Cornual implantation of the placenta is an extremely rare and potentially life-threatening form of abnormal placental location, associated with localized progressive myometrial thinning and a significant risk of uterine rupture and massive hemorrhage. Unlike classical placenta accreta spectrum, it may occur in unscarred uteri, present with subtle clinical features, and thereby pose diagnostic challenges. We report the case of a 22-year-old multigravida woman (G2P1L1) who presented in the early second trimester with intermittent lower abdominal pain and spotting per vaginum. She had no history of prior uterine surgery or identifiable risk factors for abnormal placentation. Ultrasonography revealed a single live intrauterine fetus with eccentric placental implantation in the uterine cornual region and marked thinning of the adjacent myometrium, raising a strong suspicion of abnormal cornual placental adherence. Although the patient was hemodynamically stable at presentation, the imaging findings indicated a high risk of impending uterine rupture and catastrophic hemorrhage. In view of the potential for sudden clinical deterioration, prompt surgical intervention was undertaken with appropriate preparedness for hemorrhage. Intraoperatively, cornual placental implantation with significant myometrial attenuation was confirmed. Local carboprost administration at the placental implantation site achieved good uterine tone and satisfactory hemostasis. Cornual implantation of the placenta is a rare and potentially life-threatening condition, even in an unscarred uterus. A high index of suspicion, targeted ultrasonographic evaluation, and timely surgical management are crucial to prevent catastrophic hemorrhage and optimize maternal outcomes.

Major postpartum hemorrhage (PPH) continues to be a significant contributor to maternal health complications, and rapid control of bleeding is essential to prevent hemodynamic instability and the need for surgical intervention. The JADA[®] uterine vacuum system has been increasingly adopted as a primary tool to manage PPH caused by uterine atony. Although reported success rates are high, particularly when used early, device failure can still occur and requires timely escalation of care. We present the case of a 30-year-old woman, gravida 3 para 2, who developed major PPH following a spontaneous vaginal delivery at term. Her bleeding was attributed to uterine atony and persisted despite the administration of multiple uterotonic agents, including Pitocin, methylergonovine, Hemabate, rectal misoprostol, and tranexamic acid. A JADA[®] device was placed but did not achieve adequate hemorrhage control. A second JADA[®] device was subsequently inserted, yet bleeding continued. The patient required transfusion of packed red blood cells and was taken emergently to the operating room for a supracervical hysterectomy, after which her condition stabilized. This case demonstrates sequential JADA[®] device failure in the setting of major PPH and emphasizes the need for clinicians to promptly recognize insufficient response, understand the limitations of uterine vacuum systems, and be prepared to escalate to surgical management when bleeding persists. As the JADA[®] device becomes further integrated into PPH algorithms, documenting real-world experiences with device failure is essential for refining clinical expectations, improving patient care, and reducing mortality.

Cardiac disease complicates approximately 1-4% of pregnancies and is a leading cause of maternal morbidity and mortality worldwide. The spectrum includes congenital heart disease, valvular disorders, cardiomyopathy, pulmonary hypertension, ischaemic heart disease and hypertensive disorders, including preeclampsia, which can cause significant cardiac dysfunction. Management during delivery requires careful attention to haemodynamic stability, especially when preventing or treating postpartum haemorrhage. Uterotonics are central to management, but can alter systemic vascular resistance, myocardial contractility, pulmonary artery pressure, and heart rate, with varying implications depending on the underlying cardiac pathology. This focused review examines the pharmacology, haemodynamic effects and clinical considerations of uterotonic agents in women with cardiac disease, integrating evidence from studies, case series, and consensus recommendations. Oxytocin and its long-acting analogue carbetocin are discussed in detail, alongside alternatives such as carboprost, ergometrine, misoprostol, and adjuncts including calcium and tranexamic acid. Uterotonic use in maternal cardiac disease should be individualised according to cardiovascular physiology. Careful titration, slow infusion, and appropriate haemodynamic monitoring may reduce the risk of adverse effects. Early multidisciplinary planning and protocolised care are essential for optimal outcomes. Prospective studies across different cardiac conditions are needed to inform definitive guidance.

The management of immediate and delayed postpartum hemorrhage with cesarean delivery presents specific challenges in diagnosis and treatment. Real-time monitoring and quantitation of intraoperative and postoperative blood loss facilitate rapid recognition of immediate or delayed abnormal bleeding, enabling timely intervention. Effective response to ongoing postpartum hemorrhage depends on clear communication and collaboration among the nursing, obstetric, and anesthesiology teams. Medical management involves multiple courses of uterotonics and associated resuscitative measures, which should be applied concurrently with surgical interventions if needed (targeted sutures, vessel ligation, uterine compression sutures, and, in the most severe cases, peripartum hysterectomy). Surgical injuries, such as unintended extension of the hysterotomy leading to uterine vascular pedicle injury, are among the most frequent causes of postpartum hemorrhage during or after cesarean delivery. In these cases, bleeding may occur in the intra-abdominal or retroperitoneal spaces and may not present as vaginal bleeding or be detectable with bedside ultrasound. Therefore, delayed postpartum hemorrhage should be considered a likely cause of any alteration in maternal clinical condition in the hours after cesarean delivery, even without vaginal bleeding or intra-abdominal fluid on ultrasonography. Relaparotomy remains the gold standard for diagnosing and treating suspected intra-abdominal or retroperitoneal bleeding and should be performed without unnecessary delays. Intrauterine devices, such as tamponade balloons or vacuum-induced control systems, have not been sufficiently evaluated during cesarean delivery, and uterine-sparing surgical procedures should be considered for managing refractory postpartum hemorrhage after cesarean. However, these devices may be useful to temporize bleeding until surgical control of bleeding is attained. Similarly, arterial embolization requires time and is feasible only for hemodynamically stable patients with slow persistent bleeding. We propose management algorithms for 2 types of postpartum hemorrhage associated with cesarean delivery: perioperative immediate hemorrhage and postoperative delayed hemorrhage.

The aim of this article is to provide an updated review of the practical management of intractable haematuria in the National Health Service (NHS) of the United Kingdom (UK). A literature search was performed using the PubMed Advanced Search Builder. The terms 'Intractable Haematuria' OR 'Haemorrhagic Cystitis' OR 'Radiation Cystitis' were entered in a joint search as terms in a given publication's title only. This generated 295 papers in total, which were manually screened for suitability. There were no specific inclusion or exclusion criteria. We liaised with senior pharmacists in our Medicine Information department to assess product availability. Based on the best available evidence, we propose a new treatment escalation plan for the management of intractable haematuria based on the safety profile and product availability in the UK. After initial management, first-line treatment could include intravesical hyaluronic acid, tranexamic acid, carboprost, adrenaline, or PuraStat®. Second-line treatment could include hyperbaric oxygen therapy or super selective embolisation. Percutaneous diversion and cystectomy represent last resorts. Not all proposed options for the management of intractable haematuria published in the literature are of practical use in the UK, and each has its own merits and disadvantages. The evidence base for the majority of treatment modalities recommended in the literature is overall weak, with a lack of appropriate randomised controlled trials to support their use. More research is required on available treatments and potentially novel treatments in order to drive a robust national census to serve the often morbid patient cohort presenting with intractable haematuria in the UK.

Prostaglandins are a group of endogenously produced compounds that play essential roles in regulating human physiology. Synthetically derived prostaglandins can be used to modulate numerous processes in the body. This activity will highlight the mechanism of action, indications, side effect profile, contraindications, and other information needed for healthcare team members.