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Characteristic phenotypic features of 16p13.3 microduplication include impaired mental development, arthrogryposis-like musculoskeletal anomalies (club-feet, congenital hip dislocation, and camptodactyly of fingers and toes), facial dysmorphology, and at times congenital cardiac disease. Most of the described affected individuals have microduplications involving the CREBBP gene. Findings indicate this gene to be dosage-sensitive and likely involved in the phenotypes of 16p13.3 microduplication syndrome. We describe the incidental finding of 16p13.3 microduplication in a fetus with mid-trimester sonographic examination showing absent nasal bone and transient unilateral hydronephrosis.

Liver herniation commonly associated with omphalocele occurs in only approximately 2.3% to 16% of fetuses with gastroschisis. Liver herniation in such cases is associated with considerably decreased survival rates (43% vs 97% with or without liver herniation, respectively). Rarely, abnormally positioned fetal hepatic vasculature has been reported mainly in association with congenital diaphragmatic hernia. In these rare cases, intrathoracic depiction of hepatic venous vasculature has assisted in confirming intrathoracic displacement of the fetal liver. We present a case of a large gastroschisis with complete herniation of the fetal liver in which prenatal sonography depicted an extracorporeal ductus venosus.

We describe unusual mid-trimester sonography of subtle fetal facial dysmorphic features including; flattened nasofrontal angle with an almost vertically positioned nasal bone, acute nasolabial angle, and convexity of the maxillary areas in a fetus with otherwise normal anatomy. Microarray identified a 64.5 KB interstitial deletion of 2q25.3, which includes one exon of MYT1L. Mutations and deletions in MTY1L have been associated with autosomal dominant intellectual disability, autistic features, and obesity. Association of these features and 2p25.3 microdeletion has not been reported previously. This case emphasizes the importance of detailed microarray analysis following the sonographic recognition of subtle fetal dysmorphic features.

Placental abruption occurs clinically in approximately 1% of births although placental pathology assessment suggests a higher incidence. Ultrasound rarely plays a role in the diagnosis or clinical management of patients with suspected placental abruption. A patient with an incidental sonographic finding of a large concealed abruption at 36 weeks' gestation, led to induction of labor. This case and the established association of increased stillbirth with placental abruption among patients of advanced maternal age, suggest that at term, following sonographic findings of abruption, consideration should be given to elective delivery of these patients even in the absence of clinical symptomatology.

In contrast to complete trisomy 8, which occurs in 0.8% of spontaneous pregnancy losses and is usually lethal, trisomy 8 mosaicism (Warkany syndrome 2), occurs in between 1:25,000 and 1:50,000 births and entails a widely variable phenotype including central nervous, ocular, cardiac, gastrointestinal, genitourinary and musculoskeletal abnormalities. Individuals with trisomy 8 mosaicism may exhibit developmental delays and are at increased risk of developing leukemia and myelodysplastic syndrome. We present an unusual case in which midtrimester sonographic diagnosis of fetal truncus arteriosus type I at 18 weeks' gestation, led to amniocentesis with an initial normal karyotype. Microarray analysis detected fetal trisomy 8 mosaicism. Systematic literature search reveals that the association between truncus arteriosus and trisomy 8 mosaicism has not been reported previously.

A cervical pregnancy is an uncommon ectopic pregnancy that accounts for less than 1% of such gestations. This condition is associated with an extremely high risk of massive hemorrhage and previously often required hysterectomy. The current diagnostic modality of this potentially life-threatening condition is transvaginal sonography, supported at times by magnetic resonance imaging. The definitive diagnostic imaging feature of a cervical pregnancy is the location of a gestational sac in the cervix in the presence of a closed internal uterine cervical os. We report the 3-dimensional transvaginal sonographic findings of a cervical pregnancy at 6 weeks' gestation.

