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%.

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.

Objective: This study was conducted in order to assess the prevalence of different cervicovaginal infections during pregnancy.Materials and methods: Totally 110 healthy pregnant women with complaints of vaginal symptoms in their third TRIMESTER of pregnancy were checked for vaginal candidiasis, bacterial vaginosis, vaginal trichomoniasis, streptococcus b hemoliticus, gonorrhea, syphilis, and infection by chlamydia trachomatis and HIV.Results: Among 110 studied women and mostly nullipara, the mean age was 25.2 years. All of them had at least one symptom including discharge, itching or burning of vagina. Among them 39 (35.5%) had vaginal and endocervical infection identified by laboratory tests including candidiasis 26.4%, bacterial vaginosis 8% and streptococcus b hemoliticus 5.3%. Gonorrhea and trichomoniasis were not seen. Three of the patients had positive IgG antibody for chlamydia trachomatis. None of them had serological positive test for syphilis and HIV.Conclusion: Symptomatic pregnant women need to be actively searched for infections. Besides speculum examination as an easy to carry out clinical test and if needed laboratory exams must be used to choose the best treatment.

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.