Introduction Vaccination is critical in controlling the coronavirus disease 19 (COVID-19) pandemic. However, vaccine perception and acceptance among pregnant and lactating women is unknown in Singapore. We aimed to determine the acceptance of COVID-19 vaccination among these two groups of women in Singapore, and factors associated with vaccine acceptance. Methods We conducted an anonymous, online survey on the perception and acceptance of the COVID-19 vaccine in pregnant and lactating women at a tertiary hospital in Singapore from 1st March to 31st May 2021. Information on demographics and knowledge were collected, and these factors were assessed for their relationship with vaccine acceptance. Results A total of 201 pregnant and 207 lactating women participated. Vaccine acceptance rates in pregnant and lactating women were 30.3% and 16.9% respectively. Pregnant women who were unsure or unwilling to take the vaccine cited concerns about safety of the vaccine during pregnancy (92.9%), while lactating women were concerned about potential long-term negative effects on the breastfeeding child (75.6%). Other factors significantly associated with vaccine acceptance included a lower monthly household income or education level, appropriate knowledge regarding vaccine mechanism and higher perceived maternal risk of COVID-19. Most pregnant (70.0%) and lactating women (83.7%) were willing to take the vaccine only when more safety data during pregnancy and breastfeeding were available. Conclusions COVID-19 vaccine acceptance was low among pregnant and lactating women in Singapore. Addressing safety concerns when more data is available and education on mechanism of vaccine action will likely improve acceptance among these women.

It is important to thoroughly investigate all cases of NIHF and identify its causes in order to provide appropriate antenatal and postnatal counselling. In our series, almost one-third of NIHF cases had no identified aetiology. The neonatal mortality rate was approximately 58%.

SUMMARYA 55-year-old woman in a perimenopausal state presented with severe suprapubic pain and fever. Physical examination revealed a tender pelvic mass measuring 24 weeks in size. Ultrasound of the pelvis and CT scan of the abdomen and pelvis showed a 12 cm mass arising from the posterior wall of the uterus with irregular margin inferiorly, raising suspicion of a ruptured mass. The patient was treated conservatively and discharged from the hospital with regular simple analgaesia. She had an elective total hysterectomy bilateral salpingo-oophrectomy and frozen section the following week and histology revealed a benign leiomyoma with extensive necrosis. Moreover, intraoperatively, the fibroid was found to have ruptured its capsule. This case illustrates that a ruptured degeneration of uterine leiomyoma should be considered as one of the differential diagnoses for all women presenting with abdominal pain and a large fibroid mass regardless of their hormonal status or age. BACKGROUND

Septate uterus is the most common congenital uterine anomaly encountered clinically. It is associated with infertility and adverse pregnancy outcomes including miscarriages and preterm births. Over the past few decades, the diagnosis and surgical management of uterine septum has changed significantly. Here, we present two women with complete vagino-uterine septum presenting with infertility. The diagnoses of septate uterus were made through three-dimensional (3D) ultrasound and magnetic resonance imaging (MRI) and they were treated with thin-gauge bipolar electrocautery (VERSAPOINT TM ) through hysteroscopy. A literature review of the approach to managing complete vagino-uterine septum suggests the use of combinatorial imaging modalities such as hysterosalpingography (HSG), 3D ultrasonography and MRI to accurately define the anatomy. Furthermore, compared to open surgery, treatment through hysteroscopic approaches are associated with shorter operating time and good fertility outcomes. With the use of concomitant laparoscopic and ultrasound monitoring, the incidence of uterine perforation and visceral injury may be reduced. However, referral to a centre with such expertise is essential.

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