Β-human Chorionic Gonadotropin Levels Research Articles

Transvaginal Sonographic Findings of Isolated Intramural Uterine Choriocarcinoma Mimicking an Interstitial Pregnancy

The differential diagnosis of highly vascular, intramural lesions of the myometrium Includes arteriovenous malformation, gestational trophoblastic neoplasia, hemangiomata, sarcoma, and interstitial pregnancy. We present an unusual case in which a patient with irregular uterine hemorrhage in the presence of increasing serum β-human chorionic gonadotropin (β-hCG) levels exhibited transvaginal sonographic and color Doppler imaging findings considered consistent with an interstitial pregnancy. After laparoscopy and curettage yielded normal findings but with the continuously rising serum β-hCG levels and the concern for gestational trophoblastic neoplasia, the patient underwent vaginal hysterectomy. Histopathologic findings confirmed choriocarcinoma.

A Case of Primary Choriocarcinoma of the Lung

A primary choriocarcinoma of the lung is extremely rare, and difficult to distinguish from a metastatic choriocarcinoma considering that the lung is also one of the most frequent site s of metastasis. We report a 28-year-old woman patient who was initially misdiagnosed with an ectopic pregnancy and was operated on under the impression of an unidentified malignancy of the lung, which was finally proven to be a chorio carcinoma of the lung. A pelvic examination by a gynecologist, pelvic magnetic resonance imaging and whole body fluorodeoxyglucose positron emission tomography-computed tomography was performed in order to rule out a metastatic choriocarcinoma of the lung. After a curative operation, her serum β-human chorionic gonadotropin (HCG) level, which was highly elevated in the initial evaluation, had decreased dramatically to the normal range. She is currently being followed up regularly without any evidence of recurrence or elevation of her β-HCG level. (Tuberc Respir Dis 2006; 61: 578-584)

A new predictive scoring system including shock index for unruptured tubal pregnancy patients

Objective Shock index (SI) and predictive score grading system including it for predicting medical treatment failure of tubal pregnancies have been studied. Study design Eighty-eight patients were diagnosed as nonruptured tubal pregnancies. Shock index was calculated as the ratio of heart rate to systolic arterial pressure. A predictive score was used based on four parameters including initial level of β-human chorionic gonadotropin (βhCG), aspect of the image on ultrasound, size of the ectopic mass and shock index value at admission. Results Forty patients have undergone to surgery because of tubal gestational sac size ≥4 cm and/or presence of fetal heart activity. Nineteen patients were managed expectantly. Twenty-four patients received single dose methotrexate (MTX) and five patients received second dose MTX. Success rate for single dose MTX therapy was 72% (21/29). The cut-off shock index value for tubal rupture was 0.77 with 89% sensitivity and 61% specifity. Conclusion In this study, we demonstrated that tubal pregnancy patients who were managed with nonsurgical measures at admission and who had SI values lower than 0.77 and predictive score grades greater and equal to 6.5 did not experience tubal rupture and did not need surgical intervention during nonsurgical management.

Ruptured left cornual gestation in an unstable patient

A 22-year-old woman, gravida 2, para 0, arrived at the emergency room with a 12-hour history of left lower abdominal pain. The patient stated that she was sexually active and not using any contraception. On admission, the patient was tachycardic, with blood pressure of 110/60. Her β-human chorionic gonadotropin level was positive; her blood count showed hemoglobin of 10.3 with a hematocrit of 31.

Embarazo ectópico cervical. Tratamiento médico conservador

Objective Cervical ectopic pregnancy is a rare complication that can have severe consequences if an early diagnosis is not made. This diagnosis should always be considered in vaginal bleeding in the first trimester of pregnancy. Method We present a case of cervical ectopic pregnancy diagnosed in the sixth week of gestation. Three doses of methotrexate resolved the situation clinically (expulsion of the gestational sac) and biochemically (decreased β-human chorionic gonadotrophin levels). Conclusion Cervical ectopic pregnancy is a serious and infrequent entity that can be resolved by conservative medical therapy that maintains the patient's fertility and avoids the need to resort to more aggressive treatment.

