First trimester screening aids in the diagnosis and management of an ectopic pregnancy in a noncommunicating uterine horn

Pregnancy within a noncommunicating rudimentary horn has a 70% chance of rupturing, with a maternal mortality of 0.5%. It is most commonly managed with operative removal of the horn. We report a pregnancy within a noncommunicating horn and highlight the advantage of early diagnosis via sonography. First trimester prenatal screening via sonographic examination allows early diagnosis of müllerian duct abnormalities and ectopic pregnancy. This information expedites management of such pregnancies, thus decreasing maternal morbidity and increasing the chance of future fertility.     

Sonographic diagnosis of uncomplicated first-trimester pregnancy in the rudimentary horn of a unicornuate uterus

Although pregnancy in a rudimentary uterine horn is rare, the correct diagnosis of this condition on routine sonographic examination is critical, because its natural history usually involves the rupture of the pregnant horn during the second or third trimester, resulting in life-threatening bleeding. We report a case in which the diagnosis of right unicornuate uterus with a left noncommunicating rudimentary horn was made in the first trimester on routine sonographic examination.     

三维超声对单角子宫和残角子宫的诊断价值

目的探讨三维超声对单角子宫和残角子宫的诊断及鉴别诊断价值。方法分析28例单角子宫和残角子宫的二维和三维声像图特点。结果三维超声诊断单角子宫5例,位于右侧4例,左侧1例。残角子宫23例,其中ⅡA-1a型2例,ⅡA—1b型11例,ⅡA-1c型10例。二维超声漏误诊22例,漏误诊率为78．6％,但均结合三维超声检查后获得正确诊断。结论三维超声冠状面能直观地显示子宫的外形和宫腔的形态,弥补了二维超声的不足,对单角子宫和残角子宫的诊断有极高的临床价值。     

Spontaneous septostomy in a monochorionic‐diamniotic twin gestation

Monochorionic twin gestations are associated with a greater incidence of neonatal morbidity and mortality when compared with their dichorionic counterparts. In turn, monochorionic‐monoamniotic (MCMA) gestations carry greater risks compared with monochorionic‐diamniotic (MCDA) gestations. While the true incidence of spontaneous septostomy of the dividing membranes (SSDM) in MCDA twins is unknown, SSDM has been demonstrated to be associated with increased morbidity and mortality, due to functional transition from a MCDA gestation to a MCMA gestation. We report a case of SSDM in a mid‐trimester MCDA gestation, review the literature, and describe how to identify and manage this complication.     

Twin pregnancy with Roberts syndrome in one fetus and trisomy 18 in the other

We report a case of a 26-year-old multigravida pregnant woman with a history of 3 stillbirths with hydrops fetalis who presented with 17 weeks menstrual age. Sonographic examination revealed twin gestation. Twin 1 showed subcutaneous edema, pleural effusion, and mesomelic limb shortening, suggestive of lethal skeletal dysplasia (Roberts syndrome). Twin 2 corresponded to 17 weeks menstrual age with no major malformations. Karyotyping of the fetuses showed normal karyotype in twin 1 and trisomy 18 in twin 2. Fetal autopsy confirmed the sonographic findings. The occurrence of trisomy 18 in the fetus may be due to chance, but it raises the possibility that the heterozygotes of Roberts syndrome may be at higher risk of nondisjunction and aneuploidy in the fetus. Furthermore, this case illustrates that karyotyping of both fetuses is warranted when 1 of the twins is found to have major malformations.     

Partial hydatidiform mole in septate uterus

Partial mole is a form of gestational trophoblastic disease that may be associated with serious medical complications and occasionally progresses to the second trimester of pregnancy. We present a case report of a partial mole diagnosed at 18 weeks of gestation in a septate uterus with molar placenta in one horn and a dead fetus in the other. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009     

残角子宫并宫腔经血潴留的超声诊断

目的 探讨残角子宫并宫腔经血潴留的超声特征。方法 对我院95年2月至2001年10月经B超检查诊断为残角子宫并宫腔经血潴留的病例进行回顾性分析，并与手术病理对照。结果 6年间共诊断该病例8例，与手术病理对照符合率为87％（7／8）。其中一例误诊为卵巢七克力囊肿。8例均伴有残角子宫侧肾脏缺如，对侧肾代偿性增大。结论 该先天性畸形较少见，声像图较复杂，充分认识该病的声像图特征是正确诊断本病的重要前提。     

Avoiding the fatal misdiagnosis of pregnancy in a noncommunicating rudimentary horn using 3D transvaginal ultrasound

Rudimentary horn pregnancies are an increasingly recognized complication of Mullerian duct anomalies. They can lead to uterine rupture with severe maternal morbidity and mortality. We present the case of a 28-year-old woman with a prior surgical diagnosis of bicornuate uterus who was diagnosed with a 7-week pregnancy in the left horn of a bicornuate uterus by 2D ultrasound. Further investigation with 3D ultrasound revealed that the pregnancy was within a noncommunicating rudimentary horn of a unicornuate uterus. These findings were confirmed at laparotomy. This case illustrates the importance and benefits of utilizing 3D ultrasound in diagnosing suspected Mullerian anomalies.     

