Rare case of peritoneal complete hydatidiform mole.

A 23-year-old woman, gravida 1, para 1, was transferred to our hospital with acute lower abdominal pain and vital signs consistent with shock. Her urine concentration of human chorionic gonadotrophin was 8000 mIU/mL. Transvaginal ultrasound revealed an echo-free space with mosaic echo pattern in the right adnexal area and no gestational sac in the uterus. With a preoperative diagnosis of ruptured ectopic pregnancy, emergency laparotomy was performed. The rectouterine pouch was filled with many clots containing small amounts of villous tissue. After removal of the conceptus, which was infiltrating into the peritoneum of the Pouch of Douglas, bleeding was controlled by Argon laser. Histological examination of the conceptus by immunohistochemical staining with p57(kip2) showed features of complete hydatidiform mole. This case demonstrates that the peritoneum in the Pouch of Douglas is a possible site of ectopic complete hydatidiform mole occurrence and that immunohistochemical stain is useful to confirm the diagnosis of ectopic complete hydatidiform mole.

Ultrasound evaluation of the amount of Wharton's jelly and the umbilical coiling index.

OBJECTIVES: To investigate the association between the amount of Wharton's jelly (WJ) and the umbilical coiling index (UCI). METHODS: The subjects included 140 pregnant women in the 2nd or 3rd trimester. The antenatal UCI was calculated as the reciprocal of the distance between a pair of coils. The sonographic cross-sectional areas of the cord, arteries and vein were measured. The WJ area was calculated by subtracting areas of the total vessels from the cord. RESULTS: UCIs were significantly smaller and WJ areas were significantly greater in the 3rd trimester than in the 2nd trimester. No correlations were observed between the UCI and WJ area in both trimesters. CONCLUSION: There is a reduction of the UCI during pregnancy. No direct correlations were found between the amount of WJ and UCI.

Atypical variable deceleration in the first stage of labor is a characteristic fetal heart-rate pattern for velamentous cord insertion and hypercoiled cord.

AIM: To evaluate whether various umbilical cord abnormalities, including velamentous, marginal cord insertion (VCI, MCI), hypercoiled cord (HCC) and nuchal cord (NC), affect the appearance of atypical variable deceleration (VD) during labor. METHODS: A cohort study was conducted which included cases with cord abnormalities (314 cases) and without them (487 controls), both of which were delivered in our hospital between June 2005 and December 2006. The relationship between cord abnormalities and the intrapartum fetal heart-rate (FHR) pattern were retrospectively investigated focusing on VD. Analysis of FHR patterns was performed for 30 uterine contractions at the end of the first stage and throughout the whole of the second stage of labor. FHR patterns were analyzed for the presence of VD, atypical and pure VD. The frequencies of each FHR patterns per uterine contraction were assessed. The type of atypical VD was diagnosed in sequence as loss of variability during VD, overshoot, slow return of the FHR to the baseline, VD with no acceleration, and biphasic deceleration. Pure VD was typical VD without signs of atypia. RESULTS: Frequencies of total VDs were significantly high in cases with VCI, HCC or NC in the first stage. Atypical VDs frequently occurred in cases with VCI, HCC and NC, and pure VDs did in cases with NC. In the second stage, frequencies of total and all types of VDs were not different. CONCLUSION: Mainly atypical VD in the first stage was a characteristic FHR pattern for VCI and HCC, and the appearance of such a pattern in cases with antepartum information on these abnormalities could suggest unfavorable fetal status.