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A 33-year-old woman was diagnosed at 15 weeks gestation with a twin pregnancy complicated by an acardiac acephalic foetus. The patient opted for expectant management with close foetal surveillance. Serial ultrasonography showed polyhydramnios at 22 weeks gestation. However, subsequent scans over the next two weeks showed cessation of blood flow in the acardiac foetus, decreasing size of the foetal mass, as well as gradual resolution of the polyhydramnios. Subsequent follow-up was rather uneventful and she underwent an uncomplicated elective caesarean section at 35 weeks, resulting in a healthy 2,820 g girl. The baby was found to have intestinal atresia at birth. She underwent surgery successfully and was well when discharged. The possible causes and pathophysiology of intestinal atresia are discussed.

We report a rare and unusual case of an Abdominal pregnancy that was delivered successfully at term. It is the first documented case in the local literature in almost 30 years. What makes it even more exceptional is that despite the high mortality associated with the condition, both mother and baby survived the ordeal. She subsequently delivered another child, 2 years later by an elective lower segment caesarean section and had a tubal ligation performed concomitantly. A review of the topic and its management is also presented.

Currently, women with gestational diabetes mellitus have a repeat oral glucose tolerance test 6 weeks after delivery to identify those with persistent glucose intolerance. In this study, 298 women with gestational diabetes had a postnatal oral glucose tolerance test and of these, 23.2% had persistent glucose intolerance after delivery. The aim of this study was to determine if the antenatal oral glucose tolerance test results could be used to predict which patients would have persistent glucose intolerance after delivery. If only those with severely abnormal antenatal results had persistent disease, then those with only mildly abnormal antenatal results could be spared the postnatal oral glucose tolerance test. Using receiver operator characteristic curves, this study showed that the antenatal oral glucose tolerance test results could not be used to predict reliably which patients would continue to have abnormal glucose tolerance postnatally. Hence, postnatal oral glucose tolerance testing of all patients with gestational diabetes is still necessary as the detection of persistent glucose intolerance is important for the control of the diabetic condition so as to minimise long-term complications.

A rare case of non-puerperal uterine inversion caused by a large fundal leiomyoma in a 36-year-virgo intacta resulting in intractable haemorrhage was reported. After a myomectomy, attempts to reduce the inversion vaginally by transecting the anterior and posterior cervix was unsuccessful and a laparotomy was performed. The inversion was successfully corrected with return of normal function of the uterus.

Placental Chorioangioma occurs in 1% of pregnancies and are generally asymptomatic. However, they are known to cause a number of complications which are detrimental to the mother, fetus or the neonate. A typical case where acute polyhydramnios precipitated premature labour and delivery of the fetus as a result of a large placental chorioangioma is presented. A brief review of the other possible complications are also included.

Maternal alpha-fetoprotein in (MSAFP) has recently been proposed for screening of Down's syndrome. This is based on the association of a lowered MSAFP level at a given gestational age in Down's syndrome (DS) pregnancies. Most conventional 'screening' programmes in DS are based on the maternal age alone, selecting older mothers, who are at greater risk of having a DS infant born, for antenatal karyotyping. However, as 75% of DS infants are born to mothers less than 35 years old, a combination of blood tests including MSAFP and maternal age as independent risk factors would screen the younger mothers as a good cost-benefit ratio in selecting the 'at-risk' mothers for karyotyping. In this study, the gestational age was calculated from the first day of the last menstrual period (LMP) as well as from ultrasound cephalometry. The local MSAFP levels follow the same trend at a slightly higher level as those based on clinical evaluation of the Abbot AFP-EIA Monoclonal kits.