OBJECTIVE:To present a case report of a unilateral triplet ectopic pregnancy (EP) conceived by IVF-embryo transfer. DESIGN:Case report. SETTING:University Hospital, Budapest, Hungary. PATIENT(S):A 26-year-old infertile woman with a history of right salpingectomy, hyperprolactinemia, and male factor infertility underwent IVF-embryo transfer of three embryos. Early transvaginal sonography revealed a triplet pregnancy in the left fallopian tube (two at interstitial and one at ampullary location). INTERVENTION(S):Multiple dose methotrexate (MTX) therapy was applied. MAIN OUTCOME MEASURE(S):Follow-up pelvic ultrasounds and laboratory testing confirmed fetal cardiac activity cessation and decreasing beta-hCG levels. RESULT(S):In spite of the decreasing beta-hCG levels the tube's diameter increased, the patient's symptoms escalated, and finally, the level of hemoglobin and hematocrit decreased. Laparotomy was performed with the removal of the left tube and cornual part of the uterus. CONCLUSION(S):Our case represents a very rare condition, a unilateral triplet EP after IVF-embryo transfer-the first one ever reported in the literature. After IVF-embryo transfer early ultrasound examinations are important to identify EPs at an early stage when medical management can still be taken into consideration. Strict monitoring is necessary to identify the success of medical intervention or the need for surgery.

Görbe, Évaa; Vámos, Ritab; Rudas, Gáborc; Jeager, Judita; Harmath, Ágnesa; Csaba, Ákosa; Csabay, Lászlóa Author Information

A 33-year-old primagravida with a history of polycystic ovary syndrome was referred because of symptoms of moderate hyperandrogenism. Serum hormone levels, measured regularly from the 7th week of pregnancy until delivery, showed very high increases of testosterone, androstenedione and estradiol. Ultrasound showed no evidence of adrenal or ovarian masses. She delivered a female newborn with normal female external genitalia. Umbilical cord hormone levels were normal, except for a modest increase of serum testosterone. After delivery the androgen levels of the mother returned to normal and the symptoms of hyperandrogenism were also slightly improved.

To determine whether iliac wing angle measurement in first and second trimester fetuses is a useful sonographic marker for the detection of trisomy 21, 18 and 13. Methods: Fetal iliac angle measurements were performed in 1928 first and second trimester fetuses, between 1999 and 2004. The measurement was taken from a transverse section of the fetal pelvis. The results of the measurements were compared among fetuses with trisomy 21 (n=50) trisomy 18 (n=16), trisomy 13 (n=11) and euploid fetuses (n=1754). The sensitivity, specificity, positive and negative predictive value and false positive ration in trisomy 21 fetuses compared for multiple cutoff value. Statistical signifiance for measurements was estimated for trisomy 21, 18 and 13, gestational age and fetal sex. Results: In the normal fetuses the mean iliac wing angle was 64 degrees. The mean iliac wing angle in the feiuses with tri somy 21 was 90,7 degrees; 73,5 degrees and 75,6 degrees in fetuses with trisomy, 18 and 13. These values-detected in fetuses with trisomy 21 were significantly higher than those seen in normal fetuses. There was no significant difference between the iliac angle measured: in fetuses with trisomy 18 and 13 and healthy fetuses. Conclusions: The proven larger iliac wing angle in neonates with Down-syndrome can be demonstrated sonographically during the pregnancy and may be useful in prenatal screening of trisomy 21. The first time when the measurement is possible is eleventh week of gestation. Fetal sex or gestational age did not have a statistically significant influence on iliac angle value.

Congenital teratomas of the umbilical cord are extremely rare. Only eleven case are known in the literature and two of those were associated with exomphalos. A 23-year old mother was performed a routine ultrasound examination in the 17 week of gestation. The ultrasonographic examination revealed a 49 × 25 mm midline sac adjacent to the anterior abdominal wall containing a solid and cystic mass. The parents asked for termination of pregnancy. The fetus weighed 131 g without the tumor. From 4 mm of the fetal end the cord contained a sac, measuring 5.5 × 6 × 6 cm, covered by transparent membranes. Fetal organs, small and large bowels with appendix, and the spleen were herniated into the exomphalos, as well as a solid and cystic tumor mass of 3 × 3.5 × 4 cm. Examination of the did not revealed any further malformation, histology of parenchymal organs showed normal development. The placenta was of normal size and shape but an unusual membranous sac was attached to the fetal surface, marginally. It was connected with the umbilical cord with an amniotic band. Microscopical examination of the tumor revealed complex structure consisting of various tissues from the three germinal layers. Mature tissue types were represented by well differentiated respiratory and intestinal glands, skin with dermal appendages, islets of cartilage, renal glomeruli, smooth muscle fibers, and ganglion cells, scattered in mesenchymal tissue. Large amount of immature neural tissue was present. Malignant component was not detected. The tumor was diagnosed as a benign immature umbilical cord teratoma. In the course of ultrasonographic scanning umbilical cord teratoma might be suspected when a solid and cystic, rapidly growing lesion is seen, attached to the cord in midline location. When the tumor is surrounded by membranous structures and hiding in an omphalocele the narrowing of the cord between the tumor and the abdominal wall could be a useful sign.

