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Most individuals fall into one of two categories, clearly male or clearly female with complete consistency of genetic, gonadal, anatomic, and psychological aspects of sex within any one individual. However, there clearly is a complex gradient that runs from male to female occupied by many different varieties of people who do not fall neatly into one of the two standard sexual definitions. One of the most fascinating processes is the pathway of sexual differentiation—in other words: how does the embryo make the developmental “choice” between producing a male fetus or a female fetus, and thus between producing a man or a woman? It is found that what most people think of as a rather simple binary process is actually replete with complexity, and occasionally some ambiguity. It is curious that the key “genetic switch” in sex determination acts only once at a very early point in fetal development and solely determines whether structures called indifferent gonads become testes or ovaries. From that point on it is the hormones produced by the gonads that determine biological sex; these hormones act by mediating an extremely complex series of events that activates genes required to build male structures or by allowing the development of female structures. As sexual development continues, these hormone-mediated processes continue to govern the physical aspects of sexual differentiation.

Spontaneous bladder rupture is a rare condition, with diagnosis more rare in the prenatal than postnatal period. To our knowledge, there have been 7 cases of prenatally diagnosed bladder ruptures and all have been males. We report the first case of prenatal diagnosis of spontaneous bladder rupture in a female fetus. After a primary Cesarean-section birth, a tear in the newborn infant bladder dome was identified and repaired in 2 layers. The cause of the bladder rupture remains unknown.

We report a female fetus with occipital encephalocele, dysraphism of the cervical spine, right renal agenesis and Mullerian agenesis. Additional findings included posterior cleft palate, absent left umbilical artery and Meckel's diverticulum. This fetus had the features of MURCS association with occipital encephalocele. This is the second report of encephalocele with MURCS association.

Perineal hernias are very rare and mostly reported in adults, with only 7 cases reported in children. We report a female fetus, terminated at 18 weeks of gestation due to trisomy 18. In addition to multiple typical findings of trisomy 18, this fetus had perineal hernia with defect of the perineal skin and prolapse of multiple bowel loops. To our knowledge there are no reported cases of perineal hernia presenting antenatally nor are there reported cases of perineal hernia associated with trisomy 18.

To investigate the influence of fetal sex on maternal testosterone levels throughout pregnancy, blood was sampled from 37 healthy pregnant women from week 14 until term and at 6 weeks postpartum. Testosterone concentrations were measured with a highly specific RIA after chromatographic purification. Mean (+/- SD) testosterone at the end of gestation was significantly higher compared to non-pregnant values (3.10 +/- 2.38 mM/l, n = 32 vs 1.14 +/- 1.06 nM/l, n = 35). It appeared that in women carrying a male fetus testosterone levels gradually increased during pregnancy up to 3.99 +/- 2.72 nM/l. In women carrying a female fetus the levels decreased after the first trimester from 2.44 nM/l to 1.80 nM/l. A statistically significant difference (P less than 0.01) existed in maternal testosterone concentrations between both groups during the second half of pregnancy.

Emesis gravidarum, an invariably benign condition characterised by nausea and occasional vomiting, is experienced in 80% of pregnancies. It usually remits after 14 weeks. It is associated with improved obstetric outcome. Hyperemesis gravidarum is defined here as persisting vomiting necessitating hospital admission. It occurs in 1:3000 pregnancies. Hyperemesis gravidarum is associated with low maternal age, primigravidity, female fetus, multiple pregnancy, psychiatric and behavioural factors and previous unsuccessful pregnancy. It occurs less frequently in smokers and in unmarried mothers. The aetiology is unknown. There are various likely mechanisms, including the role of human chorionic gonadotrophin and its probable thyrotrophic activity. The importance of excluding other causes of vomiting in pregnancy must be emphasised and the differential diagnoses considered. The significance of transient hyperthyroidism in almost half of hyperemetic pregnancies may be of importance. Emesis gravidarum is usually transient and drug treatment is not needed. Ideally all drugs should be avoided in the first trimester. However, if an anti-emetic is required the antihistamines appear safe and effective. Meclozine (Ancoloxin) is the drug of choice. The safety of phenothiazines is less secure and they should be reserved for those hyperemetics not responding to other measures. If all other treatment fails termination of pregnancy may be necessary as a last resort.

