Neural tube defects are a heterogenous group of malformations resulting from failure of neural tube closure during early embryogenesis. Anencephaly is the commonest form of neural tube defect and results from failure of closure of the anterior portion of the neural tube. Anencephaly is characterized by absence of the cranium along with cerebral hemispheres that are rudimentary or absent and risk of recurrence after affected child is 2-3%. Periconceptual folic acid intake may decrease the incidence and recurrence of anencephaly.

Most often, anencephaly is discovered by conventional two-dimensional ultrasonography at the time of attempted biparietal diameter determination for fetal age in the second trimester. Two-dimensional transvaginal ultrasonography has a limitation in a motion of the transducer shaft due to narrow space of the vagina. It is sometimes impossible to obtain information of the whole brain and to miss the fetal CNS(central nervous system) anomalies. Recent advanced three-dimensional ultrasonography has remarkably improved not only surface rendering but also multiplanar analysis of internal structure.

Recently, we encountered one case of recurrent anencephaly that had occurred in a same pregnant woman and three-dimensional transvaginal ultrasonography enabled us to diagnose anencephaly at 11³ weeks of gestation. We report this case with brief review of the literatures.

This study has been composed of 5 cases of cordocentesis between 21 and 34 weeks of gestational age from February 1997 to January 1998 at the Ehwa Medical Center. Indications for cordocentesis were as follows : 1) rapid karyotyping 2) evaluation of hematologic status 3) intrauterine infection 4) evaluation of fetal acid-base status. The most common indication for cordocentesis was rapid karyotyping of fetal chromosome. All cases of this study were successful. In conclusion, cordocentesis is a safe and very useful procedure for evaluating fetal status.

Down syndrome is the most common autosomal abnormality disease which has multiple congenital anomalies, occurring in 1 of every 800 liveborn infants. Neonates who are affected with this disease comprise majority of the mentally retarded children. To prevent the birth of this congenital anomaly, prenatal diagnosis of Doen syndrome is important. We experienced a case of Down syndrome, diagnosed by fluorescence in situ hybridization(FISH) in pregnancy for 15 weeks 6 days. We report here eith a brief review of the literatures.

We reviewed IUI(28 cases), IPI(5 cases), POST(4 cases), GIFT(6 cases), performed in EWHA Woman's University Hospital from 1988 March to 1993 June. And the results were as follows.

1) The mean ages of patients were 29.9±3.7(IUI), 30.7±2.6(IPI), 29.3±1.2(POST), 30.3±4.3(GIFT) and the durations of infertility were 3.7±1.9(IUI), 3.0±1.9(IPI), 2.3±0.9(POST), 3.4±1.7(GIFT) years.

2) The major causes of infertility in IUI were tubal factor(9 cases), unexplained infertility(5 cases), in IPI and IUI tubal factor was 2 cases, and in GIFT, unexplained in fertility was 5 cases.

3) The major method of ovulation induction was clomiphene citrate in IUI, and FSH/hMG in IPI, POST and GIFT.

4) The result of pregnancy were 2 cases in IUI(7.1%), 1 case in IPI(20%), POST 1 case(25%), and 2 case in GIFT(33.%).

Diffuse pulmonary Iymphangitic involvement secondary to cervical carcinoma is a rare form of pulmonary metastatic disease. A patient with recurrent squamous cell carcinoma of cervix presented with rapid deterioration with marked respiratory symptoms suggestive of pulmonary embolism and right heart faiure, with which the disease is often confused.

Pulmonary Iymphangitic spread of the cancer was found postmortem. The pathogenesis of pulmonary Iymphangitic carcinomatosis is reviewed and diagnostic evaluation discussed.

The diagnosis of cervical incompetency is routinely accomplished by reviewing the clinical history and pelvic examination subjectively. Rescently by using ultrasonography. the objective method in diagnosis of cervical incompetency was developed. Especially, the transvaginal sonography can provide clear visualization of uterine cervix with an empty bladder without distrosion of cervix which was developed when abdominal sonography with distended bladder.

So author performed the study in 46 cases of pregnant women of which menstrual age was 12 weeks to 36 weeks(normal control group 36 cases, risk group 11 cases) during the period of May, 1992 to Febburary, 1993. And these two groups were performed trasvaginal sonography and measured length and diameter of cervix.

And the result were follows ;

1) The mean age was higher in risk group than normal control group, the gestational age was not significantly different between two groups, and the gravity and parity was higher in risk group than normal control group.

2) As measuring the length and diameter of cervical canal by transvaginal sonogram in nullipara and multipara in normal control group, each measurements were not significantly different between nullipara and multipara.