Methotrexate Followed by Suctional Curettage: A Successful Treatment for Cesarean Scar Pregnancy

To report the conservative management of a patient with cesarean scar pregnancy. A 28-year-old woman, gravida 3, para 2, was initially diagnosed by transvaginal sonography to have a single viable gestation in a uterine scar. A single dose of systemic methotrexate 50 mg was given intramuscularly. A suctional curettage was then performed successfully. Serum levels of β-human chorionic gonadotropin returned to normal 21 days later. The patient had suffered from persistent vaginal spotting for 2 months, but no major complications were noted at follow-up. To preserve fertility, systemic intramuscular methotrexate followed by suctional curettage may be a safe treatment alternative for cesarean scar pregnancies.

Laparoscopic management of a cornual ectopic pregnancy

There are various possibilities for treating cornual ectopic pregnancies, including medical approaches using methotrexate and surgical approaches using laparoscopy. This report describes the laparoscopic management of a large cornual ectopic pregnancy associated with a high β-human chorionic gonadotropin level and reviews the techniques and outcomes of conservative treatment described in the literature.

Presence of a Yolk Sac on Transvaginal Sonography Is the Most Reliable Predictor of Single-Dose Methotrexate Treatment Failure in Ectopic Pregnancy

The purpose of this study was to determine which imaging characteristics can be used as prognostic indicators in conjunction with beta-human chorionic gonadotropin (beta-hCG) levels in the treatment of ectopic pregnancy (EP) with single-dose methotrexate (MTX). A retrospective study was performed on 62 patients (age range, 16-47 years; mean, 29 years) treated with MTX for EP from November 2000 to August 2003. The transvaginal sonographic findings in each case were analyzed for the presence and size of an extraovarian mass or a pseudogestational sac, amount of free fluid, presence of a yolk sac, and fetal heart motion. Patient age and beta-hCG level were also noted. Success of treatment was defined as a single dose of MTX that resulted in appropriate lowering of beta-hCG levels. Of 62 patients, 17 (27%) had single-dose MTX treatment failure. A yolk sac was identified in 15 (88%) of the 17 treatment failures and in none of the cases in which treatment was successful (positive predictive value, 100%). The average beta-hCG level in the cohort of patients who had single-dose treatment failure was 3282 mIU/mL compared with 1544 mIU/mL in the treatment success cohort. The presence of fetal heart motion was seen in only 1 patient, and this patient had treatment failure. The age of the patient, size of the extraovarian mass, presence of a pseudogestational sac, and amount of free fluid did not correlate with outcome. The presence of a yolk sac was always associated with treatment failure in single-dose MTX treatment of EP and was the most reliable predictor of failure among all features analyzed. The beta-hCG level was a useful adjunct. A prediction rule was created correlating the probability of treatment success with the beta-hCG level.

A prospective study of ultrasound screening for molar pregnancies in missed miscarriages

To examine the relationship between ultrasound and histological features in the screening for molar changes in missed miscarriage. A prospective cohort study was conducted on all missed miscarriages, with features suspicious of molar pregnancy, on transvaginal ultrasound and/or on histological examination over a 5-year period. All cases of molar pregnancy diagnosed histologically were examined and cross-referenced with cases diagnosed on ultrasound and with the supplementary report from the regional referral center. When available, maternal serum beta-human chorionic gonadotropin (hCG) levels were recorded. Fifty-one cases of suspected molar pregnancy were referred to the regional center for further histological opinion and follow-up, and five cases were subsequently excluded from the final analysis because of the diagnosis of hydropic abortion (HA). In 33 cases a molar pregnancy was suspected at the initial scan. Of these, 26 (78.8%) were confirmed on histology, resulting in a 56% detection rate using ultrasound alone. In 15 cases hCG results were available, of which nine were greater than two multiples of the median. The diagnosis of both complete (CHM) and partial (PHM) hydatidiform moles in first-trimester miscarriages is difficult. hCG is significantly higher in both CHM and PHM and, in conjunction with transvaginal ultrasound, could provide the screening test required to enable clinicians to counsel women more confidently towards non-surgical methods of management of their miscarriage, where histopathological examination is not available.