RESUMENObjetivo: Establecer la validez diagnostica de la identificacion del sexo fetal en plasma de mujeres embara-zadas durante la primera mitad del embarazo mediante medicion de ADN libre fetal (ffDNA) en sangre ma-terna. Metodo: Se extrajo 20 ml de sangre periferica a 25 pacientes entre las 5 y 15 semanas de gestacion, previo consentimiento informado. Se separo el plasma mediante centrifugacion obteniendose ADN genomi-co total (materno y fetal), y se analizo por triplicado mediante PCR en tiempo real (q-PCR), con partidores especificos para secuencia del cromosoma Y (DYS14). El sexo fetal se confirmo mediante ecografia reali-zada entre las 20 y 25 semanas. Resultados: 12 pacientes presentaron amplificacion para DYS14, siendo diagnosticados como fetos masculinos. La menor edad gestacional de diagnostico fue 6+4 semanas. En 9 pacientes no se genero senal, estableciendose el sexo fetal como femenino. Hubo 4 casos en donde no se cumplieron los criterios para definir el sexo fetal, estableciendose estos como indeterminados (todos ellos antes de las 8+3 semanas). La probabilidad de diagnosticar el sexo a partir del test fue de 84% (21 de 25 pacientes). Considerando solo los 21 casos donde se pudo realizar un diagnostico, la ecografia confirmo el sexo en todos ellos, obteniendose una correlacion del 100%. Conclusion: Es posible diagnosticar el sexo fetal en sangre materna utilizando ffDNA durante la primera mitad del embarazo.PALABRAS CLAVE: ADN libre fetal, PCR en tiempo real, diagnostico prenatal no invasivoSUMMARYObjective: To validate the use of cell free fetal DNA (ffDNA) in maternal plasma to predict fetal sex in the first half of pregnancy. Method: A prospective observational cohort study of 25 pregnancies between 5 and 15 weeks of gestation was studied (median gestational age of 9+1 weeks). Maternal blood was taken and q-PCR was carried out to detect the multi-copy Y chromosome associated DSY14 gene. The end point was gender as assessed by ultrasound at 20-25 weeks. Results: A Y signal was obtained in 12 patients, so a male fetus was predicted. The earliest signal was at 6+4 weeks. In 9 patients we didn’t have any signal, so a female fetus was diagnosed. There were 4 cases where the criterion to define fetal sex was not fulfilled and were classified as equivocal (all of them before 8+3 weeks). The probability to predict fetal sex from the test was 84% (21 of 25 patients). However, when the diagnosis of fetal sex is made, there is a 100% correlation between the ultrasound and Q-PCR. Conclusion: Free fetal DNA in maternal plasma allows prediction of fetal sex in the first half of pregnancy.KEY WORDS: Free fetal DNA, real time PCR, noninvasive prenatal diagnostic

A total of 222 pregnant women had repeated hormone assays between 20 weeks and delivery; 86 of the women were smokers. The maternal hormone balance appeared to be affected by smoking. Smoking affected maternal serum levels of hPL and hCG in pregnancies with a female fetus whereas maternal serum concentrations of oestriol and prolactin were affected in pregnancies with a male fetus. Significantly higher hCG levels were found in mothers who smoked and had a girl than in those who smoked and had a boy. On the basis of our results we feel that smoking mainly affects the placenta.

Anorexia nervosa (AN) is approximately 10 times more common in females than in males. The reasons for this difference are not yet understood. Several mechanisms have been hypothesized as possible causes.To determine whether the different hormonal environments to which male and female fetuses are exposed in utero might contribute to the increased risk of developing AN in females.The study is based on a large population-based cohort of Swedish twins. The strategy used is to compare the prevalence for AN between same-sex and opposite-sex twins.The study shows that the risk of developing AN in female twins is higher than in male twins, as expected. The only exception is male members of opposite-sex pairs, who have a higher risk of developing the illness when compared with other males (P = .62 for narrow diagnostic criteria and P = .60 for broad diagnostic criteria). In fact, their risk is at a level that is not statistically significantly different from that of females from such a pair. A plausible explanation for this phenomenon is that in pregnancies bearing a female fetus, a substance is produced, probably hormonal, that increases the risk of having AN in adulthood. Because the male half of an opposite-sex twin pair would also be exposed to this substance, it could account for the observed elevated risk in males with female twins. The most likely candidates are sex steroid hormones.The results of our study are compatible with the hypothesis that intrauterine exposure to sex hormones might influence neurodevelopment, affecting the risk of developing AN in adult life. This might be a factor contributing to the higher risk of developing AN in females.