Objective The purpose of this study was to create reference range nomograms of the axial fetal neck circumference (FNC) and fetal neck area (FNA) throughout gestation. Methods This prospective cross-sectional study involved pregnant patients between 14 and 40 weeks' gestation. Inclusion criteria consisted of well-established dates (confirmed by early sonography) and nonanomalous singleton fetuses with intact fetal membranes. Sonographic measurements included biparietal diameter, head circumference, abdominal circumference, femur length, humerus length, transcerebellar diameter, and sonographically estimated fetal weight. Axial FNC and FNA values were calculated as means of 3 separate measurements. The 5th, 50th, and 95th percentiles were estimated at each week of gestational age (GA) by least squares regression for the mean and SD of the FNC and FNA as functions of GA. R(2) and associated P values for the relationships between the FNC, FNA, and other sonographic biometric measurements were calculated. Results The study included 720 consecutive patients. The mean maternal age +/- SD was 27.3 +/- 6.6 years; median gravidity, 3 (range, 1-13); and median parity, 1 (range, 0-10). The following equations were devised: mean FNC (centimeters) = -11.85 + 1.687 x GA (weeks) -0.043 x GA(2) + 0.0004951 x GA(3); SD(FNC) = 3.15 - 0.3823 x GA + 0.01733 x GA(2) - 0.0002179 x GA(3); mean FNA (square centimeters) = 37.29 - 7.0 x GA + 0.4717 x GA(2) - 0.01245 x GA(3) + 0.0001222 x GA(4); and SD(FNA) = 7.08 - 0.9413 x GA + 0.04135 x GA(2) - 0.0004829 x GA(3). Both the FNC and FNA correlated significantly and strongly with biparietal diameter, head circumference, abdominal circumference, humerus length, femur length, transcerebellar diameter, and sonographically estimated fetal weight. Conclusions Current nomograms of the axial FNC and FNA throughout gestation have been provided.

Leiomyomas of the genitourinary tract may originate from the renal pelvis, bladder, urethra, or epididymis. 1 Interestingly, leiomyomas of the bladder are more common among women (76% of cases).2 Development is usually endovesical (63%), yet extravesical (30%) and intramural cases are not rare.3 Patients may be asymptomatic or may have obstructive urinary symptoms, irritative symptoms, hematuria, flank pain, or, rarely, dysmenorrhea or dyspareunia. 2-5 Leiomyomas of the bladder have been reported in association with neurofibromatosis type 1, in which leiomyomas occur most often in the gastrointestinal tract (proximal small bowel) and tend to be multiple.6 Rarely, urinary bladder leiomyomas have been diagnosed during pregnancy 7,8 and in a woman with a previous hysterectomy. 9 Diagnostic imaging modalities used include both transabdominal and transvaginal sonography, computed tomography, and magnetic resonance imaging.10-12 Although asymptomatic, nonobstructive, and nonproblematic leiomyomas may be managed expectantly, treatment is surgical by a transurethral approach, laparoscopy, or laparotomy 1-4 We present color Doppler imaging and 3-dimensional sonographic findings of a woman with a urinary bladder leiomyoma.

Prenatal sonographic diagnoses of subcutaneous soft tissue masses include hemangiomas, malformations (capillary, lymphatic, venous, arterial, or mixed), teratomas, and, rarely, sarcomas. 1-5 Prenatally depicted malformations may be seen in association with more complex fetal conditions, including Klippel-Trenaunay-Weber (angio-osteohypertrophy) and Proteus syndromes.6"9 We present an unusual case in which extensive multiple soft tissue tumors encompassing the fetal upper chest, back, nuchal area, and bilateral axillae, considered consistent with multiple large lymphatic malformations noted at 23 weeks' gestation, decreased in size throughout the remainder of gestation. At delivery, relatively small subcutaneous masses remained. Tissue histopathologic findings obtained at biopsy and the neonate's clinical course during which the subcutaneous masses underwent a marked spontaneous decrease in size, were consistent with low-flow mixed lymphatic and venous malformations.

