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Mirror syndrome is a rare clinical condition in pregnancy associated with significant fetal mortality and maternal morbidity. It is characterized by a triad of complications: fetal hydrops, placenta oedema, and maternal oedema. We are reporting one case of late-onset Mirror syndrome in which the patient presented later in the gestation of 36 weeks due to excessive weight gain and clinical sign mimicking preeclampsia. Awareness of this disease is essential, as a failure of recognition will delay the treatment and cause higher maternal and perinatal morbidity and mortality.

Introduction: Obstetric anal sphincter injury (OASIS) is an uncommon complication that may occur during vaginal delivery and increases the risk of pelvic floor dysfunction following delivery. This 10-year review is aimed to determine the occurrence of OASIS at a tertiary teaching hospital. Methods: A retrospective review of records of women who had their newborns delivered at Hospital Universiti Sains Malaysia between 2007-2016 was conducted. OASIS was classified according to the classification proposed by Sultan AH in 1999. Women who delivered on the same day with the index delivery but without OASIS acted as the control group (n = 154). Results: There were 61,049 vaginal deliveries over the ten years. A total of 154 women were recorded to have vaginal delivery complicated with OASIS, with a cumulative prevalence of 0.25% per year. Of these, 86% (n = 133) sustained a third-degree, and the remaining 14% (n = 21) had a fourth-degree perineal tear. Three independent risk factors for OASIS were identified using multivariable analysis: primiparity, greater gestational age, and higher infant birth weight. Conclusion: Nulliparous, primiparous, and a higher infant birth weight > 3500 g pose a higher possibility of developing OASIS during vaginal delivery among women who delivered at a tertiary teaching hospital on the east coast of Malaysia.

Pericentric inversion of chromosome 9 (inv( 9)) is one of the most common variants seen in a normal human karyotype that occurs during meiosis.Despite being categorized as a normal variant, some studies using classical cytogenetics have recently shown that inv(9) could be associated with azoospermia, congenital anomalies, growth retardation, and rarely with abnormal karyotype. However, there is no reported association with cyclopia. Interestingly this genetic variant involves twin fetuses.A 36-year-old multiparous lady with dichorionic diamniotic twin pregnancy presented to the fetomaternal unit with fetal growth restriction at 34 weeks of gestation. An ultrasound scan revealed both have microcephaly, fisting hands, holoprosencephaly, and proboscis suspicious of Patau syndrome. Amniocentesis was not issued due to late pregnancy and guarded prognosis. The mother presented with preeclampsia at 35 weeks of gestation. The pregnancy managed to prolong up to 36 weeks after which caesarean section was performed due to the leading twin being in a transverse lie. Two baby twin girls were born 3 minutes apart with microcephaly and cyclops appearance. Chromosomal analysis of both twins revealed similar karyotypes of 46, XX, inv(9)(p11,q13). Pericentric inversion of chromosome 9 is regarded as a normal chromosomal variation in the general population, but in twins with cyclops is considered rare. Early referral to a tertiary hospital for twin management is highly required. It may identify fetuses with such abnormalities and counsel the parents with appropriate management.

Background This study aimed to determine the maternal preferred lateralization position at the latent phase and the effect of maternal lateralization-fetal spine concordance during the active phase of the first stage of labor on maternal comfort. Methods This prospective cohort study involved pregnant women, who attended to labor room at Hospital Raja Perempuan Zainab II with singleton pregnancies in the first stage of labor at 37 weeks of gestation and beyond. They were recruited after fulfilling the criteria selection. Fetal occiput and spine position was confirmed by transabdominal ultrasound examination, and the maternal preference position at the latent phase of the first stage of labor was identified. Participants were randomly assigned to one of two maternal position groups: same lateralization with the fetal spine (n = 180) and opposite to the fetal spine (n = 180). The maternal mean comfort score was assessed during the first stage of labor. Secondary outcome measures (labor duration, pain relief, cardiotocography (CTG) reactivity, and fetal condition at birth) were recorded. The results were analyzed using descriptive statistics, chi-square test (categorical variables), and t-test (numerical variables to evaluate differences while kappa statistics to show agreement between groups) Results The preferred maternal position at the latent phase of labor was associated with the same maternal lateralization-fetal spine concordance (p < 0.001). Higher means comfort score in the same lateral position of the mother and fetal spine during the active phase of the first stage of labor but the difference is not significant. A significant association between maternal position and fetal well-being based on cardiotocography (CTG) tracing with the same position having more cases of normal CTG tracing. Duration of labor, mode of delivery, the requirement of analgesia, and Apgar score were not associated with lateralization of the mother and fetal spine position during labor. Conclusion Parturients preferred lying in concordant with the fetal spine lateralization position at the latent phase of the first stage of labor and they were also more comfortable in that position during the active phase of labor with reassuring fetal well-being on CTG tracing.

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