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Incarceration of the gravid uterus is a rare phenomenon, associated with maternal and fetal morbidity and mortality. A 37-year-old gravida 2 para 1 develops a recurrent incarceration in her second pregnancy. Therefore, examination and follow-up early in the next pregnancy is advised.

An increasing number of pregnancies are presumed being terminated following prenatal detection of orofacial cleft during structural ultrasound.After examining the data and literature on this topic it is concluded that the reported cases are merely incidents. For the interpretation of prenatal detection rates a distinction should be made between isolated orofacial cleft and the frequently occurring associated form of orofacial cleft which is usually characterized by other, often major structural or chromosome anomalies. The ultrasound detection rate of the isolated form is low and varies in the literature between 18 and 56%. Together with all Dutch centres of prenatal medicine a care plan was adopted for the management of prenatally detected orofacial cleft including diagnosis (detailed ultrasound examination and karyotyping), medical support (genetic consultations, plastic surgery and psychosocial counselling) and treatment (obstetric and neonatal management). In the presence of associated major congenital anomalies termination of pregnancy may be considered before the 24th week of pregnancy.

Objective: To investigate accuracy and reliability of four different ultrasound-related volume-measuring methods., Design: Observational study., Setting: Both in vitro and in vivo., Population or Sample: Ten phantoms for in vitro measurements and 28 pregnancies with gestational ages ranging from 6 to 11 weeks for in vivo measurements were included., Methods: Three-dimensional (3D) ultrasound images of phantoms (with known variable contents) and yolk sacs were used to calculate volumes using four different methods: Virtual Organ Computed-Aided AnaLysis (VOCAL), inversion mode, Sono Automatic Volume Calculation (SonoAVC) and V-Scope. V-Scope is a newly developed 3D volume visualisation application using a Barco I-Space virtual reality system. Intra- and interobserver agreement was established by calculating intraclass correlation coefficients (ICC)., Main Outcome Measure: Evaluation of accuracy and reliability by comparing the different techniques with true volumes (in vitro) and with each other (in vitro and in vivo)., Results: In the in vitro study, volume measurements by VOCAL, inversion mode and V-Scope proved to be accurate. SonoAVC measurements resulted in a substantial systematic underestimation. Correlation coefficients of measured versus true volumes were excellent in all four techniques. For all techniques, an intra- and interobserver agreement of at least 0.91 was found. Yolk sac measurements by the different techniques proved to be highly correlated (ICCs>0.91)., Conclusions: We demonstrated that VOCAL, inversion mode and V-Scope can all be used to measure volumes of hypoechoic structures. The newly introduced V-Scope application proved to be accurate and reliable.

Objective: To demonstrate the use of a novel three-dimensional (3D) virtual reality (VR) system in the visualization of first trimester growth and development in a case of confined placental trisomy 16 mosaicism (CPM+16)., Design: Case report., Setting: Prospective study on first trimester growth using a 3D VR system., Patient(s): A 34-year-old gravida 1, para 0 was seen weekly in the first trimester for 3D ultrasound examinations., Intervention(s): Chorionic villus sampling was performed because of an enlarged nuchal translucency (NT) measurement and low pregnancy-associated plasma protein-A levels, followed by amniocentesis., Result(s): Amniocentesis revealed a CPM+16. On two-dimensional (2D) and 3D ultrasound no structural anomalies were found with normal fetal Dopplers. Growth remained below the 2.3 percentile. At 37 weeks, a female child of 2010 g (<2.5 percentile) was born. After birth, growth climbed to the 50th percentile in the first 2 months., Conclusion(s): The I-Space VR system provided information about phenotypes not obtainable by standard 2D ultrasound. In this case, the delay in growth and development could be observed very early in pregnancy. Since first trimester screening programs are still improving and becoming even more important, systems such as the I-Space open a new era for in vivo studies on the physiologic and pathologic processes involved in embryogenesis.