WEB This is a Web exclusive article. mperforate hymen is a rare genital anomaly in which a layer of epithelized connective tissue that forms the hymen has no opening and completely obstructs the vaginal introitus. Hydrocolpos and hydrometrocolpos may occur secondary to this condition. Imperforate hymen usually does not cause symptoms until puberty [1]. This anomaly manifests as an abdominal mass that is detectable during the prenatal period only rarely [2]. We present a case of bilateral hydroureteronephrosis caused by hydrocolpos in a female fetus with an imperforate hymen that was diagnosed using prenatal MRI.

A 17-week female fetus had severe osteogenesis imperfecta and gross holoprosencephaly. This unusual combination has not previously been documented. No obvious environmental or genetic determinants were present.

Female infanticide1 is a practice that has been performed in numerous cultures throughout the world. Infanticide has, in its early history, included males as well as females. In keeping with the thematic focus of this book, however, the emphasis here is primarily on the killing of females.2 Throughout its history the practice of female infanticide has encompassed a wide geographical spread and has consumed more countries than has the practice of female circumcision. In brief, the practice has occurred on virtually every continent at some point in history (Mays, 1993, p. 883; Williamson, 1978, p. 63).

A doctor who was recorded in a newspaper sting apparently approving the abortion of an unwanted female fetus has been suspended from practice for three months by the UK Medical Practitioners Tribunal Service. Palaniappan Rajmohan admitted falsely recording that “Ms A” wanted a termination because she was “too young for pregnancy” when she had told him that the real reason was the sex of the fetus. Unknown to Rajmohan, Ms A was accompanied by a reporter from the Daily Telegraph , which was investigating illegal sex selection abortions, and the encounter in …

Vaginal temperatures (VT) of crossbred (Japanese Black crossed Holstein-Friesian) beef cows (n = 31) were measured by a data-logging apparatus to obtain serial data from days 0 to 6 before parturition. For both single and twin pregnancies, no significant differences were observed in VT during days 3-6 before parturition. Maternal VT was not affected by maternal weight just after parturition, parity, fetal sex, or total fetal litter weight. Average of twin litter weights for two males (MM) and two females (FF) had the strong positive correlations (r = 0.84; P0.05) with maternal VT, whereas twin weights of mixed-gender twins (FM) did not correlate with maternal VT (r = -0.26; P = 0.61). Maternal temperature decreased as weights of the female fetus of FM twins became heavier (r = -0.82; P0.05). In contrast, maternal VT of FF and MM twins increased as twin weights increased. We defined when the VT began to decrease before parturition by two different methods. One was the "same hours method" where differences in VT between a particular time of day and the corresponding time of the preceding day were compared when the VT was consistentlyor =0.3 oror =0.5 degrees C for more than 3h. The second method was the "maximum-minimum method" where decreased in the maximum or the minimum values of the day overor =0.3 andor =0.5 degrees C were compared to values of preceding day. Onset of decreased VT before expulsion was not different between singletons and twins. In an attempt to define the critical condition in predicting parturition, we estimated assumable predicting probability using the 31 cows that were collected VT. When the parturition occurred within 60 h in the "same hours method" and 72 h since VT wasor =0.3 degrees C and in the "maximum-minimum method", the assumable probability was 100%. In verification experiment under these condition, the "same hours method" had a higher probability of predicting the time of parturition than the "maximum-minimum method", and it was possible to detect the onset of decreased VT at the correct time by the minutes. We concluded that "same hours method" was useful for predicting parturition time in cattle with single and twin pregnancies by the serial measurement of vaginal temperature.

