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Although severe hemolytic disease in patients with partial D is rare, this neonatal death illustrates the need for a change in management of women with weak D.

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The qualitative and quantitative effects of bladder and vaginal balloon volumes on the sonographic diagnosis of paravaginal defects were evaluated. Transabdominal ultrasound measurements were performed on patients with stage 4 prolapse and coexisting paravaginal defects (study group) as well as on nulliparous patients without prolapse or paravaginal defects (control group). Paravaginal defects were measured, first without a water-filled condom in the vagina, and then sequentially with a 30, 60 and 90 ml water-filled balloon in the vagina at bladder volumes of 150 and 300 ml. Paravaginal defects were detected on transabdominal ultrasound in both groups. In both the study and the control groups the size of the paravaginal defect was directly related to the size of the balloon placed in the vagina (P<0.0001). There were no significant differences in the size of the paravaginal defects measured at a bladder volume of 150 ml compared to those measured at 300 ml. We conclude that transabdominal ultrasound is not useful in detecting paravaginal defects.