Background: The aim of this study was to demonstrate that Carnegie Stages could be assigned to embryos visualized with a 3D virtual reality system., Methods: We analysed 48 3D ultrasound scans of 19 IVF/ICSI pregnancies at 7-10 weeks' gestation. These datasets were visualized as 3D 'holograms' in the BARCO I-Space virtual reality system. Embryos were staged according to external morphological features (i.e. mainly limb development). After staging, the crown rump length (CRL) was measured. Stage and CRL were compared with gestational age based on the date of oocyte retrieval and with the classical data on embryology from the Carnegie Collection., Results: Embryonic staging was relatively easy because the I-Space allows depth perception, which helps in the estimation of size and position. The presumed stages corresponded well with the measured CRL. However, in 28 out of 48 cases, the stages seemed to have been reached earlier than previously described for the Carnegie Collection., Conclusions: The I-Space, tentatively named Virtual Embryoscopy, is a promising non-invasive tool for early pregnancy evaluation. Combining embryonic growth with embryonic development opens a new area to study the relationship between embryonic growth, development and morphology, as well as second and third trimester pregnancy complications.

The nomenclature used to describe findings during early pregnancy in The Netherlands needs to be revised. Various terms, like 'abortion' and 'miscarriage', are used to describe the same phenomenon, which is confusing for both patients and doctors. In addition, the meaning of some terms, like 'missed abortion', has changed over time. In accordance with the revision of the European nomenclature in the English language by the Special Interest Group for Early Pregnancy of the European Society for Human Reproduction and Embryology (ESHRE), a revision of the nomenclature in the Dutch language is needed as well. An unambiguous Dutch terminology pertaining to early pregnancy is recommended that corresponds to the English terminology; this includes the Dutch terms 'embryo' [embryo], 'foetus' [foetus], 'biochemische zwangerschap' [biochemical pregnancy], 'zwangerschap met onbekende lokalisatie' [pregnancy of unknown location], 'miskraam' [miscarriage], 'lege vruchtzak' [empty sac], 'gestopte hart-activiteit' [fetal loss], 'herhaalde miskraam' [recurrent miscarriage], 'extra-uteriene zwangerschap' [ectopic pregnancy], and 'trofoblast-ziekte' [gestational trophoblastic disease], because these are based on well-defined clinical and ultrasonographic concepts.

Background: The aim of this study was to investigate normal chorionic villous vascularization using CD31 immunofluorescence and confocal laser scanning microscopy (CLSM) to elucidate the spatial arrangement in terms of connections between vessels and cords and their branching patterns compared to deficient chorionic villous vascularization in complicated pregnancies., Methods: A descriptive morphologic study using CLSM after CD31 immunofluorescence staining of placental biopsies from normal pregnancies (n = 20), complete hydatidiform molar pregnancies (CHMs; n = 3) and empty sacs (n = 3), with a well documented gestational age (GA)., Results: In this three-dimensional study, first trimester chorionic villi were occupied by a complex network of mainly cords with redundant connections as early as 5(+5) weeks GA. With increasing GA cords transform into vessels. From about 9 weeks GA onwards, vascular development is characterized by the presence of two large vessels located centrally and surrounded by and connected to a capillary network. In first trimester CHM and empty sacs, we observed a primitive network of mainly cords., Conclusions: This first visualization of the spatio-temporal patterns of blood vessel formation in placental villi is characterized by the development of the vasculosyncytial membrane from a complex network of cords and can be regarded as the placental development before it becomes functional at the end of organogenesis.

Objective: A practical attempt to simplify and improve the technique of artificial uterine cavity distension by instilling gel instead of flushing saline., Design: Prospective observational study., Setting: Teaching hospital., Patient(s): One hundred twenty patients with an indication for sonohysterography (abnormal uterine bleeding, exclusion of congenital abnormalities, or preoperative or postoperative evaluation of submucous myomas, polyps, or synechiae)., Intervention(s): A hydroxyethylcellulose gel containing anesthetic and antiseptic agents was instilled in the uterine cavity through a plastic intrauterine insemination cannula attached to a flexible plastic tube and a syringe. Transvaginal (3-dimensional) ultrasonography was performed concomitantly., Main Outcome Measure(s): Stable filling of the uterine cavity allowing a high-quality ultrasonographic visualization., Result(s): An optimal distension of the uterine cavity could be achieved with an average of only 4 mL (range, 2-10 mL) in 113 patients. As expected, a stable filling of the uterine cavity permitted a precise visualization of the uterine cavity and its linings and offered an optimal presentation for a 3-dimensional ultrasound recording and reconstruction., Conclusion(s): Gel instillation is a simple technique with minimal inconvenience for the patient and seems to be an attractive alternative to saline infusion during sonohysterography.