Freemartins are XX/XY chimaeras that develop as a result of the fusion of the placental circulation of at least one male and one female fetus. Of 19 freemartin ewes, 13 had testis-like structures, seven of them in an abdominal position and six in an inguinal position. Histologically, their gonads had structures resembling seminiferous tubules and interstitial cells, and grossly, most had structures derived from the mesonephric ducts (vasa deferentia, epididymides and vesicular glands). The other six freemartin ewes had small, undifferentiated gonads that lacked either follicles or seminiferous tubule-like structures. They also lacked any structures derived from the mesonephric ducts. No derivatives of the paramesonephric ducts were detectable in any of the freemartin ewes. The gonads of the male-type freemartins stained immunocytochemically for 3beta-hydroxysteroid dehydrogenase (3beta-HSD) and histochemically for alkaline phosphatase (AP) in a similar way to, but more extensively and intensely than, the gonads of normal rams, and the staining was confined to interstitial cell-like structures. The staining in the undifferentiated-type freemartins was weak, but both 3beta-HSD and AP were present in unidentified cell types.

The differential diagnosis for antenatal bladder dilation and hydronephrosis is extensive, ranging from posterior urethral valves to neurogenic bladder. We present a case of a female fetus diagnosed antenatally with severe megacystis and bilateral hydroureteronephrosis. The patient was found to have megacystis-microcolon-intestinal hypoperistalsis syndrome, a rare, congenital, and generally fatal disorder in which there is functional obstruction of the bladder and intestine.

An acardiac twin is a unique complication of monochorionic twinning, in which a normal pump twin perfuses the acardiac twin. The mortality rate of the pump twin is greater than 50%. Herein we present the successful treatment of an acardiac twin with alcoholization as follows. An acardiac twin was diagnosed at 24 weeks gestation. Circulation interruption of the acardiac twin was successfully achieved by injection of absolute alcohol (5 mL) into the intra-abdominal umbilical artery. Serial ultrasound after the procedure revealed normal growth of the pump twin, whereas the acardiac twin was shrinking. Spontaneous premature delivery at 34 weeks gestation resulted in a normal surviving female baby weighing 2410g and an acardiac female fetus weighing 300g. This experience suggests that this simple technique may be an alternative treatment for an acardiac twin.

Severe placental dysfunction is much more common in pregnancies with a male than with a female fetus. Furthermore, the birthweight/placental weight ratio is increased in these pregnancies, consistent with fetal growth restriction, and is higher with a male fetus than with a female fetus. These observations of placental insufficiency may underlie the increased in-utero loss rate of male fetuses.

International audience; The results of 30 prenatal diagnoses for fragile X syndrome are reported. Amniotic fluid cells were examined in 1 case, fetal blood in 4, and chorionic villi samples in the others. Of the 5 fetuses analyzed by cytogenetic methods, 1 had showed 4% of fraXq27.3 expression sites and the pregnancy was terminated. For 1 diagnosis, linkage analysis was used: the female fetus turned out to be normal. In 24 fetuses, the direct analysis of the mutation by StB12.3 probe was performed: 6 female and 3 male fetuses were found to carry a full mutation and 1 female fetus was found to carry a premutation. In 3 cases, the diagnoses were verified on fetal blood samples. Several tissues of 2 aborted male fetuses were analyzed for the fragile X mutation. The results are reported and discussed.

Two fetuses with severe bilateral renal hypoplasia are described; both diagnoses were made following elective abortion for oligohydramnios and suspected renal dysplasia. A 20-week female fetus (46,XX) had pulmonary hypoplasia and very small kidneys (7% of expected weight) that were normally shaped and nondysplastic, with well-formed medullae and metanephric blastema and markedly diminished cortices with only rare glomeruli. A 23-week male fetus (46,XY) had small kidneys (13% of expected weight) that were nondysplastic, normally shaped, and histologically well organized with moderately decreased numbers of glomeruli. Isolated bilateral renal hypoplasia has not previously been well characterized in fetuses; the presence of oligohydramnios (both cases) and pulmonary hypoplasia (one case) suggests that this finding is associated with impaired fetal renal function and may adversely influence neonatal survival.

Numerous reports in the literature suggest that hormones may transfer from one fetus to another, in humans as in animals. In a large sample of over seven thousand Australian adult twins, it was found that opposite-sex females showed a statistically significant tendency to hold more masculine attitudes than did same-sex female twins. This may be due to post-natal social interaction, but could also be caused by the transfer of testosterone from the male to the female fetus in opposite-sex twins.