Ruptured Intramural Pregnancy with Low and Declining β-human Chorionic Gonadotropin Levels

Intramural pregnancy is the rarest type of ectopic pregnancy and its diagnosis is usually not made until surgery. This case of intramural pregnancy had an unusual course and an ultrasound appearance not previously reported. A 29-year-old woman presented with vaginal bleeding. Ultrasound revealed an empty uterus and a heterogeneous mass at the fundus that displayed prominent blood flow on color Doppler and power Doppler ultrasound. Initial serum β-human chorionic gonadotropin (β-hCG) level was 441 mIU/mL and dropped to 295 mIU/mL 2 days later. The woman, however, had heavy vaginal bleeding on the following day. The mass was excised at emergency laparotomy. The pathologic report confirmed the diagnosis of intramural pregnancy. Intramural pregnancy may appear as a heterogeneous mass with prominent blood flow on Doppler ultrasound. The possibility of rupture should be kept in mind even if serum β-hCG is low and keeps falling.

Vaginal fluid β-human chorionic gonadotropin level in the diagnosis of premature rupture of membranes

Vaginal fluid β-human chorionic gonadotropin level in the diagnosis of premature rupture of membranes

Elevated Second-Trimester Free β-hCG as an Isolated Finding and Pregnancy Outcomes

Objective: To investigate the relationship between unexplained elevated second-trimester free β-human chorionic gonadotropin (β-hCG) levels and pregnancy complications as well as adverse pregnancy outcomes. Methods: The study cohort comprised 2,110 non-smoking women with chromosomal and structurally normal fetuses at low-risk for both Down’s syndrome (risk <1:250) and neural tube defects (maternal serum α-fetoprotein <2.0 MoM). A free β-hCG value of ≧2.0 MoM was used to define the populations with elevated levels of free β-hCG. Descriptive statistics, χ² test, Fisher’s exact test, and logistic regression analysis were used for statistical analysis, and p < 0.05 was considered statistically significant. Results: The mean maternal age of the study group was significantly lower than in controls (27.9 ± 4.3 and 30.6 ± 5.1 years, respectively, p < 0.05), while the proportion of primigravidas was significantly higher compared to that of controls (p < 0.05). After adjustment of the 2 groups according to maternal age and parity, we observed an increased incidence of preeclampsia among women with elevated free β-hCG levels in relation to controls (p < 0.05). However, a logistic regression analysis demonstrated that the free β-hCG level was not a predictor of the occurrence of preeclampsia. No significant relationship was found with the incidence of gestational diabetes, oligohydramnios, polyhydramnios, pregnancy-related hypertension, intrauterine growth retardation, preterm delivery, spontaneous abortion and stillbirths (p > 0.05).

Rectal adenocarcinoma with choriocarcinomatous differentiation: Clinical and genetic aspects

Nongestational choriocarcinomas are rare tumors. In the gastrointestinal tract, they are characterized by a biphasic tumor growth with separated areas of adenocarcinomatous and choriocarcinomatous differentiation. We here report a case of a combined adenocarcinoma-choriocarcinoma of the rectum. The tumor showed an aggressive clinical behavior with metastasis to the liver and lungs. A transient partial remission was achieved after 4 cycles of cisplatinum, etoposide, and ifosfamide chemotherapy, with normalization of serum β-human chorionic gonadotropin levels. At this time, viable residual choriocarcinoma cells were found in surgically resected lung metastasis. The patient succumbed 8 months after initial diagnosis to a rapid abdominal relapse. We used comparative genomic hybridization (CGH) and fluorescence in situ hybridization to elucidate the genetic relationship of adenocarcinoma and choriocarcinoma in this neoplasm. We found genetic changes characteristic for colorectal adenocarcinomas, a loss of chromosomal regions 8p21-pter as well as 18q21-pter, and a gain of 5p and 20q, in both tumor parts. This provides evidence for the common origin of both components. A differential pattern of additional genetic changes suggests a clonal evolution from a common ancestor cell. In contrast to findings from a comparative study on a choriocarcinoma of the renal pelvis, we did not find an amplification of the germ cell cancer-associated chromosomal region 12p11.2-p12.1 in the areas of choriocarcinoma but found instead a loss of Xp11.3-pter. To our knowledge, this is the first report of a CGH comparision of the adenocarcinomatous and choriocarcinomatous tumor parts in a nongestational choriocarcinoma of the gastrointestinal tract.