The differential diagnosis of highly vascular, intramural lesions of the myometrium Includes arteriovenous malformation, gestational trophoblastic neoplasia, hemangiomata, sarcoma, and interstitial pregnancy. We present an unusual case in which a patient with irregular uterine hemorrhage in the presence of increasing serum β-human chorionic gonadotropin (β-hCG) levels exhibited transvaginal sonographic and color Doppler imaging findings considered consistent with an interstitial pregnancy. After laparoscopy and curettage yielded normal findings but with the continuously rising serum β-hCG levels and the concern for gestational trophoblastic neoplasia, the patient underwent vaginal hysterectomy. Histopathologic findings confirmed choriocarcinoma.

Germ cell tumors are most commonly located within the gonads. 1 Rare extragondal locations of these tumors include the retroperitoneum, mediastinum, sacrococcygeum, and central nervous system and are considered to result from aberrant migration of germ cells from the yolk sac during fetal development. 1 - 3 We present the transvaginal sonographic diagnosis of a large retroperitoneal pelvic epidermoid cyst (monodermal teratoma).

Physiologic dilatation of the maternal urinary collecting system occurs in more than 80% of gravidas by mid gestation. 1 Caliceal and ureteral dilation are more common on the right, and, similarly, the degree of caliceal dilatation is more pronounced on the right (15 versus 5 mm). 2 Although most women with hydronephrosis during pregnancy are asymptomatic, a few may have clinical signs and symptoms related to the upper urinary system. 3 When left-sided hydronephrosis is greater than the right, particularly if the patient is symptomatic, the likelihood of a pathologic condition, especially obstructive, should be considered. We present an unusual case in which a large left upper abdominal cystic structure depicted sonographically at mid gestation, initially considered consistent with an ovarian cyst, resulted from marked maternal ureteropelvic obstruction and required nephrostomy.

Objective To assess whether fetal cerebral vascular resistance is affected by the presence of nuchal cord(s) in the third trimester. Methods A set of 115 patients with well-established dates and singleton, appropriate for gestational age (GA), nonanomalous fetuses with nuchal cord(s) diagnosed with prenatalcolorDopplerimaging,between28and41 weeks and 115 controls matched for GA, were studied. Patients with hypertension, diabetes and autoimmune conditions were excluded. Doppler indices were obtained from the umbilical artery (UA) and the fetal middle cerebral artery (MCA) upon initial diagnosis of the nuchal cord. Results Of 115 GA-matched pairs of pregnancies, 103 fetuses had a single nuchal cord and 12 a double nuchal cord. No significant differences were noted in patient age, gravidity, parity, sonographically estimated fetal weight (SEFW), and growth centile at ultrasonographic diagnosis. Mean UA systolic/diastolic ratio (S/D) was 2.28 ± 0.32 and 2.36 ± 0.33 (P = 0.03) and UA resistance index (RI) 0.55 ± 0.06 and 0.57 ± 0.06 (P = 0.02) among study and controls, respectively. Mean fetal MCA S/D and RI did not differ significantly between the two groups (fetal MCA S/D 5.01 ± 1.28 and 5.04 ± 1.71 (P = 0.86), and mean fetal MCA RI 0.78 ± 0.06 and 0.78 ± 0.05 (P = 0.88)). No significant differences were noted in GA at delivery, incidence of meconium-stained amniotic fluid, birth weight, mode of delivery, neonatal gender, 1 and 5 minute Apgar scores, or UA pH and base excess, between study and control patients. Conclusion Fetal cerebral vascular resistance is not affected by the presence of nuchal cord(s) in the third trimester of pregnancy. Copyright  2005 ISUOG. Published by John Wiley & Sons, Ltd.