Our aim was to evaluate whether the sex of a fetus could be determined in maternal whole venous blood by in situ hybridization without enrichment of fetal cells. This procedure is virtually without risks to the fetus or the mother. Blood samples were obtained from 59 women at different stages of pregnancy. Twenty preparations were discarded because they were technically unfit for in situ hybridization. Of the remaining 39 pregnant women, 18 had a male fetus, one had male twins, and 20 had a female fetus. Y-positive cells were detected in 12 of the 19 pregnancies with male fetuses and in two of the 20 pregnancies with a female fetus. The frequencies of cells with Y-signals ranged from 1 in 100,000 to 1 in 639. Our results show that fetal cells in maternal blood cannot be reliably used for prenatal diagnosis without prior enrichment of fetal cells.

Gender biased sex selection, widespread in many parts of Asia, has serious and profoundly debilitating effects on the mental and physical health of women, says a report by five United Nations agencies. Selection in favour of boys “is a symptom of pervasive social, cultural, political, and economic injustices against women, and a manifest violation of women’s human rights,” it says. “The increasing availability of technologies such as amniocentesis and ultrasonography has facilitated an increase in the occurrence of sex selection,” concludes the report, compiled by the World Health Organization, Unicef, UN Women, and other agencies. The discovery of a female fetus, it argues, can lead to its abortion, and it claims …

We present a female fetus with the lethal acrofacial dysostosis syndrome recently delineated by Rodriguez et al. [1990]. The present findings confirm that this syndrome constitutes a true MCA syndrome in which mandibulofacial dysostosis and severe limb reduction defects are associated with complex malformations of different organs and systems especially the CNS, the urogenital tract, heart, and lungs.

A severely retarded male child with Joubert syndrome is described. He had severe neurological anomalies including Dandy-Walker malformation, hypoplasia of the corpus callosum, occipital meningo-encephalocele, and bilateral coloboma of the optic nerve with retrobulbar cystic mass. This is the first male described so far with both coloboma and other midline defects. A detailed autopsy on an affected female fetus from the mother's second pregnancy is presented.

Design, Setting, and Participants:The study is based onalargepopulation-basedcohortofSwedishtwins.The strategy used is to compare the prevalence for AN between same-sex and opposite-sex twins. Results:ThestudyshowsthattheriskofdevelopingAN in female twins is higher than in male twins, as expected.Theonlyexceptionismalemembersofoppositesex pairs, who have a higher risk of developing the illnesswhencomparedwithothermales(P=.62fornarrow diagnostic criteria and P =.60 for broad diagnostic criteria). In fact, their risk is at a level that is not statisticallysignificantlydifferentfromthatoffemalesfromsuch a pair. A plausible explanation for this phenomenon is that in pregnancies bearing a female fetus, a substance is produced, probably hormonal, that increases the risk of having AN in adulthood. Because the male half of an opposite-sextwinpairwouldalsobeexposedtothissubstance, it could account for the observed elevated risk in males with female twins. The most likely candidates are sex steroid hormones. Conclusions: The results of our study are compatible withthehypothesisthatintrauterineexposuretosexhormones might influence neurodevelopment, affecting the risk of developing AN in adult life. This might be a factor contributing to the higher risk of developing AN in females.

A 32-week-gestation female fetus presented with a diagnosis of left hydroureteronephrosis. Both the right kidney and the amniotic fluid volume were normal. Spontaneous term delivery occurred and postnatal imaging revealed Society for Fetal Urology grade IV hydroureteronephrosis of the left upper pole. Cystoscopy revealed an ectopic ureteral orifice at the bladder neck; this was incised back onto the trigone of the bladder. Follow-up imaging studies revealed resolution of the upper pole hydroureteronephrosis and absence of vesicoureteral reflux. The patient was continent. Select cases of ectopic ureters may be incised transurethrally (as is the ectopic ureterocele) in the neonate.

The polymerase chain reaction was used to amplify a Y-specific repeat sequence in peripheral blood DNA samples from 19 pregnant women who had a gestational age of 9 to 41 weeks. Y-specific sequences were amplified from all 12 women who bore a male fetus but in none of 7 women who bore a female fetus. With stringent precautions against contamination, this technique may assist prenatal diagnosis of sex-linked genetic disorders.

