Gynecological and obstetrical aspects of Enterobius vermicularis infection.

Enterobiasis is an easily recognizable and treatable disease with higher incidence among children. Based on these facts, its clinical importance is usually underestimated. This infection also occurs during adulthood and without treatment, it can cause severe complications in some rare cases. Unnoticed subclinical infection in women can lead to infertility and even to life-threatening conditions. It is also emphasized in this paper that the treatment of identified enterobiasis during pregnancy needs caution. After reviewing the current scientific literature, two gynecological cases are presented here.

[Early diagnosis of ectopic pregnancy]. / A méhen kívüli fogamzás korai diagnosztikája.

Ectopic pregnancy is a high-risk condition that occurs in 2% of reported pregnancies. This percentage is fivefold higher than that registered in the 1970s. Since 1970 there has been a two-fold increase in the ratio of ectopic pregnancies to all reported pregnancies in Hungary and in 2012 7.4 ectopic pregnancies per thousand registered pregnancies were reported. Recently, the majority (80%) of cases can be diagnosed in early stage, and the related mortality objectively decreased in the past few decades to 3.8/10,000 ectopic pregnancies. If a woman with positive pregnancy test has abdominal pain and/or vaginal bleeding the physician should perform a work-up to safely exclude the possibility of ectopic pregnancy. The basis of diagnosis is ultrasonography, especially vaginal ultrasound examination and measurement of the ß-subunit of human chorionic gonadotropin. The ultrasound diagnosis is based on the visualization of an ectopic mass rather than the inability to visualize an intrauterine pregnancy. In some questionable cases the diagnostic uterine curettage or laparoscopy may be useful. The actuality of this topic is justified by practical difficulties in obtaining correct diagnosis, especially in the early gestational time.

Prenatal ultrasonographic measurement of the fetal iliac angle during the first and second trimester of pregnancy.

OBJECTIVES: The aim of this study was to present our results of the sonographic measurement of the fetal iliac angle during the first and second trimesters of pregnancy. METHODS: A total of 2168 fetal iliac angle measurements were performed in a transverse section of the fetal pelvis. The iliac angle measurements were compared in fetuses with trisomy 21 (n = 52) and fetuses with normal karyotype (n = 1980). The sensitivity, specificity, positive predictive value, negative predictive value and false positive rate in trisomy 21 fetuses were compared for multiple cut-off value. Statistical significance for measurements was estimated for trisomy 21. RESULTS: A total of 2064 fetuses had adequate images for satisfactory measurement of the iliac wing angle and 1831 patients asked for a genetic invasive procedure. Of the fetuses with chromosomal aberrations, only the fetuses with trisomy 21 were included in the investigation. The risk of trisomy 21 in our population was 1 of 39. In the euploid fetuses, the mean iliac wing angle was 63.72°. The mean iliac wing angle in the fetuses with trisomy 21 was 90.32°, significantly higher than those seen in fetuses with normal karyotype. CONCLUSION: The proven larger iliac wing angle in neonates with Down syndrome can be demonstrated sonographically during the pregnancy, especially in the first and second trimesters. This marker may be useful in prenatal screening or exclusion of trisomy 21.

Risk of chromosome abnormalities in the presence of bilateral or unilateral choroid plexus cysts.

OBJECTIVES: To evaluate the rate of chromosome abnormalities in cases of uni- and bilateral choroid plexus cysts (CPCs). METHODS: A total of 10,875 ultrasound (US) examinations were performed in the second trimester, and 435 cases with CPC (4%) were found. After genetic counseling, 45 patients decided not to undergo karyotyping. The authors performed a chromosome analysis in 390 cases of CPCs. RESULTS: The total risk of chromosome abnormalities was 3.59% (n = 14) and risk of trisomies was 2.05% (n = 8). Trisomy 18 was found in 6 cases (1.54%), trisomy 21 in 1 case (0.26%), and trisomy 9 in 1 case (0.26%). The risk of 45,X karyotype was 0.77% (n = 3). One case of 47,XXY karyotype and 2 cases with other chromosome abnormalities were found. In 212 unilateral cases there were 7 with chromosome abnormalities (3.3%). In 178 bilateral cases there were 7 with abnormal karyotypes (3.93%). The CPC was associated with additional fetal US anomalies (with or without polyhydramnios/oligohydramnios) in 112 cases; chromosome abnormalities were detected in 4 cases (3.57%). 66 cases were associated with polyhydramnios/oligohydramnios but not with other fetal US anomalies; 3 cases of abnormal karyotypes were found (4.55%). The CPC was isolated in 212 cases and 7 cases were associated with chromosome disorders (3.3%). CONCLUSIONS: US plays an important role in prenatal diagnostics. Further genetic counseling is recommended in cases with CPCs.

