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We report the case of a pregnant lady who had hydrops fetalis in three successive pregnancies and discuss the possible genetic causes and the systematic approach to evaluation of her pregnancy and her future reproductive options. Hydrops fetalis can occur due to a heterogeneous number of causes. Systematic evaluation helps in determining the cause which then determines the prognosis as well as recurrence in future pregnancies. Recurrent hydrops though rare, can occur because of single gene defects causing hematological, neurological, cardiac conditions, etc. Genetic testing and consideration of the role of exome sequencing is important in counseling families regarding their future pregnancy options as well as to offer prenatal diagnosis.

Purpose: Negative childbirth experience has been associated with post-traumatic stress disorder (PTSD) and depression in the postpartum period with a significant impact on the mother as well as the infant.Methods: The current study aimed at studying the association of negative child birth experience with PTSD and depressive symptoms among primiparous mothers within 6 weeks of child birth. The Childbirth Experience Questionnaire (CEQ), PTSD checklist (PCL), and Edinburgh Postnatal Depression scale (EPDS) were used to assess negative childbirth experience, symptoms of PTSD, and depression respectively.Results: Of the 95 women in the study, fifty women (52.6%) had a score below the median of CEQ score (score of 72) indicating a negative childbirth experience. Lower Scores on CEQ indicating negative childbirth experience correlated with PTSD scores on the PCL (r = −0.560, p = 0.001) and depression scores on the EPDS (r = −0.536, p = 0.001). Of the sample of 95 women, 7.36% (N = 7) met the criteria for probable PTSD and 3.16% (N = 3) met criteria for partial PTSD. Twelve women (12.6%) had EPDS scores above 13 indicating probable clinical depression. Median CEQ scores were lower among the women who had PTSD or partial PTSD (N = 10) and among the women who had probable depression (N = 12) than those who did not. Childbirth experience emerged as the only predictor of PTSD on logistic regression (p = 0.03) (95% CI 1.17–79.61).Conclusions: Negative childbirth experiences are common and appear to be associated with depressive and PTSD symptoms. These findings emphasize the need to provide good intrapartum care including respectful maternity care for a positive childbirth experience.

Guillain Barre Syndrome is a rare immune mediated acute demyelinating polyradiculopathy, uncommon in pregnancy, but with increased mortality and morbidity. It poses a great diagnostic challenge. Good outcomes can be achieved in these patients with multidisciplinary team involvement. We would like to highlight the need for obstetricians to keep this rare cause in mind by describing the case report of a pregnant lady who presented to our hospital with muscle weakness and how timely diagnosis by appropriate investigations-nerve conduction studies and timely treatment with IVIG prevented complications. Key Messages: 1. Delay in diagnosis is common in pregnancy due to initial nonspecific symptoms which mimic changes in pregnancy. 2. GBS should be considered in pregnant patients presenting with weakness, tingling and numbness. 3. Early diagnosis by involving multidisciplinary team, appropriate investigations (NCS) and prompt initiation of immunomodulatory treatment improves outcomes. 4. Management in pregnancy is like that in the non-pregnant population. Keywords: GBS, Pregnancy, Demyelinating radiculopathy, IVIG.

Rett syndrome, a neurodevelopmental disorder is caused by MECP2 gene mutations inherited sporadically or x linked dominant fashion. It almost exclusively affects girls. Genetic testing can help in preventing recurrence by offering prenatal diagnosis in affected families. We discuss the case of a patient who had such a mutation and discuss her pregnancy outcomes.

Addison’s disease is a rare endocrine disorder. We present the management of a pregnant lady with Addison’s disease. She was managed jointly with the endocrinologists and the titrated dose of hydrocortisone and fludrocortisone dosage was regulated. Her antenatal care was uneventful and she had emergency caesarean section at 39 weeks in view of abnormal CTG. Her labour was appropriately covered with rescue steroids. However she went into hypotension immediately after delivery. She was resuscitated and was managed further in ICU where high dose steroids were given. She made an uneventful recovery. Key Messages: 1. Management of pregnancy with Addison’s disease is challenging but are often achieved with appropriate multidisciplinary management; 2. Patients with Addison’s disease tolerate pregnancy well if the replacement steroids are adjusted and monitored closely; 3. Labour and delivery need to be managed cautiously with adequate steroid replacement to ensure successful outcomes; 4. Differentials need to be considered when adequate steroid cover has been provided and still there is a picture of Addisonian crisis. Keywords: Addison’s, Complications, Crisis, Pregnancy, Stress steroids

Pregnancy occurring in patients with uterine malformations need to be managed with care as they are at risk of developing adverse outcomes. Multiple pregnancies in patients with uterine abnormalities further increase the risk of complications. Due to the rarity of this problem, there are no recommendations to guide and plan the management of these patients. Delivery planning is also tricky and needs to be individualised as either mode of delivery can be associated with complications. We discuss the management of a twin pregnancy in a primigravida (conceived after ovulation induction) with Mullerian abnormality- Septate uterus with co-existent septate cervix; ESHRE type U-2B C-1.