Recurrent miscarriage (RM; > or =3 consecutive early pregnancy losses) affects around 1% of fertile couples. Parental chromosomal anomalies, maternal thrombophilic disorders and structural uterine anomalies have been directly associated with recurrent miscarriage; however, in the vast majority of cases the pathophysiology remains unknown. We have updated the ESHRE Special Interest Group for Early Pregnancy (SIGEP) protocol for the investigation and medical management of RM. Based on the data of recently published large randomized controlled trials (RCTs) and meta-analyses, we recommend that basic investigations of a couple presenting with recurrent miscarriage should include obstetric and family history, age, BMI and exposure to toxins, full blood count, antiphospholipid antibodies (lupus anticoagulant and anticardiolipin antibodies), parental karyotype, pelvic ultrasound and/or hysterosalpingogram. Other investigations should be limited to particular cases and/or used within research programmes. Tender loving care and health advice are the only interventions that do not require more RCTs. All other proposed therapies, which require more investigations, are of no proven benefit or are associated with more harm than good.

Background: The objective of the study was to assess the reproducibility of a new classification for early pregnancy chorionic villous vascularization (Grade: I, normal; IIA, mild hypoplasia; IIB, severe hypoplasia and III, avascular) for routine microscopic examination in daily clinical practice., Methods: In this observational study, four observers scored first trimester chorionic villous vascularization. Scoring was performed in microscopic slides of chorionic tissue obtained by D&C in 30 patients with early pregnancy loss due to empty sac (n = 10), fetal death (n = 10) and termination of pregnancy (n = 10) using the new classification. Ultrasonographic measurement of trophoblastic thickness (TT) at the implantation site was available in all patients and in a reference group of 100 ongoing singleton pregnancies. The vascularization score could therefore be related to the TT., Results: The new classification resulted in a good-to-excellent agreement in histological scoring (0.73-0.90) between investigators (kappa 0.64-0.86). TT was not related to either vascularization or pregnancy outcome and only partly to hydropic degeneration., Conclusion: The vascularization scoring system is a simple, valid and effective method for assessment of chorionic villous vascularization. It is helpful in understanding the underlying cause of pregnancy loss, as the classification can distinguish between normal and abnormal embryonic development. We did not find either a relation between TT and pregnancy outcome or between TT and vascularization.

The nomenclature used to describe clinical events in early pregnancy has been criticized for lack of clarity and promoting confusion. There is no agreed glossary of terms or consensus regarding important gestational milestones. In particular there are old and poorly descriptive terms such as 'missed abortion' and 'blighted ovum', which have persisted since their introduction many years ago (Robinson, 1975) and have not undergone revision despite the widespread application of ultrasound for accurate clinical assessment and diagnosis. The authors are aware of these shortcomings in terminology and are keen to provide an updated glossary. We hope that this paper will facilitate the introduction of a revised terminology in an attempt to provide clarity and to enhance uptake and use in the literature as well as clinical assessment and documentation.

