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Severe iron deficiency anemia resulting from malabsorption can complicate pregnancy following gastric bypass surgery for morbid obesity. For women of childbearing age, this potential adverse effect must be considered.

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arlequin ichthyosis is a lethal autosomal recessive disorder characterized by an extremely thickened keratin layer of skin, flattened ears, and diffuse platelike scales.1 Prenatal sonographic diagnosis has been described, with findings of a persistently open mouth, echogenic amniotic fluid, and fixed flexion of the extremities.2-5 Here we describe a case of harlequin ichthyosis in which the syndromic features were shown best on three-dimensional (3D) and four-dimensional (4D) real-time sonography. Case ReportThe patient was a 34-year-old woman, gravida 1, para 0, who was transferred from another institution with a history of large gushes of fluid and a diagnosis of preterm premature rupture of membranes at 32 weeks. Despite this condition, the amniotic fluid index at admission was 14, suggesting the possibility of preexisting polyhydramnios. The patient was treated with antibiotics, magnesium sulfate, and steroids. She was a gestational diabetic patient whose disease was controlled well by diet. Her antepartum course was otherwise uncomplicated. Second-trimester double biochemical marker screening results and 20-week sonographic findings were reported as normal. On sonography, the amniotic fluid was noted to be unusually echogenic for 32 weeks. The toes appeared short. Short fingers were more apparent on 3D surface rendering. The upper extremities appeared relatively fixed in position.