmic implantation, the gestational sac is located more cranially and between the cervix distally and the decidualised functional endometrium cranially. Transvaginal Ultrasound (TVS), Colour Doppler and Magnetic Resonance Imaging (MRI) remain gold standard modalities for early diagnosis. Ultrasonography depicts bulging lower uterine segment with a normal cervical length and consistency. Here, the author reports a rare case of ruptured isthmic pregnancy with 20 weeks intrauterine foetus death lying in left broad ligament in a 33-year-old unbooked G3P2L2 with gestation of 31 weeks presenting in emergency. Ultrasonography depicted intrauterine foetus death with foetus lying in lower segment of uterus. Lower section caesarean section for failed induction confirmed hour glass uterus with empty upper uterine segment and bulging, distended, couvelaire lower uterine segment and left lateral rupture at cervicoisthmic junction. Dead 20 weeks foetus lying in leaves of left broad ligament. Peripartum hysterectomy was done as a life saving procedure. Cervicoisthmic pregnancy is rarest form of LLIEP and diagnosis may result in rupture with need of peripartum hysterectomy.

The 'Twin Reversed Arterial Perfusion (TRAP)' sequence or acardiac twinning, or chorioangiopagus parasiticus is an anomaly which is unique to the monochorionic multiple pregnancies and is a rare complication that affects around 1 in 100 monozygotic twin pregnancies and about 1 in 35,000 overall, with no recognized familial recurrence. [1] They have almost doubled over the last two decades as a result of both the increasing average maternal age and with the increased use of assisted reproductive techniques. Physiologically, there is lack of a well-formed cardiac structure in one foetus (acardiac) that acts as a parasite as it is haemodynamically dependent on the structurally normal co-twin (pump twin) through a superficial artery-to-artery placental anastomosis. Various theories that explain the pathogenesis of the anomaly attribute it to either dysmorphogenesis or presence of arterio-arterial anastomosis, with latter being the most popular. [2] In arterio-arterial anastomosis there is a reversal of blood flow from the umbilical artery of pump twin into umbilical artery of the perfused twin therefore bypassing the placenta, henceforth poorly oxygenated blood contributes to deficient development of the head, upper limbs, torso and heart while the better oxygenated blood flowing via umbilical artery through common iliac artery and aorta allows better development of the lower part of the body. [1]-[3] Morphological types of acardiac twins- Acardius anephus presents with absence of the head, upper limbs and torso but with preservation of the lower limbs, genitalia and viscera. It is the most common type.  Acardius anceps lacks even rudimentary heart and present with rudimentary cranial structures. It is the most developed type.  Acardius amorphous comprises of an amorphous mass of bones, muscles, fat and connective tissues. It is the least differentiated type.  Acardius acormus present with the head as the only developed structure while all other structures are essentially absent. It is the rarest type. [3],[4]

Context: Sexually transmitted infections (STIs) are a problem of increasing concern among men and women. They can affect fertility, increase maternal and neonatal morbidity, and can become a burden on both physical and emotional health. Owing to lack of awareness and partly due to the social stigma attached, couples do not come forward for screening. Antenatal testing for STIs is an effective strategy recommended to detect STIs in this subset of the population. Aims: To estimate the seroprevalence of four STIs (hepatitis B, hepatitis C virus, HIV, and syphilis) in pregnant women, to evaluate its correlation with sociodemographic characteristics and sexual behavior, and to check awareness regarding STIs. Settings and Design: It was an observational study on 500 pregnant women attending an antenatal clinic at a tertiary care hospital in rural Haryana, India. Methods and Material: Pregnant women were screened for four STIs – hepatitis B, hepatitis C virus, HIV, and syphilis. Statistical Analysis Used: The sample size was calculated considering the mean reported seroprevalence of infections in pregnant women in previous studies. The power of the study was kept 80% and the alpha error was 0.05. Results: Seroprevalence for STIs in pregnancy was 5.2% – hepatitis C virus (2.6%), hepatitis B (2.4%), and syphilis (0.4%). Conclusions: Viral STIs are more prevalent among pregnant women. Antenatal screening is an effective strategy for the detection of STIs in pregnant women.