OBJECTIVE:The aim of our study was to determine the effect of abnormal implantation on uterine circulation and to evaluate whether the assessment of uterinal blood flow can provide additional information for the diagnosis of tubal pregnancies.METHODS:Forty-nine patients with ectopic pregnancy were examined by transvaginal color Doppler immediately before surgery. Resistance and pulsatility indices of blood flow in the uterine and tubal arteries were measured.RESULTS:The blood flow parameters of the uterine and tubal arteries did not change with gestational age. There was a significant increase in blood flow on the side with the tubal gestation. Differences between sides were higher in the tubal arteries than in the main uterine arteries and showed no dependence on gestational age.CONCLUSION:The abnormal implantation and tubal trophoblast invasion in ectopic pregnancy (EP) can cause more marked blood flow changes in the adjacent supplying vessels than in the main uterine arteries.

Objective: To determine whether iliac wing angle measurement in second trimester fetuses is a useful sonographic marker for the detection of trisomy 21, 18 and 13. Methods: During the period between September 1998 and September 2001, 406 fetal iliac angle measurements were performed in women in the second trimester of their pregnancies. The iliac angle measurements in fetuses with trisomy 21 (n = 25), trisomy 18 (n = 10) and trisomy 13 (n = 5) were compared with iliac angle measurement in fetuses with normal karyotypes (n = 333). Results: The mean iliac wing angle in the fetuses with trisomy 21 was 92.67 and 79.35° and 74° in fetuses with trisomy 18 and 13 (the mean iliac wing angle in the healthy fetuses was 70.09°). Conclusion: The proven larger iliac wing angle in neonates with Down’s syndrome can be demonstrated sonographically during the pregnancy, especially during the second trimester, and may be useful in prenatal screening of trisomy 21. The sonographic measurement of the fetal iliac angle cannot be used as a marker for trisomy 18 and 13. We have shown that fetuses with trisomy 18 and 13, on average, have iliac angles only a few degrees larger than healthy fetuses.

The purpose of this study was to present our results and experiences with sonographic measurement of the fetal iliac angle during the second trimester of pregnancy. The objective of the present study was to determine whether iliac wing angle measurement in second trimester fetuses is a useful sonographic marker for the detection of trisomy 21, 18 and 13. At the Semmelweis University, I. Department of Obstetrics and Gynecology, Budapest, between September 1998 and September 2001, 406 fetal iliac angle measurements were performed in women during the second trimester of their pregnancies. The iliac angle measurements in fetuses with trisomy 21 (n = 25), trisomy 18 (n = 10) and trisomy 13 (n = 5) were compared with iliac angle measurement in fetuses with normal karyotypes (n = 333). The mean iliac wing angle in the aneuploid fetuses was as follows: 92.67° in trisomy 21, 79.35° in trisomy 18 and 74.00° in trisomy 13. The mean iliac wing angle in the healthy fetuses was 70.09°. The proven larger iliac wing angle in neonates with Down-syndrome can be demonstrated sonographically during the pregnancy, especially during the second trimester, and may be useful sonographical marker in prenatal screening of trisomy 21. The sonographic measurement of the fetal iliac angle can not be used as a marker for trisomy 18 and 13. We have shown that fetuses with trisomy 18 and 13, on average, have iliac angles only a few degrees larger than healthy fetuses.

OBJECTIVEThe aim of this study was to investigate uterine vascularity in cases of uterine leiomyomas and uterine sarcomas, as well as to determine the efficiency of uterine blood flow analysis in differentiating between them.MATERIALS AND METHODSTransvaginal color and pulsed Doppler findings obtained from 117 patients with histologically proven uterine leiomyoma and 12 with uterine sarcoma were retrospectively assessed.RESULTSThe mean intratumoral resistance index (RI) and pulsatility index (PI) were significantly lower and the intratumoral peak systolic velocity (PSV) was significantly higher in patients with sarcomas than in patients with uterine leiomyomas. Marked reduction of RI and PI and increased PSV could be found in 14 of the leiomyoma cases which showed large size and/or necrotic, degenerative and inflammatory changes. When a cut-off value of 0.5 for the RI was considered, the detection rate for uterine sarcoma was 67% and the false-positive rate was 11.8%.CONCLUSIONThese results suggest that the intratumoral RI detected by color and pulsed Doppler ultrasonography in themselves could be poor for the preoperative differential diagnosis of uterine sarcoma.

Objective: To investigate the influence of pacifier use and the introduction of formula milk on breast feeding. Methods: The mothers of 356 healthy newborn infants who initiated breast feeding while in-patients were interviewed within 3 days of birth and later at 2 and 6 months postpartum. Information regarding previous birth, breast-feeding frequency, pacifier use and the adoption of formula milk were obtained. The data were analyzed using χ2 and Kruskal-Wallis tests. Results: At the end of the second month, 264 (74%) of the mothers were still breast feeding; by the end of the sixth month this had fallen to 236 (66%). Among the 356 mothers, 152 had at least one previous infant, and 132 (86.8%) of them had breast fed a previous infant. Of the women who breast fed their previous infant for more than 2 months, 112 (84.8%) breast fed the current child until the end of the second month and 104 (78.7%) until the end of the sixth month after delivery. Of all investigated patients, 204 were primiparous (57.3%). Of these, 152 (74.5%) breast fed until the end of the second month, and 132 (64.7%) until the end of the sixth month after delivery. Among the 204 primiparae, 92 (45%) gave formula to their newborn infants. Forty-four of these 92 mothers (47.8%) had discontinued breast feeding by the end of the second month. Among the 356 newborn infants, 220 used pacifiers at the end of the second month. Within this group, 72 (33%) of the infants did not breast feed, while 148 (67%) did breast feed. Of all investigated mothers, 136 did not give pacifiers to their infants and only eight of these mothers (6%) had stopped breast feeding at the end of the second month. Conclusions: We found an inverse correlation between pacifier usage and breast feeding. Breast feeding was most common among multiparous mothers.