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In recent years, management of abdominal pain in emergency care units (ECU) has undergone a radical change. Chronic work overload of ECU and increase in severity and complexity of cases required an optimal medical imaging method, such as ultrasound, to establish an accurate diagnosis as quickly as possible. A great variety of causes may cause acute abdominal pain and the role of sonography is to accurately distinguish between these aetiologies. For the application of sonography, perhaps more so than with other imaging methods, a perfect knowledge of sonographical characteristics and technical possibilities is essential to achieve an optimal answer. The purpose of this review is to present and discuss the sonographic characteristics of extra-digestive causes of acute abdominal pain such as splenic infarction, thoracic pathologies, urinary and gynaecologic diseases or retroperitoneal pathologies.

The loss of a fetus in a multiple pregnancy is relatively frequent. The main risk factor is a monochorionic twin pregnancy. If fetal loss occurs after 16 weeks of pregnancy, the survivor is also at increased risk of intrauterine death. In monochorionic twins, the risk of neurological sequelae can be as high as 25%. These lesions are due to acute episodes of hypoperfusion immediately following the death of the co-twin. Maternal complications including coagulation disorders are rare. The management will vary according to the type of placenta, the gestational age and the condition of the surviving twin. When the last trimenon has been reached, rapid delivery is probably the safest management. In monochorinoic biamniotic twins, the risk to the survivor often justifies the induction of delivery between 28 and 32 weeks of gestation after steroids have been administered. In most cases, before the 28th week of gestation, a conservative management will be proposed. In monochorionic monoamniotic twins, immediate delivery should be considered as soon as fetal viability is reached.

Currently prenatal diagnosis relies on invasive procedures such as chorion villus sampling (CVS) or amniocentesis (AC). Many parents are reluctant to expose themselves and their child to the small, but significant risk posed by these procedures to mother and child. There is, hence, a great need for a risk-free non-invasive alternative. To achieve this goal most research has been focussed on enriching fetal cells from the blood of pregnant women. The erythroblast has emerged as the target cell of choice, since it is abundant in the early fetus, rare in normal adult blood, and since it has a very short half life, there is no risk of obtaining cells from previous pregnancies. Most enrichment protocols rely either on magnetic- or fluorescent activated cell sorting (MACS and FACS) using fetal specific antibodies. These enriched cells can be examined by FISH (fluorescence in-situ hybridisation) for the presence of the most common fetal chromosomal aneuploidies (13, 18, 21, X and Y) or by polymerase chain reaction (PCR) on singly manipulated cells for genetic disorders. The efficacy in detecting fetal aneuploidies is currently being evaluated in a phase II clinical trial under the auspices of the NIH-NICHD, the so-called NIFTY Trial, in which our group is a participant. By modifying our enrichment protocols we have recently been able to obtain detection sensitivities of almost 80%, thereby renewing our optimism that this methodology provides a solid basis for an effective non-invasive prenatal diagnostic test.