Background: Defective chorionic villous vascularization is present in pregnancies complicated by absent or abnormal embryonic development. The aim of this study was to investigate the embryonic and/or maternal genomic influence on vasculogenesis in diploid complete hydatidiform mole (CHM) and in triploid partial hydatidiform mole (PHM) in comparison with normal development., Methods: Mean villous stromal area and functional vascular area, vessels with a lumen and haemangiogenetic cords, peripherally or centrally located were measured and counted in chorionic villi of 12 CHM, 12 normal pregnancies (termination of pregnancy, TOP) and 15 PHM of which nine were without an embryo (PHM-E) and six were with an embryo (PHM + E), using quantitative CD34 immunohistochemistry., Results: TOP showed significantly more vessels per chorionic villus, centrally and peripherally located (median, range), than CHM, PHM-E and PHM + E (4.0, 0-9 versus 0.0, 0-11, 0.0, 0-18 and 1.0, 0-21). CHM showed significantly more centrally located cords than PHM-E, PHM + E and TOP (1.5, 0-22 versus 1.0, 0-15, 0.5, 0-8 and 1.0, 0-2)., Conclusions: Initiation of chorionic villous vasculogenesis is independent of the maternal genome (CHM). The development of an embryo, however, is obligatory for the modulation of normal vascularization resulting in a well developed vasculosyncytial membrane.

Objective: To investigate chorionic villous vasculogenesis (maturation) and development of the vasculosyncytial membrane (margination) using CD34 immunohistochemistry., Design: Case-control study., Setting: Microscopic analysis of first trimester chorionic villi., Patient(s): Twelve patients with anembryonic pregnancies, 12 with embryonic death, and 12 with terminated normal pregnancies., Intervention(s): Quantitative analysis of chorionic villi blinded to group and gestational age using CD34 immunohistochemistry., Main Outcome Measure(s): Vascular parameters (mean functional vascular area, vessels with a lumen, and hemangiogenetic cords, peripherally or centrally located)., Result(s): Terminated normal pregnancies show significantly more vessels per chorionic villus (maturation) (mean +/- SEM) in comparison with embryonic deaths and anembryonic pregnancies (5.3 +/- 0.3 vs. 1.4 +/- 0.2 and 0.7 +/- 0.1), located mainly peripherally (margination) (3.0 +/- 0.2 vs. 0.9 +/- 0.2 and 0.2 +/- 0.0). Anembryonic pregnancies show significantly more centrally located cords in comparison with embryonic deaths and termination of pregnancies (3.3 +/- 0.2 vs. 2.7 +/- 0.2 and 1.5 +/- 0.1)., Conclusion(s): A defective chorionic villous vascularization, demonstrating inadequate vasculogenesis and abnormal development of the vasculosyncytial membrane, is seen in pregnancies complicated by embryonic death and is even more pronounced in anembryonic pregnancies. Initiation of placental vasculogenesis is a basic feature in all types of pregnancy and is subsequently modulated directly or indirectly by embryonic signaling.

Lifestyle changes are recommended as the first step in the treatment of pregnant women with heartburn. If symptoms persist, antacids or the mucoprotective sucralfate can be prescribed. If symptoms are persistent and severe, acid secretion inhibitors may be prescribed; the proton-pump inhibitor omeprazole is the drug of choice. It is unlikely that this drug could harm the fetus but the possibility cannot be entirely excluded. Prescription should be delayed until after the first trimester, whenever possible. Patients who have become pregnant while using these drugs can be reassured.

Objectives: To compare the efficacy and safety of intracervical PGE(2) gel (Prepidil) with intravaginal PGE(2) insert (Propess) in cervical ripening and induction of labour., Study Design: This was a retrospective analysis of patients with single pregnancies, intact membranes and a viable fetus who required cervical ripening. In the first half of 1998, all patients received Prepidil and in the first half of 1999 all patients received Propess. In both periods 50 consecutive files were retrieved and compared., Results: The Prepidil and Propess group were similar in patient characteristics, indication for induction of labour and delivery outcome. Cervical ripening within 24 h was achieved in the Propess group in 80% as compared to 56% in the Prepidil group. The application-membrane rupture-interval was shorter in the Propess group compared to the Prepidil group (23.7 +/- 21.3 h versus 56.4 +/- 77.7 h, P = 0.009) as well as the application-delivery interval (29.8 +/- 22.0 h versus 62.0 +/- 78.8 h, P = 0.039). In the Propess group 62% delivered within 24 h compared to 28% in the Prepidil group. A smaller number of applications was observed in the Propess group (1.2 versus 1.8, P < 0.005). Both methods proved to be safe in cervical priming and no relevant differences in mode of delivery and outcome of labour were detected. None of the patients required an emergency caesarean section during the treatment with prostaglandines., Conclusions: Both prostaglandin E(2) agents are safe and effective in achieving cervical ripening; however the vaginal insert demonstrated a shorter application-delivery interval. The hospital stay was consequently shorter, contributing to cost effectiveness., (Copyright 2002 Elsevier Science Ireland Ltd.)

