Cervicoisthmic pregnancy has a high risk of abortion or preterm delivery, and only 11 cases of live birth have been reported since 1980. In addition, almost all cases require blood transfusion and hysterectomy because of profuse bleeding after delivery of the placenta. A 39-year-old nulliparous woman who became pregnant after a fourth intracytoplasmic sperm injection was diagnosed with cervicoisthmic pregnancy on ultrasonography at 6 weeks' gestation. A healthy neonate was delivered by cesarean section at 32 weeks, but hysterectomy and blood transfusion were required. Perinatal management is discussed.

Objective: To investigate the efficacy of a new device for sperm preparation involving migration-gravity sedimentation without centrifugation (MIGLIS), compared with density-gradient centrifugation (DGC) for normozoospermic intrauterine insemination (IUI). Design: Retrospective cohort study. Setting: Not applicable.

It is well documented that maternal morbidity and neonatal morbidity and mortality increase alike in high-order multiple (HOM) births. There have, however, been few reports concerning the costs of maternal and neonatal medical care associated with HOM births. This is the first such report on the situation in Japan. All triplet and quadruplet pregnancies managed at this institution from before 16 weeks' gestation, and delivered at no earlier than 22 weeks' gestation, between 1997 and 2002 were included. Prophylactic cervical ligature, hospitalization to prevent premature labor from 23 weeks' gestation until delivery, and delivery by cesarean section, were all routine for HOM pregnancies. All women with singleton and twin pregnancies, who underwent fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and also delivered their babies at no earlier than 22 weeks' gestation at this institution, between 1997 and 2002, were also examined as controls. Prophylactic cervical ligature, preventive hospitalization, and cesarean section were not routine in the control group. The average gestational ages at delivery in singleton ( = 58), twin ( = 21), triplet ( = 14) and quadruplet ( = 1) pregnancies, were 39.4, 35.6, 31.9 and 25.1 weeks, respectively ( < 0.001 by anova). Birthweights were 2886 ± 425 g, 2117 ± 623 g, 1430 ± 373 g, and 633 ± 77 g (mean ± SD), respectively ( < 0.001). The average inpatient medical care cost for mother and child(ren), from maternal admissions after 12 weeks' gestation to the discharge of all family members from hospital, was ¥703 279 yen (∼US$5861), ¥4 903 270 (∼US$40 861), ¥11 810 327 (∼US$98 419), and ¥44 961 000 (∼US$374 675), respectively ( < 0.001). The present study outlined the high costs of medical care for HOM pregnancies. Not only from a medical viewpoint, but also from the viewpoint of medical costs, it is important to avoid HOM pregnancies as a result of infertility treatment. (Reprod Med Biol 2004;: 159-164).

Objective : Mature cystic teratoma of the greater omentum is a very rare tumor which is difficult to diagnose accurately before treatment, and its origin is not yet clear. We experienced a case of mature cystic teratoma of the greater omentum resected by laparoscopic surgery. Patient : The patient had a history of right salpingo-oophorectomy by laparoscopic surgery because of struma ovarii in another hospital. She was referred to our hospital after transvaginal ultrasonography in follow-up examination revealed recurrence of the tumor. Magnetic resonance imaging findings were suggestive of mature cystic teratoma of the right ovary, but given her right adnexa had been resected we diagnosed her mature cystic teratoma of left ovary. We performed laparoscopic surgery. Intraoperatively the left ovary was normal, and there was no right adnexa. Careful examination of the abdominal cavity showed a 7 cm tumor in the inferior greater omentum. There was no tumor adhesion to the uterus or adnexa, and it was resected easily by a vessel-sealing device. Gross examination showed a tumor consisting of fat and hair, and the pathological diagnosis was mature cystic teratoma of the greater omentum. Conclusion : It is important that ectopic mature cystic teratoma is considered when transvaginal ultrasonography findings are suggestive of tumor. Laparoscopic surgery is useful for the detection of accidental tumor in the abdominal cavity and for the resection of mature cystic teratoma of the greater omentum.