Natural history of fetal renal pyelectasis.

OBJECTIVE: To follow the natural progression of fetal renal pyelectasis detected in the mid second trimester ultrasound in an unselected obstetric population. STUDY DESIGN: Single-centered, retrospective study that included all level II ultrasounds done from Jan 2008 to Dec 2009. The initial level II ultrasound was done in the mid second trimester. The renal pyelectasis detected on the antenatal ultrasound (AUS) was classified as mild (5-7 mm), moderate (7.1-9 mm), or severe (>9.1 mm). Postnatal outcomes were classified as "Resolved", "Improving", or "Worsened". RESULTS: Ninety-eight cases of fetal renal pyelectasis were detected. Sixteen patients were excluded. Of the remaining 82 cases of fetal pyelectasis, 32 (39%) were mild, 21 (25.6%) moderate, and 29 (35.4%) severe. In 74 (90.2%) infants, pyelectasis resolved, remained stable, or improved in the postnatal ultrasound. In eight (9.8%) infants, pyelectasis worsened. CONCLUSION: Totally, 90.2% of pyelectasis detected on AUS resolved spontaneously, remained stable or improved. The magnitude of fetal renal pyelectasis did not correlate with postnatal outcome. All fetal renal pyelectasis ≥ 5 mm detected on the mid second trimester ultrasound should be followed antenatally. Those fetuses with persistent pyelectasis should be evaluated after birth and followed until resolution of pyelectasis or until a diagnosis is obtained.

Accurate preoperative diagnosis of ovarian pregnancy with transvaginal scan.

Ovarian pregnancy is a rare variant of ectopic pregnancy, and an accurate preoperative diagnosis is very challenging. Dr. Saint Monnissey described the first reported case of ovarian pregnancy in 17th century. Transvaginal ultrasonography is a valuable tool in identifying an ovarian pregnancy from other types of ectopic pregnancies. Management with laparoscopy or laparotomy is required in all cases, and in almost all cases, ovary can be preserved since implantation is usually superficial (Koo et al.; 2011). A single case of an ovarian pregnancy, consistent with Spiegelberg's criteria is presented here. This case history demonstrates the use of ultrasonography (USG) and surgery in the diagnosis and treatment, respectively, of the ovarian pregnancy. As we step into an era where in vitro fertilization rate is on its hike, one should be aware that incidence of ovarian pregnancy is also increasing, necessitating a high index of suspicion.