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Uterine torsion during pregnancy is only sporadically reported in the literature. Here we present a case of leiomyoma causing uterine torsion in pregnancy and review the literature on etiology, diagnosis, and management. A 25-years-old primigravida with leiomyoma complicating pregnancy was admitted in our hospital with abdominal pain and uterine tenderness. She underwent emergency LSCS (lower segment cesarean section) for fetal bradycardia. Intraoperatively, the uterus was rotated 180 degrees left to right. Inadvertent incision on the posterior wall was avoided by proper delineation of anatomy. Torsion was corrected by exteriorization of leiomyoma and uterus, and lower segment cesarean was carried out safely. Prompt recognition and management of this condition is necessary for better maternal and fetal outcome.

INTRODUCTION In the era of modern obstetrics when multiple pregnancies are on increase it is very important to know the incidence and obstetric outcomes of twin deliveries. Twin pregnancy is still associated with increased maternal and perinatal morbidity and mortality as well as healthcare costs. (1,2,3) MATERIALS AND METHODS: This is a retrospective study of twin deliveries done in the rural medical college teaching hospital over a period of 3 years. RESULTS: During the study period, incidence of twin delivery was 19.37 per 1000 deliveries. Majority cases of twins were young primies in age group (20-30 years). Preterm delivery occurred in 68% cases and was therefore, the most common morbidity followed by anaemia (38%) and PIH (28%). Most common presentation was vertex (66%) and malpresentation were present in 44% of cases. 54% were delivered by caesarean section. In 88% second baby delivered within 15 minutes. Uterine inertia, PROM, fetal distress, PPH, cord prolapse and abruption were complications during labour. There was no maternal mortality in present study. Average weight of first baby was 1679.63 gms and 2 nd baby was 1586.94 gms. Perinatal mortality of 1 st baby was 27.55 for 1 st baby and 37.25% for 2 nd baby. Average gestational age for patients in whom cervical encirclage was done was 34 weeks. CONCLUSION: Preterm delivery and low birth weight babies are main challenges to the obstetrician. Incidence of LSCS is quite high with malpresentation of leading (twin A) baby is a major indication for LSCS. The use of antenatal care services and good intrapartum management will help improve outcome in twin pregnancies.

Maternal mortality is an important indicator of health care system. As the mortality rates are consistently decreasing the focus is shifted on maternal near miss which describes severe maternal morbidity which shares the common pathway as mortality. Maternal near miss indicators are relevant in developing world and low resource setting as it indicates the gaps in the health system. In 2009 WHO working group has standardized the criteria for selecting these cases. MATERIAL AND METHODS: This study is performed in rural medical college between October 2012 to september2014 and maternal near miss cases are identified according to WHO criteria. Variables related to age, parity, gestational age, intensive care unit admission, ventilator support, requirement of massive blood transfusion were analyzed. Further the events leading to maternal near miss were studied. Finally the indices like maternal near miss incidence ratio, maternal near miss: maternal mortality ratio and mortality index were calculated. RESULTS: during the study period 2409 deliveries were conducted of which 2385 were live births. Potentially life threatening conditions were identified to be 265 and maternal near miss cases were 22. Maternal near miss incidence ratio was 9.2per 1000 live births, maternal near miss to maternal mortality ratio was 11:1 and mortality index was 8.3%. The leading causes of maternal near miss were abruption and rupture uterus requiring emergency hysterectomy. The morbidity was high in unbooked cases. CONCLUSION: maternal near miss is good alternative indicator of health care system. Lacunae between grass root level and tertiary centers should be filled.

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