3) The mean length of cervix by transvaginal sonography was 3.0±0.97cm in risk group, 4.7±0.89cm in normal control group and the cervical length was significantly shorter in risk group than normal control group(P<0.01).

4) The mean diameter of cervix by transvaginal sonogram was 2.0±0.37cm in risk group, 0.5±0.21cm in normal control group and the diameter of cervix was significantly greater in risk group than normal control group(P<0.01).

Transvaginal sonographic measurement of cervical length and diameter in diagnosis of incompetent internal os of cervix is noninvasive and relatively objective method.

We have reviewed 35 cycles in 27 patients who underwent IVF and ET with reasonable indications from March 1992 to February 1993. The method of ovarian hyperstimulation were FSH/hMG/hCG(N=10), GnRH agonist(N=24), C.C./hMG/hCG(N=1).

The results were as follows ;

1) The mean age of patients was 33.04±4.17 and mean duration of infertility was 5.52±3.37 years.

2) Major indications for IVF and ET were tubal factor(77.80%), peritoneal factor(18.50%), and unexplained infertility(3.70%).

3) In the past history of patients, there were previous ectopic pregnancy in 5 cases(17.24%), previous tuboplasty in 5 cases(17.24%), pevic inflammatory disease in 4 cases(16.00%), and tuberculosis in 3 cases(12.00%).

4) The cancellation was only one case in FSH/hMG/hCG group.

5) The timing of hCG administration in FSH/hMG/hCG group was 9.56±1.50 day and GnRH-a group was 9.17±0.99 day.

6) The mean numbers of follicles larger than 16mm were 6.78±4.71 in FSH/hMG/hCG group and 5.33±3.82 in GnRH-a group.

7) The mean numbers of oocyte aspirated were 6.44±3.17 in FSH/hMG/hCG group and 5.54±2.27 in GnRH-a group.

8) The fertilization and cleavage rate was 59.93±33.91% in FSH/hMC/hCG group and 57.61±30.81 in GnRH-a group.

9) The mean number of embryos transfered were 4.56±3.69 in FSH/hMe/hCG group and 3.38±2.10 in GnRH-a group.

10) Pregnancy rate were 22.2% in FSH/hMG/hCC group and 25% in GnRH-a group.

11) There were 8 cases of pregnancies which consisted of two live births of 3 babies, 3 cases of ongoing pregnancies, one spontaneous abortion, two chemical pregnancies.

We experienced a case of trisomy 16 discovered with missed abortion in pregnancy achievedby IVF-ET. Spontaneous abortion rate after IVF-ET was higher than normal pregnancy. Chro-mosome anomalies had been reported in spontaneous abortions after IVF-ET. We had attempted to karyotype which miscarriged gestational 8 weeks, and the result was found trisomy 16.So we reported the case with a brief review of literatures.

No abstract available.

An interstitial tubal pregnancy is a gestation occuring in the itramural porion of the endosalpinx. Its incidence is estimated to about 2.5% of all gestations. Symptoms and signs of interstitial pregnancy cannot be differentiated from the symptoms and signs of other ectopic pregnancies. Unruptured interstitial gestations are usually diagnosed incidental to the work-up of a suspected ecropic gestation. Ultrasoundl and diagnostic laparoscopy will aid in establishing the correct diagnosis. We present a case of unruptured interstitial pregnancy with brief review of litarture.

The principle of sonography depends on the transmission of a pulsed sound beam through a particular area of the body and on the interpretation of echo pattern produced from interfaces of tissues with different acoustic impedances or densities. Then it is limited to frequencies in the range from 1 to 20 million cycles/sec. in clinical practice. Real time examination provides many sonographic informations. Namely, determination of gestational age without an accurate last menstrual period is difficult, but the correlation between fetal biparietal diameter by ultrasound and gestational age is compromised by normal biologic variation in fetal growth rates. It is possible to estimate fetal weight with reasonable accuracy by meansuring biparietal diameter and abdominal circumference. Ultrasound scanning is also helpful in differential diagnosis of pelvic masses. So, ultrasound as a non-invasivd iagnostic tool has a wide variety of practical applcations which are extremely useful in obstetrical and gynecological practice.

Choriocarcinoma arises sometimes after hydatidiform mole, occasionally after abortion, and rarely after normal term pregnancy and ectopic pregnancy. Recently we had the opportunity to observe 26-year-old female patient who had choriocarcinoma following term pregnancy. In this paper, we report a case of choriscarcinoma following term pregnancy with a brief review of related literature.