Prenatally diagnosed fetal brain injuries with known antenatal etiologies.

Periventricular leukomalacia of pre- or postnatal onset is responsible for severe neurological and intellectual impairment and cerebral palsy later in life. The etiology is multifactorial, involving hypoxic-ischemic insults of various origin. The disorder is characterized by multiple necrotic foci of the white matter found most frequently adjacent to the lateral ventricles. In the past, intrapartum factors were thought to be the major cause of neonatal brain damage, but recent investigations highlighted the role of antenatal risk factors. We present 4 cases of antenatally diagnosed brain injury with known and unusual etiology.

[Fetal ischaemic brain injury in the second trimester of pregnancy]. / Magzati ischaemia okozta agykárosodás a terhesség középso harmadában.

Based on clinical, epidemiologic, and experimental studies, the aetiology of white matter damage, specially periventricular leukomalacia (PVL), is multifactorial and involves pre- and perinatal factors. Each of these factors is supposed to be a major precursor for neurological and intellectual impairment, and cerebral palsy (CP) in later life. Antenatal rather than intrapartum factors are now emerging as the major determinants of cerebral palsy. In this case report maternal trauma, benign tumour, severe anaemia and fetal cerebral vascular malformation are supposed as causative factors in intrauterine periventricular leukomalacia resulting from hypoxic-ischaemic injury.

Large gastrointestinal stromal tumor presenting as an ovarian tumor. A case report.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors of the gastrointestinal tract localized mostly in the upper or medial part of the digestion tract. CASE: A colonic GIST in a young woman extended to the pelvis, giving the impression of an ovarian tumor. CONCLUSION: In the case of a pelvic mass, especially if other unusual anamnestic data and signs are present, the possibility of other than a gynecologic tumor has to be considered. Every effort should be made to identify the origin of the tumor and related anatomic structures, especially the ovaries.

Sonographic measurement of the fetal iliac angle in trisomy 21, 18 and 13.

OBJECTIVE: To determine whether iliac wing angle measurement in second trimester fetuses is a useful sonographic marker for the detection of trisomy 21, 18 and 13. METHODS: During the period between September 1998 and September 2001, 406 fetal iliac angle measurements were performed in women in the second trimester of their pregnancies. The iliac angle measurements in fetuses with trisomy 21 (n = 25), trisomy 18 (n = 10) and trisomy 13 (n = 5) were compared with iliac angle measurement in fetuses with normal karyotypes (n = 333). RESULTS: The mean iliac wing angle in the fetuses with trisomy 21 was 92.67 and 79.35 degrees and 74 degrees in fetuses with trisomy 18 and 13 (the mean iliac wing angle in the healthy fetuses was 70.09 degrees ). CONCLUSION: The proven larger iliac wing angle in neonates with Down's syndrome can be demonstrated sonographically during the pregnancy, especially during the second trimester, and may be useful in prenatal screening of trisomy 21. The sonographic measurement of the fetal iliac angle cannot be used as a marker for trisomy 18 and 13. We have shown that fetuses with trisomy 18 and 13, on average, have iliac angles only a few degrees larger than healthy fetuses.

Assessment of uterine circulation in ectopic pregnancy by transvaginal color Doppler.

OBJECTIVE: The aim of our study was to determine the effect of abnormal implantation on uterine circulation and to evaluate whether the assessment of uterinal blood flow can provide additional information for the diagnosis of tubal pregnancies. METHODS: Forty-nine patients with ectopic pregnancy were examined by transvaginal color Doppler immediately before surgery. Resistance and pulsatility indices of blood flow in the uterine and tubal arteries were measured. RESULTS: The blood flow parameters of the uterine and tubal arteries did not change with gestational age. There was a significant increase in blood flow on the side with the tubal gestation. Differences between sides were higher in the tubal arteries than in the main uterine arteries and showed no dependence on gestational age. CONCLUSION: The abnormal implantation and tubal trophoblast invasion in ectopic pregnancy (EP) can cause more marked blood flow changes in the adjacent supplying vessels than in the main uterine arteries.