David M. Sherer

Heterotopic quadruplet gestation with laparoscopic resection of ruptured interstitial pregnancy and subsequent successful outcome of triplets

A heterotopic quadruplet gestation after in vitro fertilization and embryo transfer was complicated at 8 weeks by rupture of an interstitial pregnancy. Laparoscopic resection was performed and subsequently triplets were delivered at 34 weeks. To our knowledge, this is the first report of such a case.

Fetal yawning in utero at 20 weeks gestation.

To the Editor:Fetal swallowing movements in utero have been well documented and are thought to con· tribute to the dynamic balance of amniotic fluid volume, especially in the latter half of pregnancy. The facia• coronal view is an important tool in evaluating facial anatomical integrity. This view demonstrates orbits, ocular lenses, eyelids, nose, and lips. In this scanning plane, movements of the tongue, · chewing/ and wide opening of the mouth have been noted. Recently, whUe scanning a fetus at 20 weeks (Aloka Company, Japan, Model 280 SL with a 5-MHz sector transducer)

Prenatal sonographic findings associated with a fetal horseshoe kidney.

Fusion of the upper or lower poles of the kidneys produces a horseshoe-shaped structure continuous across the midline, anterior to the great vessels. This anomaly is relatively common and is found in about 1 in 500 to 1 in 1,000 autopsies.1 Although the majority of such kidneys are fused at the lower pole, 10% are fused at the upper pole.1 This developmental abnormality occurs between approximately 7 and 9 weeks of gestation.2 We present a case of the prenatal sonographic findings associated with a fetal horseshoe kidney.

Preoperative sonographic diagnosis of a unilateral tubal twin gestation with documented fetal heart activity.

The patient, a 25-year-old gravida 5, para 4 woman, presented to the emergency department at Strong Memorial Hospital complaining of sharp, intermittent right lower-quadrant abdominal pain, commencing 3 hours prior to her presentation. Her past medical history was unremarkable. She was currently on oral contraceptives, and her last menstrual period was 12 weeks prior to her admission. The patient had noticed irregular vaginal bleeding over the past 2 weeks. Physical examination upon admission revealed a moderately distressed patient. Her blood pressure was 110/62 mm Hg, pulse was 74 beats per minute, and her abdomen was soft with positive

Endovaginal Sonographic Associated Features of a T-Shaped Uterus Due to In Utero Exposure to Diethyistilbestrol (DES):

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.