G.B. Azar

Recurrent molar pregnancies in a family with extensive intermarriage: Report of a family and review of the literature

Background Familial recurrent molar pregnancies are exceedingly rare. The genetic basis for recurrent moles is not well understood, and its association with major human lymphocytic antigen histocompatibility is debatable. The purpose of this report is to present a family with extensive intermarriage and recurrent molar pregnancies with some emphasis on the result of the human lymphocytic antigentyping. Case Two sisters, both married to first-degree cousins, had three and five pathologically confirmed molar pregnancies, respectively. A second-degree cousin, also married to her first-degree cousin, is also reported to have had five consecutive moles. Chromosomal analysis and human lymphocytic antigen-typing on the two sisters and their spouses was performed. Human lymphocytic antigen-typing was compared to a cross-sectional sample of our population. This showed a high incidence of unusual human lymphocytic antigens in these family members. Conclusion In families with extensive intermarriage and recurrent molar pregnancies, patients and their spouses may have unusual human lymphocytic antigen histocompatibility, which supports the possibility of a strong genetic predisposition expressed at the level of major histocompatibility class I and li gene translation.

Ear length: a potential sonographic marker for Down syndrome.

OBJECTIVES: The purpose of this study was to determine if antenatal sonographic determination of fetal ear length is a useful screening method for identification of fetuses with Down syndrome. METHODS: Ear length measurements were recorded in 418 fetuses undergoing ultrasound scanning between 20 and 28 weeks of gestation. Four trisomy 21 and six trisomy 18 fetuses were identified by karyotyping. The relationship between ear length and gestational age in the normal population was determined by linear regression analysis: expected ear length = −6.000 + 1.075 gestational age. The ability of measured‐to‐expected ear length cut‐off ratios to discriminate between affected and non‐affected fetuses was assessed. RESULTS: The mean ear length and measured‐to‐expected ear length ratios were significantly lower in the affected group as compared to the normal one. A measured‐to‐expected ear length ratio of less than 0.8 was 75.0% sensitive and 98.8% specific in detecting Down syndrome fetuses, and resulted in an 8.5% positive predictive value in the general population. CONCLUSIONS: This preliminary study suggests that antenatal ear length measurements might be a promising sonographic screening method for the detection of Down syndrome in the second trimester of pregnancy.

Accessory spleen presenting as adnexal mass

Pelvic splenic ectopia is a very rare entity, often unsuspected preoperatively. We report a case of an ectopic spleen presenting as an adnexal mass in a middle‐aged woman. Diagnosis was achieved intraoperatively, and confirmed pathologically. Pelvic ectopic spleen should be considered in the differential diagnosis of adnexal masses.

Postmortem cesarean section following maternal blast injury: case report.

We report a postmortem cesarean section resulting in fetal survival, performed 25 minutes after maternal blast injury. The time interval between cardiopulmonary arrest and delivery, prior maternal health status, and continued cardiopulmonary resuscitation represent important determinants of fetal survival. Improvement in maternal hemodynamic condition may potentially occur following the procedure. Postmortem cesarean section is advised in the event of fatal maternal trauma since it may result in fetal salvage.

Sonographic diagnosis of a urachal cyst in utero

With improvements in fetal screening techniques, urachal anomalies can now be detected antenatally. Characteristic sonographic features of a urachal cyst in utero are described.

Reproductive outcome following abdominal metroplasty

Objective: To evaluate pregnancy outcome following uterine unification procedures in patients with uterine anomalies. Methods: A retrospective survey included all abdominal metroplasty procedures performed on 43 patients at the American University of Beirut Medical Center between January 1, 1974 and December 31, 1991. Age at metroplasty, type of anomaly and surgical procedures, as well as preoperative and postoperative reproductive performance were all recorded. Results: Forty (93%) out of 43 patients who underwent metroplasty had postoperative live births compared with five (12%) prior to surgery. The fetal wastage rate dropped from 93% pre‐ to 16% postoperatively. All seven patients with a history of primary infertility conceived and had live births. Conclusion: Our data suggest a remarkable improvement following abdominal metroplasty in patients with both typical and uncharacteristic preoperative reproductive performance.

High-velocity penetrating wounds of the gravid uterus: Review of 16 years of civil war

Objective: To evaluate the value of selective laparotomy in pregnant women with penetrating abdominal injuries. Methods: A retrospective survey was carried out at our center over 16 years of civil war, extending from 1975 to 1991. Fourteen pregnant women had uterine injuries secondary to high-velocity abdominal penetrating trauma. The corresponding management was evaluated carefully with respect to maternal and fetal outcomes. Results: Two maternal deaths occurred, neither resulting solely from intra-abdominal injuries. Visceral injuries were present when the entrance of the missile was in either the upper abdomen or the back. When the entry site was anterior and below the uterine fundus, visceral injuries were absent in all six women upon surgical exploration. Perinatal deaths occurred in half of the cases and were due to maternal shock or uteroplacental or direct fetal injury. Immediate cesarean delivery was performed because of either limited surgical field exposure, fetal injury, or distress. Three patients explored were managed by delaying delivery. All later delivered vaginally with successful fetal outcomes in all three. Conclusion: Selective laparotomy may be considered in pregnant women with anterior penetrating abdominal trauma, as the likelihood of intra-abdominal injuries may be predicted based on the location of the penetrating wound. (Obstet Gynecol 1994;83:259-64)

Conservative management of pelvic spleen

Adnexal tumors tend to originate from the female genital tract [l]. However, a rare occurrence of an adnexal mass can be due to a pelvic spleen. Surgical removal is recommended to avoid torsion and rupture [2,3]. We report a case of a pelvic spleen that was left in situ with no complications over a 15-year period. Our patient was a 21-year-old nulliparous female who was noted to have an asymptomatic left adnexal mass on routine examination. Pelvic ultrasound confirmed the presence of a 9 x 9 cm solid mass in the left adnexal region. She had been maintained on oral contraceptive pills for 6 months. At laparotomy, the uterus, ovaries and tubes were normal. A large red mass located posterior to the uterus was attached to a long pedicle originating from the left upper quadrant of the abdomen. Palpation of the other abdominal organs was normal. The diagnosis of ectopic pelvic spleen was made. It was not resected, however, as