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Tetralogy of fallot (TOF) is one of the commonest congenital anomalies. TOF is mostly diagnosed early in the life and to reach adulthood, such patients usually require some sort of surgical correction. Management of pregnancy in uncorrected TOF cases poses a significant challenge for obstetrician and team. Most of the time, it ends with significant fetomaternal morbidity or mortality. Here is a case of pregnancy with uncorrected TOF, which was successfully managed with multidisciplinary approach.

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Introduction: Sickle cell disease is an uncommon cause of anemia and jaundice during pregnancy. However, SCD is expected in Maharashtra, especially the Vidarbha region. SCD in pregnancy can cause various maternal and fetal complications. This study was conducted to know maternal and fetal outcomes in pregnancy with sickle cell disease in the third trimester. Methodology: This retrospective data were collected from hospital records of medical colleges located in central India for one and a half years, from November 2019 to January 2021. Forty-two women were admitted with pregnancy with sickle cell disease in the third trimester during the study period. The baseline characteristics, frequency of sickle hemoglobin variants, and maternal and fetal pregnancy outcomes were collected. Results: Compiled data were analyzed by simple descriptive statistics and frequency tables. Majority were primigravida (59.52%). Type of sickle cell was determined based on HB electrophoresis; out of 42 patients, 36 had AS pattern, 5 had SS pattern SCD, and 1 had As+b thal minor. The most common medical complication was anemia [73.80%] and UTI 26.19%. The most common adverse obstetric outcomes observed were IUGR/Oligohydramnios 42.85% and pre-eclampsia 21.42%. Majority of patients delivered by LSCS 42.85%. An adverse outcome in the fetus was fetal distress 45.23% and meconium-stained amniotic fluid 42.86%. Discussion: Due to hematological changes, extra demands, and sickle crisis, complications in both mother and fetus are more common in sickle cell anemia. Conclusions: Early detection and management of sickle cell anemia during pregnancy can reduce the adverse outcome in both mother and baby.

Background: Thyroid hormones are crucial regulators of early development and play an important role in the maintenance of a normal pregnancy and in the development of the fetus, particularly the fetal brain. The effective management of Grave's Disease (GD) during pregnancy is challenging for the clinician. The most common causes of hyperthyroidism are autoimmune GD and multinodular goiter.A 35 year old lady at 28 weeks of pregnancy, a case of Graves' disease on anti-thyroid drug with uncontrolled thyrotoxic symptoms despite regular medication didn't show clinical and biochemical normalization even with the maximum dose of antithyroid drug and antihypertensive drug permissible at pregnancy. At gestational week 28, T4 and T3 remained elevated with suppressed serum TSH and high levels of TSH receptor antibody levels. The patient had to be followed up medically with guarded prognosis. On follow up patient didn't show any clinical or biochemical remission. Despite high thyroid hormones levels and higher anti-TSH receptor antibody levels all throughout the gestation and with maximum dose of PTU the patient delivered a healthy baby with no clinical symptoms of thyrotoxicosis, goitre or any stigmata of PTU in the neonate. Mother's TFT was closed monitored and anti-thyroid medication was titred. We present a rare case of resistant GD in pregnancy, in different stages of pregnancy management encountered many challenges.

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