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Hyperreactio luteinalis is a condition associated with bilateral and, in rare cases, unilateral ovarian enlargement due to theca lutein cysts. Hyperreactio luteinalis is a benign condition, usually found incidentally at cesarean section, which can appear anaplastic and lead to unnecessary ovarian resection. A 21-year-old Hispanic woman, G2P1, presented at 19 weeks with a singleton pregnancy, bilaterally enlarged ovaries, and a normal beta hCG. Over the next four months, her ovaries increased 75% in size with the right ovary becoming entrapped in the pelvis. The patient underwent a primary low transverse cesarean section. The ovaries had an anaplastic appearance and on frozen section revealed multiple benign theca lutein cysts. There are 51 reported cases of hyperreactio luteinalis associated with a normal pregnancy in the literature. It is estimated that approximately 60% of the cases of hyperreactio luteinalis unassociated with trophoblastic disease occur with normal singleton pregnancy. There are multiple benign ovarian lesions including hyperreactio luteinalis that can mimic ovarian neoplasms. Accordingly, it is important to exclude these from the differential diagnosis via a wedge biopsy and frozen section to avoid unnecessary surgical excision.

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The sonographic diagnosis of a twin pregnancy complicated by acardius anceps of one fetus, total placenta previa, uterine overdistension, and preterm labor is presented and management is discussed. Attempted selective fetocide is described, but was not successful. Clinical management of severe discordant sonographic dysmorphology is discussed, and diagnostic criteria for sonographic diagnosis of acardia are presented.