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Pulmonary hypoplasia is often associated with sonographically detectable conditions: oligohydramnios, prolonged premature rupture of membranes, and, not infrequently, fetal anomalies. In their efforts to improve prenatal sonographic diagnosis of this condition, investigators have used an array of different sonographic biometric measurements and fetal behavioral patterns. Definitions of these measurements and their respective successes in predicting pulmonary hypoplasia are presented. The sonographic parameters that have been of most value in the prediction of pulmonary hypoplasia are chest circumference, direct measurements of the lung, lung length, lung span to hemithorax diameter, and more complex formulas, such as lung area/heart area x 100/chest area. Although fetal measurements may help predict pulmonary hypoplasia, no single sonographic finding consistently leads to a prediction of the presence of pulmonary hypoplasia. Therefore, obstetric management (i.e., nonintervention) cannot currently be altered with the finding of abnormal biometric parameters unless a known lethal anomaly is observed.

A case of acute appendicitis involving an appendix located unusually low in the pelvis was preoperatively misdiagnosed, using ultrasound, as hydrosalpinx. We discuss factors that led to this error and how similar occurrences may be avoided. This case emphasizes that gynecologic sonographers should to be familiar with the sonographic characteristics of acute appendicitis.

With endovaginal sonography, very small gestational sacs may be detected. We describe a case in which endovaginal color Doppler sonography demonstrated active embryonic heart motion in an ectopic gestation at 5 weeks. The possible clinical application of this enhanced diagnostic modality is discussed.

Interstitial pregnancies carry a higher maternal morbidity and mortality rate, due to the abundant ovarian and uterine arterial supply of this region, than do other tubal pregnancies. Prerupture diagnosis is crucial, inasmuch as rupture (which usually occurs at a later stage than in tubal gestations) may be followed by rapid exsanguination. Precise early diagnosis may permit conservative nonsurgical treatment with methotrexate. A case is presented in which preoperative diagnosis of an unruptured interstitial pregnancy was aided by endovaginal sonographic examination. Considerations of subsequent management are discussed.

Tubal pregnancies rupture commonly between 6 and 10 weeks gestation. An unusual, sonographically diagnosed, viable 14-week ampullary tubal pregnancy is presented. The multiple sonographic growth parameters were appropriate for gestational age. Expedient surgery was performed.

In utero exposure to diethylstilbestrol (DES), a synthetic estrogen, affects structures arising in the mullerian duct system of female fetuses. Transabdominal sonography has been found to be a nonionizing, noninvasive alternative to hysterosalpingography in diagnosing these congenital abnormalities. Endovaginal sonography has shown enhanced resolution of the female pelvic organs. The endovaginal features of a T-shaped uterus due to in utero DES exposure are presented in a woman with infertility.

A case in which moderate bilateral maternal hydronephrosis was documented sonographi cally at 7 weeks0 gestatio, and resolved spontane ously immediately after micturition, is presented. This occurrences emphasizes the importance of obtaining an empty bladder before renal sono graphic examination to avid false positive diag nosis of pathologic or pregnancy-associated uri nary tract dilatation.