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Objective To investigate risk factors and pregnancy outcome of patients with placenta previa. Methods A population-based study comparing all singleton pregnancies of women with and without placenta previa was conducted. Stratified analysis using multiple logistic regression models was performed to control for confounders. Results During the study period, there were 185,476 deliveries, of which, 0.42% were complicated with placenta previa. Using a multivariable analysis with backward elimination, the following risk factors were independently associated with placenta previa: infertility treatments (OR 1.97; 95% CI 1.45–2.66; P  < 0.001), prior cesarean delivery (CD; OR 1.76; 95% CI 1.48–2.09; P  < 0.001) and advanced maternal age (OR 1.08; 95% CI 1.07–1.09; P  < 0.001). Placenta previa was significantly associated with adverse outcomes such as peripartum hysterectomy (5.3 vs. 0.04%; P  < 0.001), previous episode of second trimester bleeding (3.9 vs. 0.05%; P  < 0.001), blood transfusion (21.9 vs. 1.2%; P  < 0.001), maternal sepsis (0.4 vs. 0.02%; P  < 0.001), vasa previa (0.5 vs. 0.1%; P  < 0.001), malpresentation (19.8 vs. 5.4%; P  < 0.001), postpartum hemorrhage (1.4 vs. 0.5%; P  = 0.001) and placenta accreta (3.0 vs. 1.3%; P  < 0.001). Placenta previa was significantly associated with adverse perinatal outcomes such as higher rates of perinatal mortality (6.6 vs. 1.3%; P  < 0.001), an Apgar score <7 after 1 and 5 min (25.3 vs. 5.9%; P  < 0.001, and 7.1 vs. 2.6%, P  < 0.001, respectively), congenital malformations (11.5 vs. 5.1%; P  < 0.001) and intrauterine growth restriction (3.6 vs. 2.1%; P  = 0.003). Using another multivariable logistic regression model, with perinatal mortality as the outcome variable, controlling for confounders, such as preterm birth, maternal age, etc., placenta previa was not found as an independent risk factor for perinatal mortality (weighted OR 1.018; 95% CI 0.74–1.40; P  = 0.910). Conclusions Infertility treatments, prior cesarean section, and advanced maternal age are independent risk factors for placenta previa. An increase in the incidence of these risk factors probably contributes to a rise in the number of pregnancies complicated with placenta previa and its association with adverse maternal and perinatal outcomes. Careful surveillance of these risk factors is recommended with timely delivery in order to reduce the associated complications.

Background Cases of acute fatty liver of pregnancy are extremely rare but represent a serious complication as a life-threatening condition for both the mother and newborn in late-term pregnancy. Preoperatively, adequate management with multidisciplinary teams and timely delivery are potentially required to save materno-fetal life. Herein, we report a rare, inconspicuous case of acute fatty liver of pregnancy in third-trimester pregnancy and a review of the literature to underscore this hazardous entity. Case presentation A 28 year-old pregnant Vietnamese woman was transferred to our tertiary referral hospital for suspicion of acute fatty liver of pregnancy without prodromal signs, except for intermittent abdominal pain at 39 weeks 3 days of gestational age. In accordance with the Swansea criteria, laboratory findings contributed to confirming the diagnosis of acute fatty liver of pregnancy. Immediately, an emergent cesarean section was rapidly performed. Postoperatively, the patient recovered gradually with rapid improvement of biochemical and hematological parameters. The woman and her neonate were discharged uneventfully after 9 days of hospitalization. Conclusions Acute fatty liver of pregnancy may be asymptomatic and can progress quickly, affecting multiple organs. Early diagnosis is based on abnormal presentation of serum laboratory tests. In addition, clinicians ought to assess the diagnosis following the Swansea criteria. Importantly, supportive therapy, strict monitoring, and early termination of pregnancy, when appropriate, are still the mandatory protocols for the management of acute fatty liver of pregnancy. Highlights Acute fatty liver of pregnancy may be asymptomatic; however, this entity can progress rapidly, affecting multiple organs. Early diagnosis should be made on the basis of biochemical and hematological tests according to the Swansea criteria. Supportive therapy, strict surveillance as well as timely termination of pregnancy are still the mandatory protocols for the management of acute fatty liver of pregnancy in term pregnancy.

Fetal ascites is a non-specific finding which can be associated with fetal hydrops or an isolated intra-abdominal cause. We describe a case of fetal ascites associated with an intra-abdominal mass suspected to be ovarian in nature and diagnosed in the third trimester. The mother developed maternal mirror syndrome, previously reported to be associated with fetal hydrops but not reported in cases of isolated fetal ascites. Neonatal laparoscopy revealed the left ovary was oedematous and enlarged next to an inflamed and oedematous deep ring suggesting a previously incarcerated ovarian inguinal hernia, causing reactive ascites due to vascular compromise. Both the baby and mother went on to make a full recovery. This case both highlights a rare cause of fetal ascites associated with an ovary antenatally incarcerated in an inguinal hernia and maternal mirror syndrome associated with isolated ascites due to this pathology.

Conjoined twins are rare, occurring in 1 in 250 000 live births, with cephalopagus twins reported in 1 in 3 000 000 live births. In cases of conjoined twins, early diagnosis is crucial for the health of the mother and pregnancy management and counselling. We present a case of cephalo-omphalopagus conjoined twins, with imaging findings, delivery considerations and patient-centred care recommendations. A patient in her 30s, gravida 2 para 0, was transferred to our care after an anatomical ultrasound demonstrated fusion of the fetal heads, chests and abdomens. Due to a complex congenital heart defect with a shared heart, the family was counselled on the anticipated prognosis and management options. Twin girls were delivered at 34+4 weeks via caesarean delivery, and the family was able to spend time with them as desired. This case demonstrates that prenatal diagnosis is helpful, and family involvement through patient-centred care and shared decision-making can improve perceived outcomes.

Purpose One of the major problems in international literature is how to measure postpartum blood loss with accuracy. We aimed in this research to assess the accuracy of visual estimation of postpartum blood loss (by each of two main health-care providers) compared with the gravimetric calculation method. Methods We carried out a prospective cohort study at King Abdulaziz Medical City, Riyadh, Saudi Arabia between 1 November 2009 and 31 December 2009. All women who were admitted to labor and delivery suite and delivered vaginally were included in the study. Postpartum blood loss was visually estimated by the attending physician and obstetrics nurse and then objectively calculated by a gravimetric machine. Comparison between the three methods of blood loss calculation was carried out. Results A total of 150 patients were included in this study. There was a significant difference between the gravimetric calculated blood loss and both health-care providers’ estimation with a tendency to underestimate the loss by about 30%. The background and seniority of the assessing health-care provider did not affect the accuracy of the estimation. The corrected incidence of postpartum hemorrhage in Saudi Arabia was found to be 1.47%. Conclusion Health-care providers tend to underestimate the volume of postpartum blood loss by about 30%. Training and continuous auditing of the diagnosis of postpartum hemorrhage is needed to avoid missing cases and thus preventing associated morbidity and mortality.

Fetal lymphangiomas are benign tumours that arise from abnormalities in the development of the lymphoid system. They mostly present on the neck and rarely appear on the limbs and chest wall (2–5%). We are reporting two cases of rare and isolated lymphangiomas diagnosed by prenatal ultrasound in the second and third trimesters. In both cases, adequate counselling, ultrasound surveillance until delivery and postnatal referral were provided. Prenatal diagnosis of lymphangiomas is essential to establish the prognosis, decide the route of delivery and guide a postnatal multidisciplinary approach.