Objective To assess the feasibility of sonographic depiction of the fetal hard palate and secondarily to create nomograms throughout gestation of its sonographic width, length and area. Methods This was a cross-sectional study of pregnant patients between 15 and 41 weeks' gestation. Inclusion criteria consisted of well-established dates (confirmed by early ultrasound), and singleton, non-anomalous fetuses. Sonographic measurements obtained included biparietal diameter, head circumference, abdominal circumference and femur length. Fetal hard palate measurements included maximum width, maximum length and the calculated area. Tables were prepared depicting the estimated mean ± SD and 5th, 50th and 95th centiles at each gestational week between 15 and 41 weeks. Pearson's correlation coefficient and associated P-values for the relationships between fetal hard palate measurements and other sonographic measurements and coefficients of variation for each of the fetal hard palate measurements were calculated. Results The study included 602 consecutive patients. The mean maternal age was 28.7 ± 6.3 years, with median gravidity of 2 (range, 1–12) and parity 1 (range, 0–8). All attempts at obtaining fetal hard palate ultrasound measurements were successful. Mean fetal hard palate width (cm) = −0.73579345 + 0.11370432 × GA − 0.00083919 × GA2 and SD = −0.017842055 + 0.005142475 × GA, where GA is gestational age in weeks. Mean fetal hard palate length (cm) = −0.82020463 + 0.11767777 × GA − 0.00092801 × GA2 and SD = −0.043064317 + 0.006378869 × GA. Mean fetal hard palate area (cm2) = −2.40090641 + 0.17136556 × GA + 0.00097308 × GA2 and SD = −0.603647741 + 0.040740282 × GA. Sonographic measurements of the fetal hard palate width, length and area correlated significantly and strongly with gestational age (all P < 0.001) and significantly but less strongly with femur length (P = 0.004). Conclusion The fetal hard palate may be depicted sonographically with relative ease between 15 and 41 weeks' gestation and measurements of the fetal hard palate width, length and area correlate well with gestational age, biparietal diameter, abdominal circumference, sonographic estimated fetal weight, and femur length. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.

Objective To test the null hypothesis that no correlation exists between transvaginal digital examination and the gold standard technique of intrapartum transabdominal ultrasound determination of fetal head engagement, and secondarily to compare the performance of attending physicians and senior residents in depicting fetal head engagement by transvaginal digital examination. Methods Two hundred and twenty-two consecutive patients in labor > 37 weeks' gestation with normal singleton cephalic-presenting fetuses and with either ruptured or intact membranes were included. Of these, 119 were nulliparous and 103 were multiparous. Transvaginal digital examinations were performed by either attending physicians or senior residents and were followed immediately by transverse suprapubic sonographic assessments by a single sonographer. The fetal head was considered engaged on transvaginal digital examination if the leading part of the fetal head was positioned at least at maternal ischial spine station 0, and on transverse suprapubic ultrasound if the fetal biparietal diameter was below the maternal pelvic inlet. Examiners were blinded to each other's findings and the effect of examiner experience on the rate of agreement between the two techniques was assessed. The effect of several other independent variables upon the rate of agreement between the two modalities was also assessed. Results Overall, transvaginal digital examinations were consistent with ultrasound determinations with a raw percent agreement rate of 85.6% (95% confidence interval (CI), 80.8–90.3); κ = 69.5% (95% CI, 59.4–73.9; P < 0.001). When stratified according to parity, the raw percent agreement rate for nulliparous patients was 81.5% (95% CI, 73.4–88.0); κ = 60.7% (95% CI, 45.9–64.1; P < 0.001), and for multiparous patients it was 90.3% (95% CI, 84.1–95.9); κ = 80.4% (95% CI, 63.0–87.5; P < 0.001). Maternal age, gravidity, maternal body mass index, gestational age, cervical dilatation, effacement, membrane status, ischial spine station of the fetal head, fetal head position at ultrasound assessment, birth weight and mode of delivery did not significantly affect rate of agreement. Parity did not affect examination consistency in multiparous patients, but in the whole group increasing parity increased the rate of agreement between modalities. Presence of combined spinal epidural anesthesia significantly increased the rate of agreement in the complete group and among multiparous but not among nulliparous patients. Conclusion These data demonstrate a high rate of agreement (85.6%) between ultrasound determination and transvaginal digital assessment of fetal head engagement. Examiner experience had no effect. These data support the use of intrapartum transabdominal assessment of fetal head engagement. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.

