Multiple fetal anomalies in the first trimester; detection using transvaginal ultrasound and therapeutic abortion using mifepristone (RU486) in conjunction with gemeprost vaginal pessaries

A 30-yedr-old woman booked for antenatal care at 10 weeks gestation in her second pregnancy. Her previous pregnancy had been uncomplicated, and had resulted in the birth of a healthy female infant. An ultrasound scan was performed to confirm gestation, but there was difficulty in obtaining a satisfactory crown-rump measurement using the transabdominal probe. To obtain better resolution, a transvaginal ultrasound scan was performed using a 7.5 MHz mechanical sector probe. Fetal heart movements were seen but the fetal head was clearly abnormal, and there was a large defect in the lower lumbar region 01 the fetal spine (Fig. I). Although the appearances suggested anencephaly with spina bifida, the presence of multiple anomalies raised the possibility that the fetus was affected by an associated syndrome. The woman was informed of the detected defects and of the poor prognosis for the pregnancy. She decided to opt for pregnancy termination. It was decided an attempt would be made to obtain the fetus intact, utilizing mifepristone in conjunction with gemeprost vaginal pessaries, to allow pathological confirmation of the ultrasound diagnosis. Written informed consent was given for this procedure. The woman attended hospital a few days later, when 600 mg mifepristone was administered orally. She returned home and 48 h later she was admitted to the hospital gynaecological day case ward. Gemeprost 1 mg vaginal pessaries were administered every 3 h; a total of three pessaries were used. The products of conception were expelled 8 h after the first pessary was inserted, and abortion appeared to be complete. The woman was discharged home later the same day. The intact fetus were sent for pathological and karyotype analysis. The woman was reviewed 2 weeks later. Vaginal bleeding