Becausesonography is nowcapable of achieving increased resolution, ovarian tumors are more fre quently found in early pregnancy. In this case, we describea patientin the secondtrimester with ovarian endometriosis, which enlarged and was accompanied by structural changes inside the tumor. Case ReportA 28-year-old primigravidawas first seen in our antenatal clinic at 5 weeks of gestation. She had a history ofovarian endometriosis and had been treated with a gonadotropin-releasing hormone analogue before the pregnancy. A sonographic examination showed an intrauter me gestationsac and a right ovariantumor.The tumor was a unilocular cyst with fine in ternal echoesand a maximum diameter of 45 mm (Fig. 1A). Because the patient had a his tory of endometriosis, the tumorwasbelieved to represent an endometrial cyst and was treated conservatively.At 16 weeks ofgestation, sonographic exam ination revealeda fetus appropriatefor the ges tational age and showed an increase in size of the ovariancyst, which had reacheda maximum diameter of 85 mm. On transvaginalsonogra phy, irregularhyperechogenicrepresentingpap illary excrescences structures were seen inside the cyst. Color-flow Doppler sonography de picted vascularity within the solid irregular ar eas (Fig. 1B). These sonographic changes became more remarkable at i8 weeks of gesta flon. For further evaluation of a possible malig nancy, MR imaging was performed.The high signalintensityon TI-andT2-weightedimages was in the cystic portion of the tumor, suggest ing blood products. The solid portion was dark on Tl-weighted images and bright on 12-weighted images, suggesting malignancy that may have arisenfrom the endometriosis (Figs. lCand lD).On exploratory laparotomy performed at 20 weeksof gestation,a right ovariantumor adher ingtotheposterior wall ofthe uteruswasfound. A smallamountof asciteswasalsonoted.The tumor, which contained chocolatelike bloody fluid,hadalreadyraptured. After suctioning the fluid from the tumor, a right salpingo-oophorec tomy was performed.Papillaryexcrescences werefoundprotruding intothelumenof thetu mor. Final histopathologicexamination re vealed ovarian endometnosis with marked decidual changes and hemorrhage and without evidenceof malignancy (Fig. 1E). The patient recovered promptly and delivered a 3704-g healthymale infant at 40 weeksof gestation. during human pregnancy;thus, we did not use this contrast material in our patient. The clinical findings were indicative of malig nancy;however,final histopathologic exami nation of the tumor merely revealed solid tissue representing massive decidualization and hemorrhage. To our knowledge, ovarian endometriosisincreasingin size and accom panied by marked decidual bleeding during pregnancyis a rareoccurrence. The malignant transformation of endometri osis has been well documented, and persistent estrogenic stimulation has been implicated as a cause [4,5]. Becauseof this,ovarianendometri osis in pregnant women should be treated with special attention to structural changes that occur during pregnancy. Disc...

Objectives: To compare the utility of maternal serum human chorionic gonadotropin (MShCG) levels with that of uterine artery Doppler study in predicting small for gestational age (SGA) birth and pregnancy-induced hypertension (PIH). Methods: MShCG assay and uterine artery Doppler study were performed in 359 consecutive pregnant women with singleton pregnancies. MShCG levels ≧2.0 multiples of the median at 15–18 weeks’ gestation were considered to be elevated. An abnormal uterine artery Doppler velocimetry at 21–24 weeks’ gestation was defined as a mean pulsatility index above the 95th percentile or the presence of an early diastolic notch in either uterine artery. The predictive values of MShCG levels and uterine artery Doppler velocimetry were evaluated for the risk of SGA birth and PIH. Results: Forty-one subjects gave birth to SGA infants, and 20 developed PIH. Patients with MShCG elevation or abnormal uterine artery Doppler velocimetry showed a significantly higher incidence of SGA infants than the controls. The sensitivity and specificity of MShCG elevation for SGA birth were 17.1 and 93.4%, respectively, compared with abnormal uterine artery Doppler velocimetry, which had 24.4 and 94.3%, respectively. There was no significant difference between these methods. Elevated levels of MShCG and abnormal uterine artery Doppler velocimetry were not associated with PIH. Conclusion: Elevated levels of second-trimester MShCG were as sensitive and specific in predicting SGA births as abnormal uterine artery Doppler velocimetry.