Prompted antenatal detection of gastrointestinal tract obstruction using ultrasound proved to be diagnostic in all cases. Fetal MRI aid was a useful complementary diagnostic investigation. Correct pre-natal diagnosis allows adequate counseling, delivery planning and management care by a multidisciplinary team.

A 20-year-old nulliparous woman was referred due a cervical mass in the fetus in an ultrasound examination performed in the 25th week of pregnancy. The exam revealed an irregular, solid-cystic heterogeneous mass measuring 75x54 mm that came to the exterior through the mouth of the fetus. Three-dimensional ultrasound and magnetic resonance imaging confirmed the diagnosis of epignathus teratoma and the normal finding of the central nervous system. The patient was admitted at 28 weeks, in premature labor. Tocolysis, corticosteroid and amniotic fluid drainage were programmed to be performed before conducting ex utero intrapartum treatment (EXIT). However, there was premature rupture of membranes and the EXIT procedure was brought forward. After premature placental abruption, the newborn's birth was concluded. Tracheostomy was performed, but the newborn's condition progressed to bradycardia and death in a few minutes.

A Pilot Studyany physiologic alterations observed during pregnancy result from a combination of hormonal and mechanical factors that may cause changes to the pelvic floor 1,2 ; these changes contribute to pelvic floor dysfunction irrespective of the type of delivery. 3,4 The physical changes during twin pregnancy are more pronounced, with greater compression of the abdominal organs and higher elevation of the diaphragm than in singleton pregnancy. 5 Nevertheless, few studies have evaluated how twin pregnancy affects the pelvic floor. Studies by Goldberg et al, 6 Legendre et al, 7 and Cuerva González et al 8 revealed higher rates of stress urinary incontinence after twin deliveries; however, to our knowledge, no studies have directly evaluated the pelvic floor during pregnancy. Kubotani, MD, Edward Araujo Júnior, MD, PhD, Miriam Raquel Diniz Zanetti, PhD, Jurandir Piassi Passos, MD, Zsuzsanna Ilona Katalin de Jármy Di Bella, PhD, Julio Elito Júnior, PhD Received August 12, 2013, Objectives-The purpose of this study was to compare the morphologic characteristics of the pelvic floor musculature between women with twin and singleton pregnancies. Juliana SayuriMethods-We conducted a cross-sectional case-control study of 40 nulliparous women aged 20 to 38 years to compare women with singleton pregnancies (n = 23) to women with twin pregnancies (n = 17). Biometric measurements of the levator hiatus and the sagittal and coronal diameters were made by transperineal 3-dimensional sonography between the 28th and 38th gestational weeks. Comparisons were statistically assessed by the unpaired Student t test and Mann-Whitney U test.Results-For the women with singleton pregnancies, the mean sagittal diameters at rest, during the Valsalva maneuver, and during pelvic floor contraction were 5.3, 5.7, and 4.5 cm, respectively, and the mean coronal diameters under these conditions were 3.8, 4.1, and 3.6 cm. For the women with twin pregnancies, the corresponding values were as follows: mean sagittal diameters, 5.3, 5.8, and 4.6 cm; and mean coronal diameters, 4.3, 4.3, and 3.8 cm. The differences in coronal diameters were statistically significant at rest (P < .01) and during contraction (P = .04). The mean levator hiatal areas for the women with singleton pregnancies were 14.6, 16.9, and 11.7 cm 2 at rest, during Valsalva, and during contraction, respectively; for the women with twin pregnancies, these values were 16.0, 18.6, and 12.6 cm 2 .Conclusions-Hiatal measurements were higher in twin than in singleton pregnancies, with coronal diameters reaching significance at rest and during contraction, suggesting that pelvic support undergoes greater changes during twin pregnancy.

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A case of prenatally diagnosed otocephaly is reported. Otocephaly is an extremely rare malformation characterized by absence or hypoplasia of the mandible and abnormal horizontal position of the ears. 2D ultrasound performed at 25 weeks of gestation revealed agnathia, proboscis and hypotelorism. 3D ultrasound (rendering mode) and magnetic resonance imaging were used to evaluate the facial features, and were essential for characterization of facial malformations in otocephaly and for the demonstration and correct prenatal counseling of the couple.