Congenital hypoplasia of bilateral internal carotid arteries (ICAs) is an extremely rare anomaly with less than 25 reported cases in literature till date. We present a case of a 30-year-old primigravida, who developed seizures and subsequently loss of consciousness just few minutes after the delivery of a healthy male child. To the best of our knowledge, this is the first case with bilateral ICA hypoplasia presenting in postpartum female who developed infarct in bilateral frontal region and subarachnoid hemorrhage (SAH). On a postpartum three-dimensional (3D) computed tomography (CT) angiography, bilateral ICA hypoplasia was confirmed and the manifestations of infarcts were probably the consequence of altered hemodynamics of pregnancy. In conclusion, a patient in her late pregnancy and postpartum period, having nonspecific cerebral symptoms or having suffered a cerebrovascular accident, should not only be evaluated for pregnancy or puerperium-related complications but also whenever possible a baseline screening with Doppler study of neck vessels and a noncontrast magnetic resonance imaging (MRI) angiography of neck and cerebral vessels should be performed to rule out congenital anomalies.

Introduction: The importance of partogram is to prevent the maternal and perinatal complications. The WHO has simplified the partogram for its use by skilled birth attendants. Aims and Objectives: To study the progress and outcome of labour using modified WHO partogram in spontaneous labour in primigravidas. Materials and Methods: A cross sectional study of 100 women primigravidas admitted to Jhalawar Medical College from November 2017 to October 2018 with spontaneous onset of labour at term with no high risk factors were recruited for the study using modified WHO Partogram. Patients were divided into 3 groups –. Group 1- cervical dilatation and descent curve falling to the left of the alert line. Group 2- cervical dilatation and descent curve falling to the right of the alert line. Group 3 with women to right of action line was planned. Results: Most women belonged to age group of 21-25 years. The mean gestational age was 38.2 weeks. In Group 1, the mean duration of active phase of first stage of labour was 4.52±0.10 hours, where as it was 5.94±1.46 hours in Group 2. In Group 2, the mean duration of second stage of labour was 45.44±1.94 mins but it was 34.42±16.41mins in Group 1study subjects. Mean rate of cervical dilatation is 1.2 cm/hr. Seventy seven percent had normal delivery, 11% had caesarean delivery and 12% had instrumental delivery. Augmentation was significantly higher in Group 2 (92.3%) than in Group 1 (67.8%). In the study group, there were no maternal and perinatal deaths. Conclusion: The partograph is an inexpensive and easily accessible tool that can effectively monitor the progress of labour. The WHO simplified partograph is highly useful in identifying when to intervene and also reduces perinatal and maternal mishaps. Keywords: WHO partogram, Alert line, Maternal outcome, Perinatal outcome

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A regimen of low dose mifepristone (100 mg) followed 24 hours later by vaginal misoprostol can be safely and effectively used for early abortion.