Background and Objectives: To evaluate maternal characteristics associated with placenta previa in comparison with breech cesarean controls, as well as maternal and neonatal outcomes. Materials and Methods: A retrospective case-control study was conducted at the Hospital of Lithuanian University of Health Sciences, Kaunas Clinics (2015-2022). A total of 150 cases of placenta previa were compared with a control group of participants who underwent cesarean delivery due to fetal breech presentation without placenta previa. Results: In multivariable analysis, higher parity, prior cesarean delivery, in vitro fertilization, prior surgical termination of pregnancy, and prior uterine surgery were independently associated with placenta previa compared with breech cesarean controls. Maternal complications were significantly more frequent in the placenta previa group and included placenta accreta spectrum disorders, second- and third-trimester hemorrhage, postpartum hemorrhage, and increased need for blood transfusion. The most severe outcomes, including cesarean hysterectomy, occurred exclusively in cases complicated by placenta accreta spectrum disorders. Neonatal outcomes in the placenta previa group were characterized by higher rates of preterm birth, low Apgar scores, and birth weight < 2500 g. Adverse neonatal outcomes were partly associated with earlier gestational age at delivery. However, placenta previa remained associated with low Apgar score after adjustment. Conclusions: Compared with breech cesarean controls, placenta previa was associated with multiple maternal characteristics, including higher parity, prior cesarean delivery, in vitro fertilization, prior surgical termination of pregnancy, and prior uterine surgery. The condition is linked to increased maternal hemorrhagic morbidity, particularly in cases complicated by placenta accreta spectrum disorders, as well as adverse neonatal outcomes mainly related to prematurity. These findings highlight the importance of careful antenatal monitoring and delivery planning in specialized centers.

Uterine rupture following myomectomy represents a rare but severe complication of pregnancy, with a reported incidence of less than 1%. It most commonly occurs during the late second or third trimester and is associated with significant maternal hemorrhage and fetal compromise. We report the case of a 36-year-old G3P0 woman at 28 + 5 weeks of gestation with a history of prior laparoscopic myomectomy complicated by postoperative hemorrhage and sepsis, who presented with acute abdominal pain and hemodynamic instability. Emergency laparotomy revealed approximately 1000 mL hemoperitoneum and a 3 cm rupture of the posterior wall of the lower uterine segment. A live preterm neonate was delivered via cesarean section, followed by total hysterectomy due to extensive uterine pathology and ongoing hemorrhage. The postoperative course was uneventful, and the neonate required intensive care support. This case underscores the importance of maintaining a high index of suspicion for uterine rupture in pregnant patients with a history of uterine surgery and highlights the potential role of surgical technique and uterine wall reconstruction in determining subsequent scar integrity.

Background: Aneurysmal subarachnoid hemorrhage (SAH) during pregnancy is rare, occurring in approximately 0.01-0.05% of pregnancies, most commonly in the third trimester. Its management is particularly challenging, requiring careful consideration of both maternal and fetal outcomes. Methods: We report the case of a 32-year-old woman at 31 weeks of gestation who presented with severe headache and left third cranial nerve palsy. Imaging revealed diffuse SAH with significant obstructive hydrocephalus and a 5 mm left posterior communicating artery aneurysm. Following multidisciplinary discussion, surgical clipping was performed while preserving the pregnancy to allow for fetal lung maturation. On postoperative day 8, the patient developed right-sided weakness and aphasia secondary to severe vasospasm. Initial management with catecholamine-induced hypertension resulted in increased uterine contractions and fetal distress. Subsequent intra-arterial administration of nimodipine effectively resolved the vasospasm, enabling cessation of vasopressor therapy. After achieving fetal lung maturity, cesarean section was performed at 34 weeks, followed by ventriculo-peritoneal shunt placement for communicating hydrocephalus. Due to sustained shunt failure, the distal catheter was finally inserted into the superior vena cava at the junction of the atrium. Results: The patient showed gradual neurological recovery with complete resolution of third cranial nerve palsy, and both mother and infant were discharged without complications. Conclusions: This case highlights that while standard vasospasm therapies can be implemented during pregnancy, hemodynamic approaches may provoke maternal and fetal complications. Endovascular rescue strategies should be promptly considered for severe vasospasm, and ventriculo-atrial shunting for complex communicating hydrocephalus may serve as a viable alternative option in post-cesarean patients.

