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Ectopic pregnancy is a high-risk condition that occurs in 2% of reported pregnancies. This percentage is fivefold higher than that registered in the 1970s. Since 1970 there has been a two-fold increase in the ratio of ectopic pregnancies to all reported pregnancies in Hungary and in 2012 7.4 ectopic pregnancies per thousand registered pregnancies were reported. Recently, the majority (80%) of cases can be diagnosed in early stage, and the related mortality objectively decreased in the past few decades to 3.8/10,000 ectopic pregnancies. If a woman with positive pregnancy test has abdominal pain and/or vaginal bleeding the physician should perform a work-up to safely exclude the possibility of ectopic pregnancy. The basis of diagnosis is ultrasonography, especially vaginal ultrasound examination and measurement of the β-subunit of human chorionic gonadotropin. The ultrasound diagnosis is based on the visualization of an ectopic mass rather than the inability to visualize an intrauterine pregnancy. In some questionable cases the diagnostic uterine curettage or laparoscopy may be useful. The actuality of this topic is justified by practical difficulties in obtaining correct diagnosis, especially in the early gestational time.Méhen kívüli terhességnek nevezzük azt az állapotot, amikor a megtermékenyített petesejt nem a méh üregében ágyazódik be és indul fejlődésnek. A kórkép az összes terhesség körülbelül 2%-ában fordul elő, leggyakrabban a petevezetékben. Az 1970-es évektől gyakorisága napjainkig ötszörösére emelkedett, hazánkban az összes terhességre vonatkoztatva csaknem duplájára nőtt, 2012-ben 1000 terhességre számítva 7,4 méhen kívüli terhesség jutott. Jelenleg az elváltozás közel 80%-ban intakt állapotban felismerhető, a kórképből eredő mortalitás az 1970-es évektől 90%-kal csökkent, jelenleg 3,8/10 000 terhesség. Általános szabály, hogy pozitív terhességi teszt, alhasi fájdalom és/vagy hüvelyi vérzés esetén gondolni kell méhen kívüli terhesség lehetőségére, és olyan kivizsgálási tervet kell kiépíteni, hogy azt biztonsággal ki lehessen zárni. Mortalitás és morbiditás szempontjából nagy fontossággal bír a korai felismerés és kezelés, amelynek alapját az ultrahangvizsgálat, legfőképpen a hüvelyi ultrahangvizsgálat és a szérum β-humán choriogonadotropin szintjének meghatározása adja. Az ultrahang-diagnosztika alapját inkább a méhen kívüli terhesség kimutatása, mintsem a méhen belüli terhesség igazolásának hiánya adja. Kérdéses esetekben segítséget jelenthet a diagnosztikus abrasio vagy akár laparoszkópia elvégzése is. A téma aktualitását az adja, hogy a rendelkezésre álló vizsgálati módszerek ellenére az akár életveszélyes állapotot jelentő kórkép felismerése esetenként nem egyszerű és a diagnózis felállítása nagy szakmai kihívást jelenthet, főleg a terhesség korai szakaszában. Orv. Hetil., 2014, 155(29), 1158–1166.

The aim of this study was to present our results of the sonographic measurement of the fetal iliac angle during the first and second trimesters of pregnancy.A total of 2168 fetal iliac angle measurements were performed in a transverse section of the fetal pelvis. The iliac angle measurements were compared in fetuses with trisomy 21 (n = 52) and fetuses with normal karyotype (n = 1980). The sensitivity, specificity, positive predictive value, negative predictive value and false positive rate in trisomy 21 fetuses were compared for multiple cut-off value. Statistical significance for measurements was estimated for trisomy 21.A total of 2064 fetuses had adequate images for satisfactory measurement of the iliac wing angle and 1831 patients asked for a genetic invasive procedure. Of the fetuses with chromosomal aberrations, only the fetuses with trisomy 21 were included in the investigation. The risk of trisomy 21 in our population was 1 of 39. In the euploid fetuses, the mean iliac wing angle was 63.72°. The mean iliac wing angle in the fetuses with trisomy 21 was 90.32°, significantly higher than those seen in fetuses with normal karyotype.The proven larger iliac wing angle in neonates with Down syndrome can be demonstrated sonographically during the pregnancy, especially in the first and second trimesters. This marker may be useful in prenatal screening or exclusion of trisomy 21.

Objectives: To evaluate the rate of chromosome abnormalities in cases of uni- and bilateral choroid plexus cysts (CPCs). Methods: A total of 10,875 ultrasound (US) examinations were performed in the second trimester, and 435 cases with CPC (4%) were found. After genetic counseling, 45 patients decided not to undergo karyotyping. The authors performed a chromosome analysis in 390 cases of CPCs. Results: The total risk of chromosome abnormalities was 3.59% (n = 14) and risk of trisomies was 2.05% (n = 8). Trisomy 18 was found in 6 cases (1.54%), trisomy 21 in 1 case (0.26%), and trisomy 9 in 1 case (0.26%). The risk of 45,X karyotype was 0.77% (n = 3). One case of 47,XXY karyotype and 2 cases with other chromosome abnormalities were found. In 212 unilateral cases there were 7 with chromosome abnormalities (3.3%). In 178 bilateral cases there were 7 with abnormal karyotypes (3.93%). The CPC was associated with additional fetal US anomalies (with or without polyhydramnios/oligohydramnios) in 112 cases; chromosome abnormalities were detected in 4 cases (3.57%). 66 cases were associated with polyhydramnios/oligohydramnios but not with other fetal US anomalies; 3 cases of abnormal karyotypes were found (4.55%). The CPC was isolated in 212 cases and 7 cases were associated with chromosome disorders (3.3%). Conclusions: US plays an important role in prenatal diagnostics. Further genetic counseling is recommended in cases with CPCs.

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors of the gastrointestinal tract localized mostly in the upper or medial part of the digestion tract.A colonic GIST in a young woman extended to the pelvis, giving the impression of an ovarian tumor.In the case of a pelvic mass, especially if other unusual anamnestic data and signs are present, the possibility of other than a gynecologic tumor has to be considered. Every effort should be made to identify the origin of the tumor and related anatomic structures, especially the ovaries.

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.