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Introduction: This review aims to present the different applications and benefits of intrapartum ultrasound (IPUS) compared to the traditional digital vaginal examination. IPUS is non-invasive, does not cause pain or discomfort to the woman and may reduce the rate of ascending infections. In comparison to the vaginal exam, IPUS is more accurate in diagnosing fetal head position and station, is easy to acquire and has a faster learning curve. Applications of IPUS include: 1. Diagnosing the fetal head position either by suprapubic or trans-perineal ultrasound when the fetal head is low, which is more accurate than the digital vaginal exam; 2. Measuring cervical dilatation and effacement by trans-perineal ultrasound. This may be of more value especially in patients with ruptured membranes or patients who have difficulty with invasive examinations; 3. Assessing fetal head station and labor progress by measuring the head-perineal distance (HPD) and the angle of progression (AOP); 4. Estimating the pelvic size relative to the fetal head by measuring the pubic arch angle and fetal head circumference; 5. Predicting the mode of delivery before and during the labor process; 6. Prior to deciding the mode of delivery in a prolonged second stage of labor; 7. Providing a visual biofeedback to improve pushing efforts and mother-baby connection.

Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic disease (GTD) that originates from the implantation site intermediate trophoblast. It accounts for about 1% of all GTDs, with an estimated incidence of 1 per 100,000 pregnancies. Most patients are in their thirties and the prevailing presenting symptom is abnormal vaginal bleeding. More than half of the patients present with disease limited to the uterus and the remainder present with disease extension beyond the uterus. The overall mortality rate is 25%. The most important adverse prognostic factor is disease extension beyond the uterus. Other adverse prognostic factors are interval from antecedent pregnancy > 2 years, mitotic count > 5 mitotic figures/10 high-power fields, and age > 40 years. Since PSTT is less sensitive to chemotherapy than GTDs originating from cytotrophoblast and syncytiotrophoblast (hydatidiform mole, invasive mole, and choriocarcinoma), hysterectomy is the mainstay of treatment. Systemic multi-agent chemotherapy is administered in the presence of disease extension beyond the uterus and considered in the presence of other adverse prognostic factors. The EP/EMA regimen seems to be the most effective chemotherapy available to date for PSTT. Although PSTT produces less human chorionic gonadotropin (hCG) than choriocarcinoma, beta-hCG is still the best available serum marker for monitoring the response to treatment and for follow-up.

Cervical carcinoma is one of the most common malignancies diagnosed during pregnancy since about 30% of diagnosed women are in their fertile years. Diagnosis of cervical cancer during pregnancy superimposes ethical dilemmas on the clinical considerations. Both maternal and fetal outcome should be considered when managing such a case. Is it necessary to discontinue the pregnancy? What are the implications of delayed treatment? How does the treatment affect the fetus and newborn? This article reviews the practical aspects of these issues and suggests management proposals.

Of the 720 patients with thyroid cancer we saw from 1953 to 1989, 49 were younger than 20 years at diagnosis, and the female/male ratio was 4.4:1. The histologic type was papillary in 34, follicular in 14 and medullary in 1. Initial treatment in 41 was total or near-total thyroidectomy, and in 8 hemithyroidectomy. 23 underwent neck dissection in addition to thyroidectomy. 49% of those who underwent total thyroidectomy had foci of bilateral thyroid carcinoma on serial histological section. Local and distant relapse of thyroid carcinoma occurred in 4 of the 8 who underwent hemithyroidectomy, but in only 1 of the 41 who underwent total thyroidectomy. Our recommendations include total thyroidectomy, radioiodine therapy, and modified neck dissection when neck metastases are presented.

Metastases to the mandible are very rare and account for only 1% of all oral tumors. The most common primary in such cases is the breast. Only 20 cases of metastases to the mandible of tumors of the large bowel have been reported. We present the case of a 59-year-old woman with metastatic disease of the mandible in whom the primary tumor was an adenocarcinoma of the sigmoid. Metastases to the oral cavity and mandible should be included in the differential diagnosis of gingival or mandibular lesions in a patient with a previous or current malignancy.