In an open, randomized study in an outpatient clinic of a large teaching hospital, thirty-one female volunteers with regular cycles and established ovulation by ultrasonography were given one of two triphasic oral contraceptives containing ethinylestradiol combined with levonorgestrel or desogestrel during six cycles of treatment. The main outcome measures were transvaginal ultrasonography and serum E2 and P measurements in pill cycles 1, 3 and 6. No ovarian activity was found in 10 subjects. Among the remaining 21 women who showed ovarian activity, most follicle-like structures developed in the pill-free week and decreased in size or disappeared in the first pill week. One women taking triphasic desogestrel had evidence of a luteinized unruptured follicle and one women taking triphasic levonorgestrel had a possible ovulation. The latter women also showed symptoms of lower abdominal pain. A statistically significant difference in ovarian activity between the two oral contraceptives could not be established. The two triphasic oral contraceptives suppressed ovarian activity to the same degree. A trend was seen towards increasing ovarian activity with duration of use in both treatment groups.

The Human yolk sac has long been considered a vestigial organ, an evolutionary remnant. In the last decade, however, it has been discovered that the human yolk sac plays an active and crucial role during organogenesis. Due to an absent maternal intervillous circulation during the first 12 weeks of pregnancy, the concept of transport of nutrients and oxygen to the embryo must be thoroughly reconsidered. Here the yolk sac plays an essential role by its active and passive transport to the embryo, and by its production of necessary substances. Animal experiments have demonstrated that hyperglycaemia has an initial deleterious effect on yolk sac structure, which then results in embryopathy. Study of the yolk sac by means of ultrasound has not become an important diagnostic method yet. On the basis of clinical studies and animal experiments, however, it may be expected that this organ plays a crucial role in the development of spontaneous abortion and structural congenital defects.

Clinical and ultrasound data of 403 first-trimester pregnancies were collected prospectively. Consequences for determination of gestational age as well as the risk of spontaneous abortion were investigated. There was a clear relation between embryonal growth delay and the risk of spontaneous abortion: the risk of spontaneous abortion was significantly higher if the crown-rump length lagged 7 or more days behind the expected gestation time based on the duration of the amenorrhoea (16% versus 5.0%; p less than 0.01). It is important to know the exact duration of pregnancy, because a difference of one or two weeks can be critical in terms of survival or disability. 22.7% of the pregnant women who had a regular menstrual cycle before this pregnancy appeared to have an embryonal growth delay of seven days or more in relation to the reference curve. This illustrates the necessity of crown-rump length measurements in order to obtain accurate assessment of gestational age, which is fundamental in obstetric care.

A family is described in which both a mother and an infertile daughter had premature menopause at the ages of 31 and 28 years, respectively. Initially, an extensive investigation revealed no apparent cause for their conditions. However, when cytogenetic analysis in the daughter was performed, a terminal deletion in the long arm of one of the X-chromosomes was found. The karyotype was: 46,Xdel(X),(q25-qter). Chromosomal investigation in the mother showed an identical deletion. The karyotype of the patient's 35-year-old sister is normal. She has a normal menstrual cycle and two normal children. The presence of such familial cases suggests that chromosomal investigation should be considered in young women with oligomenorrhea, especially those whose mothers have experienced a premature menopause.

