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Fetal seizures are an unusual phenomenon. When diagnosed by ultrasonography, they are frequently associated with malformations and carry a poor prognosis. We describe first trimester seizures in two siblings with arthrogryposis multiplex congenita. In both cases, convulsions appeared before other sonographic signs of the disease. Review of the literature revealed 11 other cases of fetal seizures diagnosed by ultrasound, all later in gestation. Fetal seizures may be the first manifestation of defective neural and motor development. Therefore, in pregnancies at high risk for neuromuscular disease, early sonographic evaluation of fetal motility, in addition to the anatomical survey, is advised.

fetal anomalies present postnatally corresponded very closely to those diagnosed prenatally. At 6 hours of life one of the conjoined twins had worsening congestive heart failure and at day 3 of life a successful urgent separation occurred for the pump twin while the anomalous acardiac twin expired. The pump twin continues to do well today but will need further surgical revisions. This is the first case of conjoined twins in which one twin had acardia and the pregnancy was managed with the assistance of Doppler and MRI in addition to ultrasound. To provide optimal treatment for infants with complex anomalies more than one imaging modality may be required and a multidisciplinary team approach is critical. Accurate prenatal diagnosis was critical in our case as urgent intervention was required.

Objective: To describe pregnancy and epidemiological characteristics of the MFPR at our institution. Materials and methods: 290 consecutive cases of MFPR were performed during the years 08/1998–02/2002. The transvaginal route (TVS) was chosen in cases of extreme obesity, patient with abdominal scars and if the fetus in the lowest sac had to be reduced and could not be reached transabdominally (TAS). Prophylactic antibiotics was given. 271 cases were defined as successful by delivery of liveborn babies after 24 postmenstrual weeks of gestation (Group 1). 19 cases had pregnancy losses at, or before 24 weeks (Group 2). Epidemiological as well as pregnancy characteristics were compared. Results: The total pregnancy loss rate was 6.5% (19/290). The loss rate of MFPR by TAS was 3.45% (7/203) and by TVS 13.3 (10/75). Pregnancy losses in relation to starting numbers were was: 4.6% for starting with twins, 7.1% for triplets, 3.3% for quadruplets, 13.6% for quintuplets and 9% for starting number of 6 and above. Pregnancy losses in relation to finishing numbers were: 7.3% for ending with a singleton, 6.3% for twins and 0% for triplets. Parity was higher among Group 1 compared to Group 2 (1.2 ± 0.5 vs. 0.7 ± 1.4, respectively). This difference was statistically significant (p = 0.0001). In Group 1, there was a higher rate of transabdominal reductions compared to Group 2 (72.4% vs. 36.8%). This difference was statistically significant (p < 0.008). No statistical difference was found between the two groups regarding to selective reduction (10% vs. 16%, p = 0.31) respectively. Conclusions: 1. The success rate was higher when the procedure was done abdominally and the patient was multiparous. 2. No significant trend was seen as far as starting or finishing numbers were concerned. 3. The transvaginal route should be reserved only for cases in which the transabdominal approach is hard or impossible to perform.