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Transvaginal sonography (TVS) enables sex determination at an early stage of pregnancy. The morphologic features of fetal external genitalia at 13 weeks to 16 weeks, menstrual age, are different from those seen later in pregnancy; therefore an attempt to determine fetal gender at this early stage by the same criteria as those used later is hazardous, especially for determining the male sex. The main diagnostic criteria for male gender determination by TVS are the "dome" sign representing the sonographic visualization of the fetal scrotum, the cranially directed phallus, and the longitudinal raphe at the base of the penis. The diagnostic criteria for female gender are the 2 or 4 parallel lines representing the labial folds and the caudally directed phallus (clitoris). The length of the fetal phallus at this early stage is not diagnostic and may be the main pitfall to the unexperienced sonographer. Between weeks 13 and 14 sex diagnosis was possible in 130/171 pregnancies (76%) in our first 2 years and 188/235 (80%) in our last 2 years of experience. Between weeks 15 and 16 sex diagnosis was possible in 122/139 pregnancies (88%) during our first 2 years and 96.7% (528/546) during the last 2 years of experience. The accuracy rate for fetal male gender identification increased from 91.7% during the first 2 years of TVS experience to 99.7% during the last 2 years of TVS experience, and the accuracy rate for female gender identification, increased from 93.3% to 100%, respectively, applying the above criteria and based on acquired experience of early fetal sex identification by TVS early in gestation. Early and precise determination of fetal sex is possible and might avoid invasive procedures such as amniocentesis.

A previous retrospective study has found an increased risk of uterine cervical atypia in women with systemic lupus erythematosus (SLE) who have been treated with cytotoxic drugs. Our objective was to prospectively reveal any increased incidence of cervical atypia in SLE patients and to evaluate the relationship to previous chemotherapy. A total of 39 SLE women were prospectively referred for cytologic PAP smears of the uterine cervix. A significantly higher incidence of cervical atypia was found in SLE women (35.9%) compared with non-SLE control groups (< or = 5%; P < 0.01). No significant difference was found between the incidence of atypia in patients previously treated by cytotoxic medications such as cyclophosphamide pulses or methotrexate (4 of 9) compared with SLE women not receiving cytotoxic drugs (10 of 30). Colposcopically directed biopsies revealed three cases of cervical intraepithelial neoplasia (CIN) I-III (23%) among the cases with atypia. We conclude that women with SLE should have regular cytologic cervical smears because of a significantly increased incidence of atypia, regardless of previous cytotoxic therapy.

Urinary tract anomalies are common. Prenatal diagnosis is important and enables either special obstetric management or termination of pregnancy and probably in the future, intrauterine intervention. Transvaginal sonography (TVS) allows visualization of the normal and anomalous fetal urinary tract at an early stage. One thousand nine hundred and forty women were examined via TVS at an early stage of pregnancy between 10 and 16 weeks from the last menstrual period (LMP) and 35 anomalies (1.8 per cent) were clearly identified: 29 cases of low urinary tract obstruction, 2 cases of multicystic dysplastic kidney, 2 cases of polycystic kidney (infantile type), 1 case of double collecting system, and 1 case of horseshoe kidney. Potter syndrome could be ruled out in three patients who had delivered fetuses suffering from this anomaly in previous pregnancies. The concise and early identification of anomalies makes TVS an important aid in the hands of the obstetrician, ultrasonographer, and neonatologist.

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