The Second Trimester scan is the most important sonographic evaluation during pregnancy. The Second Trimester ultrasound examination is not only for confirming gestational age but also it provides an ideal opportunity for assessing fetal anatomy and therefore structural normality. In addition, assessment of placental position and morphology, amniotic fluid volume, number of fetuses, evaluation of soft markers for chromosomal defects and the comparative interpretation of various measurements are all important pointers to potential problems. This examination is commonly referred to as a „routine Second Trimester anomaly scan‟. The optimal time at which to offer the routine anomaly scan is the earliest gestation at which the necessary measurements and a full fetal anatomy survey can be performed and the latest gestation at which an acceptable range of options can be offered to the parents if an abnormality is detected. Although the measurements required to date the pregnancy accurately can be taken after 15 weeks of gestation, and most of the fetal anatomy can be evaluated at 18–20 weeks, the optimal time for examination of fetal heart can be provided at 23-28 weeks. It is recommend that the routine anomaly scan is performed between 20 and 24 weeks but we recommend anomaly scan to be done before 20 weeks (18-20 weeks) in Iran as we have limitation for legal termination if needed. Although it is necessary to examine the entire fetus and other uterine contents in detail, it is not always feasible to do this in the order suggested. It is suggested that the measurements are always carried out early in the examination so that they are not forgotten. It is not reasonable to expect all structural fetal abnormalities amenable to ultrasound detection to be diagnosed at a routine Second Trimester anomaly scan. Though if the approach is systematic then no major structural abnormality should be missed. However there are several examples from anomalies such as microcephaly which might be missed in Second Trimester scan if there is no serial examination. In the majority of normal pregnancies, measurement of the biparietal diameter (BPD) and femur length (FL) provide the most accurate assessment of gestational age in the Second Trimester. It is recommended that measurements of the head circumference (HC), transcerebellar diameter (TCD) and abdominal circumference (AC) are also undertaken. They provide further confirmation of gestational age and aid in the exclusion of growth related abnormalities and spina bifida. In addition, their inclusion encourages a systematic examination of the whole fetus. An ultrasound examination is in the unique position of being both a screening test and a diagnostic test for fetal anomalies. Its clinical value is directly dependent on the skills of the sonographer, first, in obtaining the correct images for evaluation and measurement and, Second, in the correct interpretation in each specific and unique clinical situation. Such examinations must only be performed by individuals who have undergone a supervised period of training that enables them to identify and distinguish between the range of normal findings, findings of uncertain significance and abnormalities at varying stages of gestation.

Background: To compare the umbilical cord diameter (UCD) at early Second Trimester (at 17– 19 weeks of gestation) in trisomy 21 and normal fetuses and determined value of measuring UCD in screening trisomy 21. Methods: This was a case– control study. The UCD was measured in 39 fetuses with trisomy 21 (documented by chorionic villus sampling or amniocentesis) and 39 fetuses in control group at 17– 19 weeks of gestation. The control groups were low‑ risk fetuses for aneuploidy in routine screening and were shown not to have aneuploidy after birth. Results: Mean of UCD in fetuses with trisomy 21 was lower than normal fetuses, but there were no significant differences between them (7. 48 ± 0. 99 mm vs. 7. 66 ± 0. 91 mm; P = 0. 41). Mean of UCD had no significant difference between other maternal variable, for example, body mass index and obstetric history. Mean of UCD among mothers who had previous cesarean section was significantly lower than without it (7. 21 ± 0. 97 vs. 7. 71 ± 0. 97; P = 0. 03). Conclusions: At 17– 19 weeks of gestation, the UCD of fetuses with trisomy 21 is thinner than normal, but the importance of this difference is too small for using this measurement in screening.

Introduction: Preeclampsia is the most common medical complication in pregnancy. Regarding the pathophysiology and complex etiology of preeclampsia, a wide range of markers have been investigated. In addition to predictive value, identification of these factors may provide a clear mechanism for the pathogenesis of preeclampsia. This review study was performed with aim to evaluate the role of four serum markers and uterine artery Doppler ultrasonography in predicting preeclampsia at Second Trimester of pregnancy.Methods: In this review study, the databases of SID, Weily online library, Elsevier, Scopus, Pubmed, and the Google Scholar search engine were used during 2000 to 2017 in order to find the relevant studies. To access all articles in English and Persian, the key words of BHCG, Inhibin A, Activin A, alpha-fetoprotein, serum markers, uterine artery Doppler sonography, Second Trimester, and preeclampsia prediction were used with all possible combinations of these words.Results: The results of various studies indicate that none of the studied markers, including AFP, b-HCG, INH-A and Activin A alone, do not provide predictive power for preeclampsia with high sensitivity and specificity. However, uterine artery Doppler ultrasonography at Second Trimester of pregnancy can be used as a screening test to predict preeclampsia in high risk women.Conclusion: The most important strategies for prediction of preeclampsia include individual characteristics, uterine artery ultrasonography, and biomarkers. None of these markers alone can' t predict preeclampsia with high sensitivity and specificity.

Introduction: The purpose of this study was to compare the efficacy and side effects of two different misoprostol regimens for Second-Trimester pregnancy termination.Methods: 60 consenting women who were at 14 to 28 weeks of gestation with indications for pregnancy termination were randomly assigned to two equal groups to receive either vaginal or oral misoprostol. The dosing regimen was 400μg as the initial dose followed by 400μg and up to 3 doses (1200 mg) if needed in each group. Efficacy and side effects were compared.Results: 30 patients randomly assigned to vaginal and 30 to oral misoprostol group. Demographic characteristics were similar in both the groups. The percentage of women who delivered was significantly higher in vaginal group than the oral group (86.7 vs.43.3, P=0.0006).The average induction to delivery interval was shorter in vaginal group, but this difference was not significant (9.7±4.2 vs. 12.7±7.3 P=0.083). No significant differences in complication rates or side effects were noted between the two groups.Conclusion: Vaginal administration of misoprostol resulted in a higher success rate for Second Trimester pregnancy termination, whereas, no significant differences in induction to delivery time and complication rates were noted between vaginal and oral groups.

Background: Considering the effect of preterm delivery in morbidity and mortality of newborns, its precaution and prevention is so important.Objective: To investigate the association between Second Trimester maternal serum biomarkers (Human Chorionic Gonadotropin, Alpha-fetoprotein, Non-conjugated estrogen, Inhibin A) and pre-term delivery.Materials and Methods: This is a historical cohort study that has been performed for 700 pregnant women, clients of Nilou Lab in the Second Trimester of pregnancy to take the Quad Marker test between March to September 2008. The information of mothers having required conditions to enter to study has been registered and after delivery, they called again to be interviewed. These data sets using statistical tests: chi-square test and Roc Curve was analysis.Results: There is a direct relationship between preterm delivery and increase of Alpha-fetoprotein (p=0.011) and inhibin A (p=0.03) serum level and. Also, there is an inverse relationship between the non-conjugated estrogen (p=0.002) serum level and preterm delivery. Moreover, there is not any relationship between the increase human chorionic gonadotropin (p=0.68) serum level and preterm delivery.Conclusion: The increase in the Alpha-fetoprotein and Inhibin A and decrease in Non-conjugated estrogen serum levels in the Second Trimester of pregnancy lead to enhance the probability of preterm delivery. Moreover, if the current study is done with higher samples and different sampling environment, it may have different results.