The structure and development of the muscles of the bladder and the urethra were investigated in serial sections of human fetuses of 6–20 cm crown-rump length and in serial sections of this area in a newborn male and a 24-year-old adult male. We made the following findings: (1) The detrusor system does not take part in the formation of the urethral muscular system, it only forms a loop around the proximal part of the urethra. (2) The trigonal system forms a true sphincter in both males and females. In males it is more proximal than in females. (3) In the adult males studied, the external sphincter consists of both smooth and striated cir cular muscle. (4) Experience from the female fetus studied suggests that both muscular types are also present in the adult female.

A new human diploid fibroblast-like cell line has been established from lung tissue of a female fetus. This has been frozen away in large quantity and characterized for use in research and related purposes. This is the first of a planned series of human cell lines to be established, characterized, and banked in large quantity in support of the National Institute on Aging research and general cell biology.

The autonomic abdominal and pelvic nerve plexuses of the human female fetus, were studied by an in toto acetylcholinesterase method in order to obtain data on innervation of the ovaries, uterus, ureter and umbilical cord. The results of this study indicate that in the human fetus there is no anatomical evidence for the concept of a distinct regional nervous supply towards the organs of the abdomen and the pelvis. The ureteric nerve plexus contains small ganglia and the input for this plexus is found along the entire ureter. In the umbilical cord nerve plexuses were found along the blood vessels and urachus up to 30 mm from the umbilicus. The innervation of the skin does not continue in the superficial layer of the umbilical cord.

Four males, the sons of 2 sisters, apparently have a new syndrome of mental retardation, seizures and psoriasis. Due to the relationship between the affected males we propose the inheritance to be X-linked recessive although cosegregation of two separate disorders may be occurring. Psoriasis has never been reported as a monogenic disorder. Results of cytogenetic studies, including fra (X) and high-resolution prometaphase analysis, were negative. Steroid sulfatase activities of cultured fibroblasts from 2 surviving affected males were normal. The results of HLA typing of all available relatives did not indicate a strong association between the skin disorder and certain HLA antigens. A healthy sister, who may be heterozygous carrier of the mutant X chromosome, decided on termination of 3 successive pregnancies after prenatal male sex determinations. Her fourth pregnancy with a female fetus is ongoing.

Vaginal adenosis is a rare kind of disease without specific symptoms and does not represent a very serious disorder from the beginning. Concerning the etiology teratogenetic dependencies are known which still are interpreted in different ways in the recent literature. The increased number of cases, including those with clear-cell-carcinoma of the vagina, in juveniles after exposition to DES during the early embryonal development shows in particular (Central index for the stilbestrol-adenosis-carcinoma-syndrome in the USA, since 1971) a wrong pathway in the organogenesis of cervix and vagina. This occurs at the interference zone between the epithelium of the Mullerian ducts and the epithelium of the sinus urogenitalis of the female fetus and in so far constitutes the origin of vaginal adenosis. The basics of the possibility of the development of such irregular differentiation and heterotopic dissemination are proven again by the case report of a vaginal adenosis showing the highly differentiated endocervical type. Not every case of vaginal adenosis does signify a precancerous lesion. The separation of the most frequently endocervical manifestation observed from endometrial and intermediate forms might be difficult. A positive distinction is prognostically essential, however, since clear-cell-carcinomas of the vagina are known in occurence with the endometrial type of vaginal adenosis only. Scanning electron microscopy as a method to follow tissue organization reveals the way of differentiation between the various types via ultrastructural analysis for vaginal adenosis is an example for failures of developmental organization. The same analysis is feasible in cytological smears also. The therapeutic requirements of vaginal adenosis depend on the tissular differentiation and the given local extent of the adenomatous lesions.

Fetal ovarian cyst was diagnosed by antenatal ultrasonic examination in eight pregnancies. In one case the cyst was antenatally twisted and necrotic, and the pregnancy resulted in premature birth during the 34th week. The other cases had clinically normal antenatal courses. One cyst ruptured at birth. The clinical condition of this and all the other neonates was good. Three of the neonates were managed surgically and five by conservative follow-up with repeated ultrasonic examinations. Cystic tumors of these infants disappeared without clinical complications in the subsequent six months. An ovarian etiology for cystic pelvic tumor of a female fetus should be considered. Conservative treatment after birth is possible in many cases with spontaneous involution likely during the first months of life.

