Objectives To construct new reference charts and equations for fetal biparietal diameter (BPD),

Between November 1988 and December 1993, 100 patients with a common, unruptured ectopic pregnancy were treated with 1 mg/kg injection of intratubal methotrexate under transvaginal sonographic control. Patients were not excluded from this series on the basis of the size of the adnexal mass, the term of ectopic pregnancy or initial beta-human chorionic gonadotrophin (HCG) concentrations. Patients were excluded following uncertain diagnosis, signs of a ruptured ectopic pregnancy, or a significant haemoperitoneum on ultrasound scans. The mean age of the patients was 29.5 years (range 20-41). The mean gestational age and initial HCG concentration were 7.5 weeks (5-11) and 11,614 mIU/ml (192-105,000 respectively). Of the 100 patients, 22 (22%) had an ectopic pregnancy with active cardiac activity. Complete resolution was obtained in 78 out of these 100 ectopic pregnancies. Of these, 66 patients (85%) needed only one intratubal methotrexate injection, and 12 patients (15%) required a second i.m. methotrexate injection of 1 mg/kg. In this study, local treatment with one single intratubal methotrexate injection was successful in only 66% of patients. The mean resolution time for reduction of beta-HCG concentrations was 23.5 days (range 7-40). There was no statistically significant correlation between initial beta-HCG concentrations and outcomes after methotrexate treatment of ectopic pregnancy in our study. Where embryonal heart beats were observed, the success rate of the procedure was 40.9% (nine out of 22 cases). In the absence of cardiac activity, or when ultrasound examination showed no embryo, the success rate achieved was 84.6% (66 out of 78 cases) (P < 0.01). In all, 34 patients were considered to be incompletely cured after only one intratubal methotrexate injection: 12 patients required a second i.m. injection, a stagnation of beta-HCG concentrations was observed in 15 patients, abdominal pain occurred in six patients, and one patient suffered tubal rupture with haemoperitoneum. A total of 22 patients required secondary surgical management (salpingectomy). No biochemical or clinical side-effects of methotrexate treatment occurred. Tubal alteration ascribable to methotrexate injection occurred in one patient in our study. Out of 75 patients in this series who wished to conceive, 21 (28%) became pregnant within 1 year with the following outcomes: 11 pregnancies at term, three miscarriages, one induced abortion and six recurrent ectopic pregnancies (four occurred on the same side). Our findings suggest that treatment of common unruptured ectopic pregnancy without prior selection of patients, by a single intratubal methotrexate administration was associated with a 66% success rate. This was dependent only on the presence of embryonal heart beats and there was no correlation between the success rate and initial beta-HCG concentrations. Successful outcome after methotrexate administration for ectopic pregnancy could be perfected by way of an improved selection of patients based on inactive embryonal hearts and absence...

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Walker-Warburg syndrome (WWS) is an autosomal recessive condition characterized by diffuse neurodysplasia, resulting in brain and eye abnormalities. We report on a prenatally diagnosed case of this syndrome born to a consanguineous couple. The patient was referred at 24 weeks following prenatal diagnosis of hydrocephalus at a 22 weeks routine scan. Major hydrocephalus was confirmed. In addition, abnormalities of the eye were found: an unilateral congenital cataract and a parasagital intra ocular structure in both eyes between the lens and the posterior wall of the eye. These structures were interpreted as bilateral hyperplasia of a persistent primary vitreous (PHPV). The parents elected to continue the pregnancy. Amniocentesis documented a normal male karyotype. MRI performed at 32 weeks confirmed hydrocephalus and lissencephaly II consistent with WWS, but was not contributive regarding the eye abnormalities. Ultrasonographic follow-up showed unchanged eye structures up to 34 weeks, when target like images suggestive of retinal detachment were found. The baby died immediately after birth. Autopsy showed dilated ventricles, thin cortex, type II lissencephaly and retinal dysplasia associated with retinal nonattachment, confirming the diagnosis of Walker-Warburg syndrome. The case we report demonstrates that prenatal sonographic diagnosis of retinal non attachment and of PHPV is feasible. It may have implications for prenatal diagnosis of conditions involving such abnormalities. Moreover, we report for the first time, on the prenatal occurrence of a retinal detachment following the presence of PHPV. It suggests that retinal dysplasia associated with WWS could be secondary to a retinal nonattachment due to PHPV, rather than resulting from a ''primary'' malformative process as classically accepted. P016 Süleymaniye Maternity Hospital, TurkeyObjective: To find out whether bilateral maternal uterine artery Doppler examination during first trimester scan is efficient in predicting preeclampsia. Materials and methods: All patients having a routine first trimester scan during March 2000 thru October 2002 at our antenatal care facility were requested to reveal details of antenatal, peripartum and immediate neonatal periods by means of a standardised telephone interview. Hospital records of cases with preeclampsia were checked back for accuracy. Abnormality of the uterine artery Doppler tracing was defined either by unilateral or bilateral notching, absence of the diastolic flow or reverse flow during diastole. Chi square test with alpha = 0.05 was used to detect differences of significance. Results: A total of 1187 patient were attempted to be contacted by telephone but a complete review of antenatal and neonatal findings were accomplished in 477 (40.2%). 198 of them had bilateral (41.5%), 135 unilateral (28.3%) and 144 (30.0%) no diastolic notching. Preeclampsia requiring hospitalisation has occurred in 25 patients. 14 of them had bilateral (p: 0.03), 8 unilateral (p: 0.09) notches, whereas in three we failed to detect a...

We present a prospective longitudinal study, using both laparoscopy and operative hysteroscopy, which investigated the transport of endometrial cells into the peritoneal cavity. The study was carried out between 1 January 1994 and 31 December 1994 at the Department of Obstetrics and Gynaecology, Bichat‐Claude Bernard Hospital, Paris. Included in the study were 30 patients who had intrauterine lesions, diagnosed by previous hysteroscopy. All available peritoneal fluid was collected for subsequent cytological evaluation. Pre‐ and posthysteroscopy peritoneal fluid specimens were centrifuged and aliquots were smeared and stained using Papanicolau and May–Grünewald–Giemsa stains, and paraffin inclusions were prepared and stained with haematoxylin–eosin–saffron. The criterion for specimen evaluation was the presence or absence of identifiable endometrial cell material in the peritoneal fluid collected during operative hysteroscopy. Before the operative hysteroscopy procedures, cytological investigations of the peritoneal fluid showed no presence of endometrial cells. However, in the peritoneal fluid collected after the operative hysteroscopies, endometrial cells were found in seven cases (23.3%). During the latter procedure, transport of endometrial cells through the fallopian tubes can occur, and in our prospective study this was found to happen in 23.3% of cases.