First-trimester screening for fetal aneuploidy using nuchal translucency (NT), pregnancy-associated plasma protein A, free or total β-hCG, and maternal age constitutes a very effective screening test for fetal Down syndrome. We describe a case in which a patient presented at 14 weeks' gestation with an acute abdomen 1 week after first-trimester screening (including NT measurement) performed elsewhere, which was negative for trisomies 21 and 18. Sonographic examination revealed an interstitial pregnancy with a singleton fetus with present cardiac activity, which had not been noted 1 week earlier at the time of earlier transabdominal NT measurement. This case indicates that successful acquisition of a NT measurement during first-trimester screening for fetal aneuploidy does not negate the rare possibility of an unusual ectopic pregnancy. © 2008 Wiley Periodicals, Inc. J Clin Ultrasound, 2009

We present an unusual case in which, following indeterminate findings on transabdominal sonographic assessment, transvaginal sonography clearly depicted an aborting pedunculated intracavitary leiomyoma within the uterine cervix. The lesion measured 4x4 cm and exhibited central cystic degenerative changes.

The differential diagnosis of prenatally diagnosed adrenal masses includes neuroblastoma, adrenal hemorrhage, adrenal and cortical renal cysts, adrenal adenoma and carcinoma, subdiaphragmatic pulmonary sequestration, Beckwith-Wiedemann syndrome, duplication of the renal system, Wilms tumors, congenital mesoblastic nephroma, and mesenteric and enteric duplication cysts. 1-5 The worldwide annual incidence of childhood adrenal cortical neoplasms ranges between 0.3 and 0.38 per 1 million children younger than 15 years. 6 These neoplasms are even more unusual among infants, with only 23 cases reported in the literature. 6 We present the first report of prenatal sonographic findings of a fetus with adrenal cortical adenoma.

Conjoined twins, rare complications of monozygotic twinning, occur in approximately 1% of monozygotic twins or between 1 per 100,000 and 1 per 250,000 live births. 1,2 Thoracopagus is the most common type of conjoined twins, with approximately 75% of such cases having conjoined hearts. 3 Reported cases of first-trimester transvaginal sonographic diagnosis of conjoined twins have almost uniformly involved gestational ages ranging between 11 and 14 weeks. 4-11 Earlier diagnosis is uncommon, yet single cases have been reported at 9 and 10 weeks, respectively. 12-17 An additional case of conjoined twins in a triplet pregnancy at 10.5 weeks' gestation was reported by Sepulveda et al. 18 We report an unusual case in which transvaginal color Doppler imaging confirmed the presence of thoracopagus, suspected during real-time sonography at 7 weeks' gestation.

