AbstractEthmocephaly is the most severe form of holoprosencephaly, which results from incomplete cleavage of the forebrain during embryogenesis. It is incompatible with life. Here we reported a case of ethmocephaly in a clomiphene citrate induced pregnancy. Hereby we reported a 32-year-old woman, gravida 6, at a gestational age of 23 weeks, presented for routine antenatal care. Up on ultrasound scanning, there were brain abnormalities, like a single dilated ventricle, absent falx cerebri, and facial profile abnormalities like proboscis. After delivery, on physical examination of the newborn, we found ocular hypotelorism, a 5 cm midline proboscis located above the eyes, and absent nasal structures. The mother had used clomiphene for two cycles prior to conception, with no other notable medical history. In conclusion, ethmocephaly is a severe and typically fatal condition requiring early prenatal detection for better planning. While there is no clear link between clomiphene use and holoprosencephaly, further research is needed to explore any potential risks and guide clinical practice.Keywords:  Ethmocephaly, holoprosencephaly, hypotelorism, proboscis, Clomiphene citrate

Globally, obstetric fistula is a tragic outcome following obstructed labor. Failure of complex repairs and post-operative incontinence are common. We describe an innovative surgical technique incorporating the rectus abdominis muscle flap at the time of fistula repair. We report outcomes from six patients at the Fistula Care Center in Lilongwe, Malawi in October 2023. At three months following discharge, five patients (80.0%) were continent; one patient was unable to follow-up but was continent at a one-month phone follow-up. There were no major complications. The rectus abdominis muscle flap may be considered in challenging obstetric fistula repairs.

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