Unlabelled: Clinical and ultrasound data of 403 first-trimester pregnancies were collected prospectively. For our CRL study, two groups of patients were selected: Group A with an optimal (menstrual) history (111 patients, 156 CRL measurements) and Group B with available BBT charts (17 patients, 27 CRL measurements). Compared to the Robinson CRL curve (SD +/- 4.7 days) the curve of group A (SD +/- 4.4 days) showed a small underestimation of gestational age of 2.5 days in the 8th week, gradually declining (p less than 0.001). The CRL curve of group B (SD 4.3 days) is parallel to the group A curve, displaced 2.9 days to the left, and did not differ significantly from the Robinson curve., In Conclusion: in contrast to suggestions in literature there is no need to revise the original CRL curve of Robinson. For individual variations in CRL measurements not only measure errors but also variations in the time of implantation and/or start of growth are responsible.

A case report is described of a female t(13q14q) Robertsonian translocation carrier. Her firstborn daughter appeared to be a carrier of the same translocation. Chromosomal investigation of the third of three subsequent spontaneous abortions revealed a triploidy (69XXX). Literature shows discrepancies in the reported abortion rate in the reproductive performance of t(13q14q) carriers. It is concluded that these could in part be explained by heterogenicity of the study groups due to variable presence of other factors known to influence the abortion risk. In our case report treatment for epilepsy, a luteal phase defect and high numbers of spermatozoa in the sperm count of the husband must be considered as contributory factors. It is recommended to perform systematic investigations in all cases of recurrent abortion even when a chromosomal anomaly is found in one of the partners.

The twin transfusion syndrome is diagnosed in 5.5% to 14.6% of monochorionic twins and the classical picture reveals a small anemic donor and a large plethoric recipient. Many other clinical discrepancies have been described. Today, by ultrasound it is possible to diagnose the syndrome in (early) pregnancy. In these case reports different clinical pictures and the importance of ultrasound are described. In twin pregnancies repeated ultrasound examinations should be considered with the consequences of vascular anastomoses.

This case report presents a "true" ovarian pregnancy in a women using a Dalkon shield. The gestational sac was implanted in the ovary close to the corpus luteum and contained a normally developed embryo of Carnegie Stage 11. A morphologic description of the embryo is given. The importance of a morphologic description of the conceptus in cases of ovarian pregnancy is discussed.

Placentas after uneventful pregnancies were perfused under physiologic pressure in the fetal vessels, expanded to their predelivery volume, fixated with 4% formaldehyde, and compared to their ultrasound images in pregnancy. The placentas showed a side arrangement of the fetal cotyledons in contact with the basal plate. The centers of the cotyledons showed an empty space in which the spiral arteries ended. These spaces in the placenta corresponded with transsonic areas of ultrasound. The central spaces were surrounded by a relatively dense shell of villi containing the more or less fibrotic stem villi. This explained the areas of increased echo-density, as seen by ultrasound during the last trimester of pregnancy. The fetal cotyledons, composed of a central cavity and a dense villous shell, were separated by a reticular area. The veins ended at the basal plate in these intercotyledonary areas.

In this paper the application of an open-tip phonocatheter for the detection of fetal phonocardiosignals during parturition is described. The phonocatheter is easily inserted with a conventional polythene guide via the cervical route. The fetal heart sounds are detected by the sound pick-up element located in the catheter tip. Intrauterine pressure is measured simultaneously with the help of a Statham uterine pressure transducer externally connected via the lumen to the open tip of the phonocatheter. Since fetal heart sounds can also be detected before rupture of the membranes, it is possible to measure intrauterine pressure and fetal heart activity simultaneously using only one catheter and without being limited to a particular stage in parturition.

In 2 women the diagnosis of rectus hematoma could be established by ultrasound and the further clinical course. Echoscopy is stressed as a technique which is helpful to the patient and the clinician in avoiding unnecessary operations.

The authors describe a newborn, in which a diagnosis of ascites was made before birth by ultrasound. Ascites without other signs of hydrops may be caused by meconium-peritonitis, perforation of the bile ducts, disorders of the portal or systemic circulation, flow disturbances in the lymphatic vessels, urinary obstruction or a ruptured ovarian cyst. In this case there was a chylous ascites in a child with Down's syndrome. Diagnosis, pathogenesis and treatment are discussed. With conservative treatment the child was free of symptoms at the age of 6 months.