Received July 13, 2006, from the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, Brooklyn, New York USA. Revision requested July 18, 2006. Revised manuscript accepted for publication July 19, 2006. Address correspondence to David M. Sherer, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, 445 Lenox Rd, Box 24, Brooklyn, NY 11203-2098 USA. E-mail: dmsherer@aol.com Abbreviations EXIT, ex utero intrapartum treatment; 3D, 3-dimensional n 18-year-old nulliparous patient was seen for a second opinion at the State University of New York Downstate Medical Center after the diagnosis of a fetal “neck tumor” at 35 weeks’ gestation. Real-time 2-dimensional sonography and 3-dimensional (3D) sonography (Philips Medical Systems, Bothell, WA; iU22 sonography machine with a 2to 6-MHz 3D broadband curved array transducer) depicted an appropriatefor-gestational-age singleton fetus with an 11 × 10 × 9-cm (calculated volume, 900 mL) multilobulated, semisolid, semicystic mass protruding from the oral orifice (Figures 1–3). Smaller tumors of similar consistency protruded from and completely obstructed both nostrils (Figure 3). The fetal stomach was visualized, yet polyhydramnios was suggestive of impaired (obstructed) swallowing. The fetal neck and other anatomic structures appeared normal. An epignathus (congenital teratoma) involving the oropharynx and nasopharynx was diagnosed.1 Because of the anticipated neonatal upper airway obstruction at delivery, the patient was transferred to a fetal surgery center. Ultrafast fetal magnetic resonance imaging confirmed the presence of a large, multilobulated mass in the nasopharynx, oropharynx, oral cavity, and nasal cavities projecting outside the fetus. At 36 weeks’ gestation after spontaneous rupture of membranes, a female fetus weighing 2348 g was born by cesarean delivery and a successful ex utero intrapartum treatment (EXIT) procedure (tracheotomy).2 In the early neonatal period, the tumor emanating from the oral orifice (the hard palate) was partially resected. Histopathologic examination showed a teratoma. Later, the smaller nasopharyngeal and residual oropharynx tumors were resected. The infant subsequently had swallowing and feeding difficulties and severe gastroesophageal reflux. Accordingly, gastric fundoplication and gastrostomy were planned.

Hematotrachelos, engorgement of the uterine cervix with retained blood, may represent congenital or acquired conditions. Congenital hematotrachelos may be associated with obstruction distal to the cervix in cons ditions that include imperforate hymen, complete transverse vaginal septum, and, rarely, agenesis of the vagina with cervical atresia. 1-3 In contrast, acquired hematotrachelos is usually associated with cervical stenosis as a result of destructive cervical surgeries, including cone biopsy and loop electrosurgical excision procedures performed in the clinical management of cervical dysplasia. 4-8 We report an unusual case in which the development of acute spontaneous hematotrachelos was sonographically depicted in a multiparous patient during a 5-week period in proximation with intramuscular methotrexate treatment of a suspected tubal pregnancy.

Spontaneous antepartum septostomy occurring in monochorionic diamniotic twins is extremely rare. We present a case in which prenatal sonography at 26 weeks' gestation depicted a monochorionic diamniotic twin gestation with concordant fetal growth and findings suggestive of a true knot of the umbilical cord. At Cesarean delivery at 34 weeks' gestation, spontaneous antepartum septostomy with entanglement of the two separate umbilical cords was noted. This case suggests that the differential diagnosis of findings considered consistent with a true knot of the umbilical cord in monochorionic diamniotic twin gestations, should include spontaneous antepartum septostomy and umbilical cord entanglement.

The reported incidence of a true knot of the umbilical cord is approximately 1.2% of all deliveries. 1 , 2 Prenatal sonographic diagnoses of cases of a true knot of the umbilical cord have been reported infrequently. 3 - 6 RamOn y Cajal and Martinez 7 recently reported characteristic sonographic findings of this condition, in which a detailed investigation disclosed a transverse section of the umbilical cord surrounded by a loop of umbilical cord. This finding, noted in 5 cases, was termed the "hanging noose" sign. We present an unusual case in which 2 true knots of the umbilical cord were noted by power Doppler sonography in close proximity to each other at 33 weeks' gestation and were confirmed as separate true knots of the umbilical cord by 3-dimensional sonographic imaging.

