In the last decade, diagnosis of caesarean scar (CS) pregnancy and abnormal placental invasion has gone up significantly. It appears that the history of previous caesarean section is the predisposing factor common to both conditions. Until now, these are treated as a separate entity and therefore managed differently. Recent available evidence suggests that these are not a separate entity but rather a continuum of the same condition. If the caesarean scar pregnancy is managed expectantly in the 1st trimester, most likely it evolves into placenta accreta. This leads invariably to peripartum hysterectomy for postpartum haemorrhage (PPH) and severe maternal morbidity. Early diagnosis and intervention may give a favourable outcome.

Background: Infertility is a growing concern of the society. In many cases the exact cause of infertility may not be elucidated, whether it is tubal, ovarian, uterine, or a combination of factors. This paper aims to understand the role of diagnostic hystero-laparoscopy in evaluation of cases of infertility.Methods: This prospective study included 200 infertile women and it was conducted at department of Obstetrics and Gynaecology, MGM Hospital, during the period between January 2016 to December 2016. All the infertile patients either with primary or secondary infertility were included after thorough evaluation.Results: Out of 200 cases, 118(59%) patients had primary infertility and 82(41%) had secondary infertility. While laparoscopy detected abnormalities in 49% of the cases, significant hysteroscopy findings were noted in only 23.5% of cases. The most common laparoscopic abnormalities were endometriosis (32%) and unilateral tubal lockage (24%). On hysteroscopy, periosteal adhesions were the commonest abnormality in both the groups.Conclusions: Diagnostic hystero-laparoscopy is a safe and cost-effective method and should be considered when there are abnormal HSG results, a past history of pelvic infection, pelvic surgery and /or unexplained secondary infertility during management of infertile couple. Evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies which are usually missed by other imaging modalities, can be diagnosed as well as managed in some cases by hystero-laparoscopy.

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The incidence of myoma associated with pregnancy is reported at 0.3-5%, with a majority of myomas not requiring surgical intervention during pregnancy or delivery. [5][6][7][8] In the pregnant women with coexisting fibroids, there are increased incidences of first trimester losses, pressure symptoms, pain from red degeneration (necrobiosis), torsion of a pedunculated variant, ABSTRACT Background: Myomectomy at the time of caesarean delivery is controversial because of the risk of intractable hemorrhage and increased postoperative morbidity. The incidence of myoma associated with pregnancy is reported at 0.3-5%, with a majority of myomas not requiring surgical intervention during pregnancy or delivery. Recent studies consider it to be safe in selected patients and thus allow women to have a better obstetric outcome in future pregnancies, and to avoid hysterectomy. It relieves symptoms associated with fibroids and negates the need for later surgery or sonographic follow-ups for the fibroid after delivery. Methods: We performed a prospective cohort study of 15 patients with myomas who underwent myomectomy at the time of Caesarean section at MGM Hospital between January 2016 and December 2016. In a predesigned proforma, patient's details such as age, parity, antenatal course, gestational age at delivery, type of Caesarean section, size and location of the fibroids, blood loss, postoperative morbidity and perinatal outcome were noted. Results: The incidence of hemorrhage in the study group was 20%. There was no significant increase in the incidence of postpartum fever (6.6%), operating time (50 min), and length of postpartum stay (5.6 days). No patient required hysterectomy. Size of fibroid did not appear to affect the incidence of hemorrhage, although intramural myomas were more associated with hemorrhage. Conclusions: This study shows that myomectomy during caesarean section is a safe procedure and is not associated with major intraoperative and postoperative complications.

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Our observation emphasizes the difficulty of interpreting prenatal ultrasound findings when there is no suggestive context.

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