Sex-chromosomal chimerism (XX/XY) was described in a pair of bovine like-sexed male twins. One of the twins showed malformed external genitalia, and the other was phenotypically normal. It is proposed that sex-chromosomal chimerism is associated with a choriovascular anastomosis between like-sexed twins examined and "female fetus" which may be overlooked at parturition.

Two further cases of 'female adnexal tumour of probable Wolffian origin' are described Both were retroperitoneal and presented a unique histology of uniformly close-packed bland spaces. solid islands, cords, and diffuse areas. A small hamartoma in a female fetus, part of which resembled the tumours, was traced to an area of near apposition with some paroophoron canals, providing further evidence of a Wolffian origin. The literature of this and some other putative Wolffian tumours is briefly reviewed, and the relation to rete adenomas is discussed.

Summary Two female siblings whose mother received long-term norethindrone-mestranol (Ortho-Novum) therapy during pregnancy, because of threatened abortion, were born with partial masculinization of their external genitalia. Avoidance of synthetic progesterone-estrogen combinations with androgenic activity is recommended whenever pregnancy is suspected, because these compounds cross the placental barrier and may be associated with masculinization of the female fetus and advancement of bone age.

The ratio of the sexes at birth is remarkably constant for various countries over long periods of time for populations as a whole. Data are presented to show that the sex-ratio at conception is significantly higher than sex-ratio at birth. The lesser percentage of males at birth than at conception is accounted for by a differential prenatal mortality bearing more heavily upon the male fetus than upon the female fetus. Thus the sex-ratio at birth is a function of the sex-ratio at conception and the sex-ratio of intrauterine mortality. Various lines of approach are utilized to prove that social factors affect the amount of prenatal mortality and finally the sex-ratio at birth. A group of 5,466 completed families, forming a "higher" social class, are utilized to test the general hypothesis. They show a significantly higher sex-ratio at birth than does the general population. The conclusion is reached that more desirable social environments are important factors tending to raise the sex-ratio at birth. As suc...

The normal vaginal-smear changes during the course of pregnancy are presented. Increased cornification without mucification was encountered in only six cases. Three of these soon thereafter threatened to abort. Specific estrogenic and androgenic smears are described and their significance and correlation to the fetal sex are discussed. The cytolytic smear consists of an increased number of Doderlein bacilli and complete destruction of cellular cytoplasm with intact nuclei and is believed to accompany high estrogen activity. This type of smear is associated with a female fetus. The mucoid cornified smear is the usual typical androgenic smear and is characterized by cornified cells with abundant mucoid material. The glycolytic type, with extracellular glycogen and intracellular glycopenia, is a very rare androgenic smear. Such smears are associated with a male fetus.

Mean values are reported for the primary data in fetal electrocardiographic investigation of 2,028 cases plus associated data for fetus and for mother. Statistical comparison for singles and for twins shows that the feal ECC components are in general smaller in amplitude for twins. It is shown that the maternal systolic blood pressure is higher in mothers bearing twins and that all diagnostic criteria used, including fetal ECC and heart rate criteria, reflect the greater problems of the twin fetus. It is shown that a sex difference exists in fetal ECC values; in the case of the female fetus, the peak-to-peak amplitude of the fetal complex, the fetal R wave, and the new born RII wave all being significantly larger than those for the male. The newborn S wave is larger in the male. Comparable differences are observed in electrical axis values.

A non-consanguineous union between two people with congenital aniridia is described which resulted in the stillbirth of a female fetus with complete absence of eyes, nose, and adrenal glands.

Chondrifying fibrosarcoma was found in the abdominal cavity of a bovine female fetus (Holstein-Fresian breed) aborted at the 8th month of gestation. Autopsy revealed several huge to small neoplasms in the abdominal cavity. Microscopically, marked proliferation of immature fibroblastic cells were noted with moderate numbers of collagenous fibers. Chondrifying foci of variable sizes and of various stages of maturation were scattered in the tumor.