We present the first case of an infant with paternally-derived mosaic trisomy 16. Amniocentesis following an elevated maternal serum alpha-fetoprotein level and early fetal growth restriction at 19 weeks detected a high level of mosaicism with 25/33 colonies demonstrating trisomy 16 and 8/33 colonies with a normal 46,XX karyotype. Molecular studies revealed a paternal origin of the trisomy which was present in amniotic fluid cells, representing either a post-zygotic error or a meiosis II non-disjunction without crossing-over. In addition, there was normal biparental inheritance in the normal cell line. The symmetrically growth-restricted fetus was closely monitored for the remainder of the gestation. Decreased fetal movements at 36 weeks in conjunction with electronic fetal monitoring showing evidence of fetal distress necessitated abdominal delivery. Severe growth restriction, mild facial dysmorphism, and cardiac anomalies were identified. Microsatellite analysis demonstrated biparental inheritance in skin fibroblasts with a paternal origin for the trisomy in the placenta. Follow-up cytogenetic studies of additional tissues revealed 85 per cent trisomy 16 mosaicism in the placenta, yet only cytogenetically normal cells in lymphocytes and fibroblasts.

Prenatal diagnosis of pericardial masses are infrequent and usually consist of intrapericardial teratomas or haemangiomas. We present the first report of prenatal diagnosis of a suspected pericardial cyst at 14 weeks' gestation which was subsequently confirmed by neonatal computed tomography.

Neuroendocrine small cell carcinoma of the cervix is a very rare and aggressive tumor which tends to metastasize early. This tumor is similar histologically to small cell carcinoma of the lung. Conventional treatment with surgery and/or radiation therapy has not been successful and has prompted the use of adjuvant chemotherapy regimens similar to those used for small cell carcinoma of the lung.Three patients with Stage IB neuroendocrine small cell carcinoma of the cervix treated with postoperative adjuvant chemotherapy consisting of cisplatinum and VP-16, were identified. Analysis of the outcome of these three patients and a review of the current literature were performed.Median survival was 28 months. Two patients received pelvic radiation therapy, one due to positive surgical margins and the other due to recurrent disease. Currently two patients are alive and free of disease at 17 and 61 months. The third patient developed hepatic and pelvic recurrence and died 30 months after her presentation and 18 months after recurrence.The outcome of our three patients and eight similar cases in the literature suggest an improved survival rate with adjuvant chemotherapy compared to conventional treatment with surgery and or radiation therapy.

Monoamniotic twins occur in approximately 5% of monochorionic twin gestations as a result of splitting of the inner cell mass at 8 or more days after fertilization, and they are associated with high perinatal mortality rates, ranging between 28% and 47%. 1,2 These gestations have unique pathologic conditions, including conjoined twins, a high prevalence of discordancy for fetal structural anomalies (the former and possibly also the latter resulting from consequences of the twinning process), and cord entanglement. 1 We present a case in which monoamniotic twins at first-trimester transvaginal sonography were confirmed by color Doppler imaging as having entangled umbilical cords.

Although malignant transformation of fetal cervical teratoma is extremely rare, perinatal morbidity is high and usually related to the size of the tumour, which may compromise fetal swallowing and subsequently lead to upper airway obstruction. We present a case in which mid-trimester serial sonography demonstrated markedly rapid early growth of a lesion of this type between 17 and 19 weeks' gestation indicating the aggressive nature of this tumour, assisting parental decision to terminate the pregnancy. Histopathology confirmed grade 3 immaturity of the lesion.

Gartner duct cysts, the most common benign cystic lesion of the vagina, represent embryologic remnants of the caudal end of the mesonephric (wolff-ian) duct. 1 These cysts are usually small and asymptomatic and have been reported to occur in as many as 1% of all women. Because the ureteral bud also develops from the wolffian duct, it is not surprising that Gartner duct cysts have been associated with ureteral and renal abnormalities, including congenital ipsilateral renal dysgenesis or agenesis, crossed fused renal ectopia, and ectopic ureters. 1,3-7 In addition, associated anomalies of the female genital tract, including structural uterine anomalies (ipsilateral mullerian duct obstruction, bicornuate uteri, and uterus didelphys) and diverticulosis of the fallopian tubes, have been described. 6,8,9 Transabdominal and transrectal ultrasonographic depiction of Gartner duct cysts have been reported previously. 2,5,7,10 Here we report the transvaginal ultrasonographic findings of this condition.