John Langdon Down (1828-1896) described Down’s syndrome with 3 characteristics: the skin too loose for the body, flat face, and small nose.Every woman has a risk of having a baby with Down’s syndrome which depends on her age and the history of having a previous Down’s baby (background or priori risk). Diagnosis of fetal chromosomal abnormalities requires invasive testing by amniocentesis or chorionic villous sampling (CVS), both of which have a risk of miscarriage of 1%. The risk for trisomy 21 increases with maternal age and decreases with gestational age because about 30% of affected fetuses die between the 12th and 40th week of pregnancy. However the vast majority of pregnant women are young, therefore most of Down babies are in the younger age group. Screening in the second TRIMESTER by maternal age and various combinations of total or free b-hCG, AFP, uE3 and Inhibin A can identify 56-71% of trisomy 21 pregnancies for a false positive rate of 5% (Meta-analysis by H Cuckle, P Penn and D Wright, Semin Perinatol 2005; 29: 252-7). Screening in the FIRST TRIMESTER by a combination of maternal age, fetal NT, FHR and serum free b-hCG and PAPP-A identifies about 90% of trisomy 21 pregnancies for a false positive rate of 3%. By adding other ultrasound markers: nasal bone, tricuspid regurgitation, ductus venosus Doppler and facial angle, the detection rate of 1st TRIMESTER screening increases to more than 95%.

INTRODUCTION: Abortion is the commonest complication of pregnancy and vaginal bleeding is the commonest complaint of patients within the FIRST TRIMESTER of pregnancy. Obtaining assurance about the health of fetus heart and the product of pregnancy lowers the risk of abortion. Unfortunately, there is no reliable way of predicting the outcome of pregnancy in patients with threatened abortion. Levels of CA-125, a glycoprotein of coelomic origin, rise in the FIRST TRIMESTER of pregnancy, especially in the presence of vaginal bleeding. This study was conducted to determine the efficacy of maternal serum CA-125 in predicting the outcome of pregnancy.METHODS: The extent, to which CA-125can serve as a predictor of the outcome of pregnancy, has been investigated in this study.CA-125 levels were measured in 100 women who were 8-12 weeks into their pregnancy and presented to the Emergency Services of Alzahra and Shahid Beheshti Hospitals with vaginal bleeding. The presence of fetal heart beat was demonstrated by ultrasonography. These women were followed up until the 20th week of pregnancy for abortion. Findings were analyzed with t-test and Kurscal-Wallis test using SPSS.RESULTS: The mean age of pregnancy and CA-125 level in the population under study was 9.54±1.32 weeks and 48.10±23.24Ulml, respectively. CA-125 levels in the abortion and nonabortion groups measured 73±24 U/ml and 42.4±17.52 U/ml, respectively, showing a statistically significant difference between the two groups. Eta correlation coefficient showed a strong correlation between elevated CA-125 levels and the likelihood of abortion. The CA-125 test had a sensitivity and specificity of 100% and 44.4%, respectively, at a concentration of 35 U/ml.DISCUSSION: Based on the findings of this study, CA-125 levels can be used to predict the outcome of pregnancy in patients with threatened abortion.

Introduction: Rudimentary horn pregnancy (RHP), an entity with a diagnostic dilemma is known to rupture most commonly in second TRIMESTER, sometimes in early third TRIMESTER. This case of ectopic rudimentary horn (RH) presented acutely in the FIRST TRIMESTER.Case Presentation: A 30 years old G3P2L2 with previous two vaginal deliveries presented with acute abdominal pain and features of hemorrhagic shock at 8 weeks 5 days gestational age. With clinical diagnosis of ruptured ectopic pregnancy, the patient immediately underwent laparotomy, which revealed hemoperitoneum with a unicornuate uterus along with ruptured RHP. RH excision with ipsilateral salpingectomy and right tubal ligation was done and the maternal life salvaged.Conclusion: High index of suspicion based on clinical history and examination complemented with diagnostic radiological modalities can help in prenatal and pre-rupture diagnosis of RHP, hence its prompt treatment to alleviate scope of any emergency situation and the disastrous consequences leading to maternal morbidity and mortality.

Background: A significant number of pregnancies, particularly in women with previous histories of infertility, are associated with fetal abnormalities. Methods such as the nuchal translucency (NT) measurement enable us to identify more pregnancies with chromosomal abnormalities.Materials and Methods: This analytic cross-sectional study was performed in 446 pregnant women at 11-14 weeks gestation, from 2009 to 2010 in the Fetal Medicine Unit of Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences. All NT measurements were performed by a certified sonographer using the Fetal Medicine Foundation (FMF) recommended protocol. FMF FIRST TRIMESTER software was used for primary and secondary (adjusted) risk calculation.Results: The average maternal age was 28.5 years and 15% of mothers were ³35 years of age. The average crown rump length (CRL), gestational age and NT thickness were 61.7, 12.4 weeks and 1.75 mm, respectively. There were 20 cases with increased adjusted risk (4.04%) and 4 cases of documented abnormal karyotype.Conclusion: In our study increased adjusted risk was 4.04%.Documented abnormal karyotype were 0.9% and 28% of total and high-risk groups who accepted amniocentesis, respectively. In this study, 50% of women with high-risk results and about half of those with abnormal karyotypes were seen in women under age 35. Knowing these risks is of utmost importance in pregnancy, particularly in patients with infertility histories.

Introduction & Background: Screening for Down syndrome is one of the oldest and most commonly used is-sues of prenatal screening. The aim of the screening is to select those cases who are at high risk for Down syn-drome and justify an invasive prenatal diagnostic procedure on them. The most significant advancement in FIRST TRIMESTER ultrasound screening has been the recognition of nuchal translucency (NT) as a potent marker for fetal aneuploidy. NT test is the most effective prenatal screening test to identify those at risk for trisomy 21. If NT levels increase above the 95th percentile (up to 3.4mm), the chance for a healthy baby will be decreased remarkably by combining sonographic findings and measurements of biochemical markers (Free BHCG, PAPP-A). An improvement in prenatal screening for chromosomal defects has also been achieved in recent years. These techniques altogether provide a detection rate of 90 % for the most important chromosomal anomaly (i.e Down syndrome) with the false positive rate of 5%. Meamwhile in cases of trisomy 21, nasal bone is not visible at the end of FIRST TRIMESTER. Combining the delay in nasal bone formation with other FIRST trimes-ter screenings, detection rate of trisomy 21 may increase to 97% and the false positive rate decline to 3%.