To present sonographic findings in a woman with cervical insufficiency and severe adenomyosis. She developed severe preeclampsia and fetal growth restriction necessitating cesarean delivery at 27 weeks gestation and hysterectomy. A 37-year-old gravida 7, para 0-0-6-0 with a history of multiple early and late first trimester losses conceived spontaneously. She had a past history of open myomectomy, uterine septum resection, and adenomyosis. At 8 weeks gestation, she experienced bleeding and an ultrasound revealed a 4.9 × 2.1 cm subchorionic hemorrhage. The uterus measured 18 × 13 × 18 cm and the anterior uterine wall was greater than 8 cm in diameter with a vascular, heterogeneous appearance consistent with adenomyosis. At 22 weeks gestation, cervical ultrasound demonstrated funneling and cervical shortening and examination confirmed dilation with visible membranes at the cervical os. She elected a rescue cerclage which was successfully placed. At 27 weeks gestation, she developed severe preeclampsia with fetal growth restriction (< 5%th percentile) and reversal of umbilical artery end diastolic flow (Figure 1). Fetal monitoring demonstrated recurrent fetal heart rate decelerations and a classical cesarean delivery was performed. She sustained significant uterine hemorrhage. Because of the severe adenomyosis, the uterine incision was unable to be reapproximated and hysterectomy was performed. The uterine pathology confirmed adenomyosis with a uterine weight of 2422 grams and a 2.5 cm uterine leiomyoma. The placental evaluation showed multiple small infarcts. This case demonstrates the antenatal ultrasonographic characteristics of severe adenomyosis and the potential maternal and neonatal morbidity associated with this condition during pregnancy. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

(pyloric atresia), genetic and dermatology services diagnosis was Junctional Epidermolysis Bullosa, skin biopsy was taken, working on identifying the mutation to offer the family PGD. Junctional epidermolysis bullosa: A blistering skin condition inherited in an autosomal recessive manner, due to mutation of a gene that normally promotes the formation of anchoring filaments (thread-like fibers) or hemidesmosomes (complex structures composed of many proteins). Junctional epidermolysis bullosa (JEB) is usually severe. In the most serious forms, large, ulcerated blisters on the face, trunk, and legs can be life-threatening due to complicated infections and loss of body fluid that leads to severe dehydration.

Cervical varices are a rare cause of vaginal bleeding in pregnancy. Sonographic and magnetic resonance imaging are important tools used to diagnose uterine cervical varices during pregnancy. The case presented highlights the importance of radiographic diagnosis, discusses antenatal management and describes appropriate delivery methods. A 37 year-old multigravida presented for a routine second trimester ultrasound. Her medical history was significant for twin vaginal delivery 18 years ago and cervical conization for dysplasia. During her ultrasound examination abnormal vasculature was seen in the lower uterine segment, extending through the cervix. Color doppler ultrasonography revealed tortuous vessels (Figure 1) and magnetic resonance imaging at 32 weeks confirmed a cervical varix. Her pregnancy was complicated with vaginal bleeding and abdominal pain. Ultimately, she was delivered by primary classical cesarean section at 35 weeks due to persistent vaginal bleeding. The patient had an uncomplicated postoperative course. Postpartum examination revealed normal cervical tissue. Varices of the uterine cervix are often difficult to manage during pregnancy. Imaging using ultrasound color doppler flow is useful in diagnosis. Due to a high likelihood of severe vaginal bleeding the mode of delivery is generally cesarean section. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

The ultrasonographic findings of a fourteen-week gestation in a woman with a history of a prior cervical cerclage, demonstrate a spontaneous abortion through a cervicovaginal fistula. A 36 year-old gravida 13, para 0-1-12-0, with a history of cervical incompetence presented at 14 weeks' gestation for a prophylactic Shirodkar cerclage. The most recent delivery occurred at 22 weeks after a failed prophylactic McDonald cerclage placed at 14 weeks and subsequent rescue McDonald cerclage placed at 20 weeks. At presentation she gave a two-day history of cramping and spotting. Because of the concern for spontaneous abortion, the prophylactic cerclage procedure was postponed and she was referred for ultrasound follow-up three days later. A transvaginal ultrasound revealed the external cervical os as closed and the amniotic sac appeared to be protruding through the posterior wall of the cervix (Figure 1). Bimanual and vaginal speculum exam verified that the amniotic sac was protruding through a defect in the posterior wall of the cervix into the vaginal vault through a defect most likely related to prior laceration. The pregnancy was interrupted by an uncomplicated dilatation and evacuation. Follow-up assessment of her endometrial cavity by saline infusion sonohysterograhy was normal. She later desired to proceed with prophylactic abdominal cerclage placement, which was performed without difficulty. This case demonstrates a cervicovaginal fistula occurring in a woman with cervical incompetence with prior failed cervical cerclage. The ultrasound findings suggest a need for a high index of suspicion for identifying cervicovaginal fistula in a woman with a prior cervical cerclage. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.