Twin reversed arterial perfusion: report of four cases

Twin reversed arterial perfusion (TRAP sequence), or acardiaus, is a rare and serious complication of monozygotic multiple gestation. The acardiac fetus suffers from lethal anomalies. The normal co-twin also runs a high risk of perinatal morbidity and mortality due to heart failure and prematurity. Four cases of acardius are presented. The role of sonography in the condition's diagnosis and management is discussed.     

不全纵隔子宫和弓形子宫三维超声成像及妊娠结局的追踪分析

目的探讨三维超声诊断不全纵隔子宫和弓形子宫的特点,以及畸形子宫对妊娠结局的影响。方法经宫腔镜证实的72例不全纵隔子宫和43例弓形子宫患者,分析其二维及三维超声特点,同时追踪分析妊娠结局。结果不全纵隔子宫二维和三维超声诊断符合率分别为86.1%(62/72)和97.2%(70/72),后者高于前者(P<0.05)。弓形子宫二维和三维超声诊断符合率分别为79.1%(34/43)和97.6%(42/43),后者高于前者(P<0.05)。不全纵隔子宫患者123次妊娠,弓形子宫患者64次妊娠,不全纵隔子宫患者自然流产率高于弓形子宫患者,足月分娩率低于弓形子宫患者(P<0.05)。结论三维超声可清晰显示子宫腔结构和外观形态,准确测量不全纵隔子宫和弓形子宫内膜中央部下陷深度及内膜夹角,较二维超声更具优势;明确诊断畸形子宫对不孕和早期妊娠流产的预测意义较大。     

经阴道超声检测子宫内膜病变的诊断价值

目的探讨经阴道彩色多普勒超声诊断子宫内膜病变的价值。方法对78例子宫内膜病变患者进行经阴道超声检查,其结果与病理对照,并进行分析。结果 78例患者中,子宫内膜增生诊断符合率92.5%,子宫内膜息肉诊断符合率91.7%,子宫黏膜下肌瘤诊断符合率90.9%,3例可疑子宫内膜癌经病理证实。结论经阴道彩色多普勒超声检查因其无创伤性,且超声图像特征显示清晰,是诊断子宫内膜疾病的有效手段。     

子宫角部位妊娠的超声诊断及其误诊分析

目的总结超声在诊断宫角部位妊娠过程中的经验教训。方法回顾性分析12例宫角部位妊娠病例的临床与声像图特点。结果12例中仅1例由超声直接明确诊断,2例经临床观察及反复超声检查最终由阴道彩色多普勒超声诊断,其余均在术后确诊。结论超声可以为临床早期诊断宫角部妊娠提供影像学依据,经阴道彩色多普勒超声可作为该类疾病诊断的首选方法。     

Comparison of two-dimensional and three-dimensional sonography in evaluating fetal malformations

PURPOSE: We assessed the differences between 2-dimensional (2D) and 3-dimensional (3D) sonography (US) in evaluating fetal malformations. METHODS: Both 2D US and 3D US were used to examine pregnant women whose fetuses had malformations. The diagnostic information provided by the modalities was evaluated and compared. RESULTS: A total of 62 malformations were confirmed by postnatal or postmortem follow-up in 41 fetuses of 40 pregnant women. 2D US made a definite and correct diagnosis of 49 malformations (79%), whereas 3D US definitely diagnosed 58 malformations (94%) (p < 0.01). 3D US definitely diagnosed all the abnormalities in 38 fetuses (93%), whereas 2D US did so in only 32 fetuses (78%) (p < 0.05). In 35 (60%) of the 58 malformations revealed by both 3D US and 2D US, the former provided more diagnostic information than the latter. 3D US was particularly superior to 2D US in evaluating fetal malformations of the cranium and face, spine and extremities, and body surface. CONCLUSIONS: In comparison with 2D US, 3D US improves the diagnostic capability by offering more diagnostic information in evaluating fetal malformations, particularly in displaying fetal malformations of the cranium and face, spine and extremities, and body surface. 3D US is a valuable adjunct to 2D US in prenatal diagnosis.     

超声诊断残角子宫晚孕期妊娠并破裂1例

<正>孕妇19岁,孕31周,孕1产0,因"腹痛4+d,血红蛋白进行性下降,院外提示腹腔妊娠"急诊入我院。急诊予输血纠正贫血治疗后收入我院住院部。体格检查:体温、心率、血压均正常,一般内科体格检查无特殊。专科检查:宫高平脐,腹围98cm,胎位不详,胎心144次/min,无规律宫缩。实验室检查:白细胞12.6×109/L,红细胞3.84×1012/L;血红蛋白112 g/L,血小板176×109/L。超声检查:     

超声对女性婴儿腹股沟疝伴子宫或卵巢嵌顿的诊断价值

目的 探讨超声对女耍腹股沟籼伴子宫或卵巢嵌顿的早期诊断价值。方法 分析38例经手术证实的女婴腹股沟疝患者的二维及彩色多普勒超声图象特征。结果 超声确诊的38例搞例中,20例伴有子宫或卵巢嵌顿,超声表现为典型的子宫、卵巢声像图,且嵌顿的子宫或卵巢外形大于不伴有子宫或卵巢嵌顿者。结论 女婴腹股沟疝患者,尤其是60d以下的小婴儿,超声检查对其早期诊断具有重要价值。