Mid-trimester termination of pregnancy in individuals with a previous Caesarean section (CS) presents a heightened clinical challenge due to the risk of uterine scar complications, including rupture and hemorrhage. The combined regimen of mifepristone and misoprostol is a well-established method for medical termination; however, its safety and efficacy profile in patients with a uterine scar, particularly during the mid-trimester, remains a significant area of clinical concern and requires further evidence-based evaluation. The study was aimed to find out the outcome of mid trimester termination of pregnancy in previous caesarian section by combined mifepristone and misoprostol. This prospective observational study was carried out in the Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital, Bangladesh from July 2021 to June 2022. A total of 196 patients were enrolled in this study as per selection criteria. All relevant data were collected in a data collection form (questionnaire). Data were processed and analyzed with the help of computer program SPSS windows version 23.0. Conclusion will be set on the basis of findings. The maximum patients (46.4%) were in the age group of 25 to 29 years. Mean age of the study subjects was 26.13±3.63 years ranged from 20-35 years. Most of the patients were housewife (91.8%). Most of the cases parity was single (57.7%) followed by 2 in 22.4% cases and >2 in 19.9% cases. Most women were in their second pregnancy (63.3%), while 30.6% were in their third pregnancy. Complete expulsion was occurred in 86.7% cases, incomplete in 10.2% cases and no expulsion in 3.1% cases. Mean number of doses of misoprostol for successful expulsion was 4.12±0.90 ranged from 1 to 5 doses. Mean time interval between 1st dose and spontaneous expulsion 9.39±2.74 hours ranged from 3 to 12 hours. Complications following mid trimester termination of pregnancy were severe hemorrhage (28.1%), retained placenta (17.9%), severe pain (14.3%) and scar rupture (4.6%). No complication was observed in 55.5 cases. Mid-trimester medical termianl of pregnancy with mifepristone-misoprostol is a safe and effective procedure for the patients with previous caesarian section.

Complete hydatidiform mole with a coexisting live fetus (CHMCF) is an exceptionally rare, high-risk obstetric condition, most often seen in dichorionic twin pregnancies, with an estimated incidence of 1 in 20,000-100,000. Maternal complications frequently include vaginal bleeding, early-onset preeclampsia, thyrotoxicosis, and, occasionally, progression to gestational trophoblastic neoplasia (GTN). Fetal outcomes are unpredictable, ranging from spontaneous loss to live birth. We report a case of a 25-year-old gravida 3 para 2 at 24 + 2 weeks' gestation presenting with vaginal bleeding. Ultrasound revealed a viable fetus with a normal placenta and amniotic fluid, alongside a separate multicystic intrauterine mass occupying the internal cervical os, consistent with a complete hydatidiform mole. During hospitalization, she developed worsening bleeding, preeclampsia, thyrotoxicosis, and intrauterine fetal demise. Elective hysterotomy was performed, and pathology confirmed an early third-trimester placenta with a separate complete mole. This case underscores the rapid maternal deterioration possible in CHMCF and highlights the importance of early recognition, intensive monitoring, and multidisciplinary individualized care. A brief review of the literature is included, summarizing maternal and fetal outcomes, diagnostic challenges, and management strategies.

Introduction Placenta praevia is a recognized pregnancy complication characterized by the placenta implanting partially or completely within the lower uterine segment, and it is associated with significant maternal and perinatal morbidity. Antepartum hemorrhage is a cardinal sign of placenta praevia, and it is unusual for a woman with placenta praevia to reach the late third trimester without vaginal bleeding. Many risk factors, i.e., age >30 years, previous caesarean section, history of dilatation and curettage, history of assisted reproductive techniques (ARTs), multiple pregnancies, and history of placenta praevia in previous pregnancies, need to be addressed so that a confirmed diagnosis can be made in the antenatal period, and women who are at increased risk for this condition can be managed or referred to a setup where proper and vigilant care is provided to both mother and baby. This study aims to identify the risk factors unique to our population and to stratify antenatal patients into high-risk and lower-risk pregnancy groups.  Methods The study was conducted in the Obstetrical Department of Ayub Teaching Hospital, Abbottabad, Pakistan, after approval of the topic and completion of all prerequisites, for a period of three months from July 1, 2025, to September 30, 2025. Women diagnosed with placenta praevia, including low-lying placenta praevia, through ultrasound examinations after 32 completed weeks of gestation were included in the case group. A total of 30 patients were included in the case group. Similarly, 60 women with normal placental localization were included in the control group (case:control ratio, 1:2). Detailed history was taken and recorded in a predefined proforma. For qualitative data, the Chi-square test was used, and a p-value of <0.05 was considered significant. Results In our study, several factors were associated with placenta previa. Women older than 30 years were more likely to develop placenta previa, with nearly four times higher odds compared to younger women (odds ratio (OR) 3.92, 95% confidence interval (CI): 1.55-9.93; p = 0.0064). A history of previous cesarean section also increased the risk, with cases showing six times higher odds than controls (OR: 6.00, 95% CI: 2.28-15.77; p = 0.00037). Similarly, women who had previously undergone dilatation and curettage had over five times higher odds of placenta previa (OR: 5.20, 95% CI: 1.97-13.70; p = 0.00095), and those who conceived through ARTs were nearly four times more likely to develop the condition (OR: 3.80, 95% CI: 1.49-9.67; p = 0.0037). Notably, a previous history of placenta previa was the strongest predictor of recurrence, with affected women facing markedly higher odds of developing the condition again (OR: 11.0, 95% CI: 3.23-37.42; p = 0.0001).  Conclusion Our study highlights several key risk factors for placenta previa, including advanced maternal age, previous cesarean section, history of dilatation and curettage, ARTs, and prior placenta previa. Identifying these factors early can help clinicians recognize women at higher risk and implement careful monitoring to prevent complications. While our findings align with larger studies, they provide additional insight by examining these associations within a focused case-control setting. Overall, these results emphasize the importance of individualized risk assessment and proactive management to improve maternal and fetal outcomes in pregnancies complicated by placenta previa.