high association between trisomy 21 and absence of the nasal bone at firsttrimester sonography (11-14 weeks' gestation) has been established. [1][2][3] The presence or absence of the nasal bone was found to be independent of other maternal or fetal variables and thus may be added to other sonographic markers for prenatal detection of trisomy 21. 3 Bromley et al, 4 later Bunduki et al, 5 and others 6 confirmed a mid-second-trimester (15-22 weeks' gestation) association of an absent or hypoplastic nasal bone and trisomy 21. In addition, an absent nasal bone at the 11-to 14-week sonographic scan has been associated with other fetal aneuploidies. 7,8 Cicero et al 7 reported an absent nasal bone in 161 (66.9%) of 242 fetuses with trisomy 21, 48 (57.1%) of 84 fetuses with trisomy 18, 7 (31.8%) of 22 fetuses with trisomy 13, 3 (8.8%) of 34 fetuses with 45,XO, and 4 (8.3%) of 48 fetuses with other aneuploidy defects (XXX, XXY, XYY, and triploidy). The association of an absent or hypoplastic nasal bone and aneuploidies other than trisomy 21 was confirmed by Odibo et al 8 We report a case in which sonographic depiction of an absent nasal bone at 20 weeks' gestation led to amniocentesis and the detection of a fetus with cri du chat (5p-) syndrome.

cervical pregnancy is an uncommon ectopic pregnancy that accounts for less than 1% of such gestations. 1 This condition is associated with an extremely high risk of massive hemorrhage and previously often required hysterectomy. 1 The current diagnostic modality of this potentially lifethreatening condition is transvaginal sonography, supported at times by magnetic resonance imaging. [2][3][4] The definitive diagnostic imaging feature of a cervical pregnancy is the location of a gestational sac in the cervix in the presence of a closed internal uterine cervical os. [2][3][4][5][6][7] We report the 3-dimensional transvaginal sonographic findings of a cervical pregnancy at 6 weeks' gestation.Received August 8, 2007, Case ReportA 34-year-old woman, gravida 3, para 0, came to the emergency department at State University of New York Downstate Medical Center with mild uterine hemorrhage. Her medical history was unremarkable. The patient had 2 previous spontaneous first-trimester miscarriages. Physical examination revealed a healthy individual. She was afebrile with a blood pressure of 120/78 mm Hg, a pulse of 84 beats per minute, and a respiratory rate of 20 breaths per minute. Her abdomen was soft and nontender, with no peritoneal signs elicited. Bimanual pelvic examination disclosed a soft, mildly enlarged uterus. Both adnexa were normal. The cervix was long and closed and appeared boggy on inspection.Laboratory test results revealed a hemoglobin level of 13.6 g/dL, a hematocrit value of 42%, a white blood cell count of 7.29 × 10 9 /L, and a platelet count of 255 × 10 9 /L.

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CASE REPORTA 21-year-old woman, gravida 1 para 0, presented to the emergency room at State University of New York, Downstate Medical Center with right lower abdominal pain radiating to her back, and nausea and vomiting, 3 days after surgical termination of pregnancy at 14 weeks' gestation. Her medical history was unremarkable. The patient denied a history of sexually transmitted disease, and her recent cervical cytology was normal. Three days before presentation the patient had undergone an elective outpatient termination of pregnancy by dilatation and suction curettage. The presence of a 14-week intrauterine gestation had been confirmed by ultrasound scan before the procedure. The preoperative ultrasound examination did not reveal any abnormal uterine findings, including any evidence of uterine leiomyomata. The patient had been told that the procedure, which was not performed under real-time ultrasound guidance, was uneventful. She was given routine oral antibiotics (doxycycline 100 mg twice daily for 5 days and methergine 0.2 mg twice daily for 2 days). An immediate postprocedure ultrasound examination was not obtained following the termination of pregnancy.Physical examination on presentation revealed a healthy woman. She was afebrile, with blood pressure 103/66 mmHg, and pulse 82 beats per min. Her abdomen was soft, yet with marked tenderness of the lower abdomen but no signs of peritoneal irritation. Bimanual pelvic examination disclosed a soft tender uterus enlarged to 8 weeks' size. Both adnexa were normal. The cervix was long and closed yet motion tenderness was present. Laboratory results revealed a hemoglobin level of 10.3 g/dL, hematocrit 29.9%, a white blood cell count of 9.64 × 10 9 d/L and a platelet count of 227 × 10 9 d/L. Serum creatinine, blood urea nitrogen, electrolyte levels, prothrombin time and partial thromboplastin time were normal, and the serum betahuman chorionic gonadotropin (beta-hCG) level was 5651 mIU/mL. Transvaginal ultrasonography showed an acutely retroflexed uterus with a normal endometrial echo. Both adnexa were normal. No free fluid was noted in the cul-de-sac. A 5 × 5-cm, well circumscribed mass with a hypoechoic center was noted in the anterior aspect of the lower uterine segment (Figure 1). Color Doppler imaging

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Short umbilical cords are associated with fetal anomalies, often including those with decreased or absent fetal movement, fetal akinesia/hypokinesia sequence, and restrictive dermopathies and aneuploidy. In normal fetuses, abnormally short umbilical cords have been associated with an increased risk of umbilical vessel hematomas, thrombosis, rupture, thrombocytopenia, cord compression, variable fetal heart rate decelerations, instrumental and operative deliveries, and fetal demise. We report a 24-year-old gravida 2, para 0 with a concordant dichorionic twin gestation, at 26 weeks' gestation, in whom sonography depicted fetuses with normal-appearing anatomy as well as short umbilical cord of the 1st twin. Increased fetal surveillance was conducted. Following delivery at 36 weeks' gestation, the presence of a short umbilical cord of the 1st twin measuring 19 cm was confirmed. Systematic review of the literature confirms that this is the first report of prenatal diagnosis of a short umbilical cord in an otherwise normal fetus.

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