Ultrasonographic measurements of the yolk sac were made during first trimester in 100 pregnancies. The results were related to the crown-rump length of the embryos and showed an increase in size from 7 to 11 weeks menstrual age. A possible relation between anomalies in yolk sac development and embryonic development was studied in six patients by means of serial weekly ultrasonographic examinations. In one case with absence of the yolk sac embryonic death occurred at 10 weeks menstrual age; the embryo had spina bifida.

The chorionic villous vascularization of 40 patients with first trimester spontaneous abortion was compared with that of 10 patients undergoing legal abortion (control group). The spontaneous abortion group was subdivided into a group with intrauterine embryonic death (n = 20) and a group with blighted ova (n = 20). Villous vascularization appeared unaffected after prolonged postmortem intrauterine retention. The incidence of vascularized villi was 89% in the control group, 26% in the group with embryonic death, and 9% in the group with blighted ova. In addition, the vascular density of vascularized villi was three to four times higher in the control group than in the two spontaneous abortion groups. The present study provides evidence that, in case of embryonic death and blighted ova, chorionic villous vascularization is deficient.

Between 1982 and 1986, osteogenesis imperfecta was diagnosed by ultrasound in seven fetuses. The known heterogeneity of osteogenesis imperfecta was confirmed by the prenatal ultrasonographic findings. Dependent on the type of osteogenesis imperfecta, the appearance of the limbs varied from severely shortened and broad, with very low echogeneity and absent acoustic shadow (type IIA), to only moderately shortened and thin, with almost normal echogeneity and acoustic shadow but clearly visible fractures causing angulation of the bone (types IIC and III). Ultrasonography offers the possibility to detect or exclude the lethal and severe forms of osteogenesis imperfecta early (type IIA) or halfway (types IIB, IIC, and III) through the second trimester. Prenatal diagnosis of the disease allows the option of elective abortion or may prevent unnecessary obstetric intervention.

A case is described in which a fallopian tube, 6 weeks after salpingotomy, had to be removed. The morphology of the tube was thoroughly investigated by hysterosalpingogram of the specimen and microscopic examination.

Serum thyroxine (T4), free thyroxine (FT4) and thyroxine binding globulin (TBG) were measured at 6, 8, 10, 12, 14 and 16 weeks menstrual age (MA) in 32 pregnant females, who had been selected for a high risk of spontaneous abortion on account of previous abortion (18 cases) or ovulation induction (14 cases). Eight of these subjects experienced a spontaneous abortion occurring between 8 and 20 weeks. The other women, who carried to term, served as controls. In the abortion group, mean pre-abortion TBG and T4 levels were lower than in the control group from the 6th week on. In spite of this, the way T4 changes with TBG was very similar in both groups. No detectable change or difference with respect to control values were observed for FT4. These observations are taken as evidence against impaired maternal thyroid function playing a role in the unsuccessful outcome of pregnancy. Decreased TBG was detected on the average at 5.2 (range 0-13) weeks before abortion. Diagnostic sensitivity and positive predictive value were estimated as about 70 and 80%, respectively, for the high-risk group, indicating that serum TBG might only play a minor role as a predictor of the outcome of pregnancy.

A separate clinical and ultrasound study was carried out in 20 unselected patients receiving an IUD (ML Cu 250 or Cu T-200). Clinical adverse effects were studied in relation to ultrasound findings after 0, 2 and 6 months of insertion. Using both the sound length and initial ultrasound measurements, it was possible to calculate that none of the 20 IUDs reached the fundal wall of the uterine cavity (distance 0.1-2.4 cm). The mean initial distance between the top of the uterine fundal wall and the top of the IUD (TOP) was 2.0 cm (range 1.3-2.4 cm). A downward displacement of more than 0.5 cm in consecutive measurements was observed in 3 patients. Malposition of one or two arms of the IUD was found in 8 patients. In 6 of these patients clinical complaints were present.