A Hydatidiform Mole in a Postmenopausal Woman

Abstract Gestational trophoblastic disease occurs in less than 1 per 1200 pregnancies in the United States. The spectrum of this disease ranges from benign hydatidiform mole to trophoblastic malignancy (placental-site trophoblastic tumor and choriocarcinoma). Benign gestational trophoblastic disease generally occurs in women of reproductive age and is extremely rare in postmenopausal women. To our knowledge, our case represents only the third description in the world literature of a benign complete hydatidiform mole in a woman with a history of amenorrhea greater than 1 year. We describe the case of a 61-year-old postmenopausal woman who underwent an emergent total abdominal hysterectomy due to uncontrollable vaginal bleeding associated with an increased serum β-human chorionic gonadotropin level. The resected uterus contained an endometrial, cystic, grapelike tumor. Microscopic examination demonstrated hydropic degenerated villi with a circumferential trophoblastic cell proliferation and moderate atypia, consistent with a complete hydatidiform mole. The morphologic and immunophenotypic characteristics are presented, as well as the results of a literature review.

Ectopic Pregnancy Within a Cesarean Section Scar: Report of Two Cases

Objective: Ectopic pregnancy embedded in a previous cesarean section scar is rare. We report two cases of cesarean section scar pregnancy managed with conservative treatment. Case Reports: The first patient was a 39-year-old woman who presented with vaginal spotting and delayed menstruatuion. She had undergone two previous cesarean sections sections and was found to be at 5 weeks’ gestation. The second patient was a 38-year-old woman with one previous cesarean section. She presented with vaginal bleeding and abdominal fullness and was found to be at 7 weeks’ gestation. In both cases, cesarean section scar pregnancies were diagnosed by transvaginal sonographic guidance, followed by multiple doses of intramuscular MTX. Serum β-human chorionic gonadotropin levels declined gradually and reabsorption of the gestational sacs was confirmed by sonography. Conclusions: Early detection of cesarean section scar pregnancy allowed the choice of several conservative treatment options. Intragestational sac injection of MTX systemic was effective in terminating the ectopic pregnancy, even after a fetal heartbeat was detected.

Elevated maternal midtrimester serum free β-human chorionic gonadotropin levels in vegetarian pregnancies that cause increased false-positive Down syndrome screening results

ObjectiveThe aim of this study was to examine whether midtrimester maternal serum free β-human chorionic gonadotropin and α-fetoprotein levels for Down syndrome screening differed in vegetarian pregnancies and omnivore pregnancies and to evaluate whether maternal serum vitamin B12 concentration affected these maker levels. Study designNinety-eight vegetarian and 122 omnivore singleton pregnancies were studied. Reference levels of free β-human chorionic gonadotropin and α-fetoprotein were based on a population of 6312 singleton euploid pregnancies that had been surveyed previously. Serum free β-human chorionic gonadotropin and α-fetoprotein levels were measured by enzyme immunoassay or radioimmunoassay. Multiples of the median values were calculated to determine whether different diet habits affected serum biomarker levels. Maternal serum vitamin B12 levels were determined with radioimmunoassay. ResultsThe free β-human chorionic gonadotropin multiples of the median values were elevated significantly in the vegetarian pregnancies group (1.28 multiples of the median) compared with that of the reference population (1.00 multiples of the median) (P<.001). A negative association between the serum free β-human chorionic gonadotropin multiples of the median values and the concentration of maternal serum vitamin B12 was observed in the vegetarian pregnancies. No correlation was found between the α-fetoprotein multiples of the median values and the maternal serum vitamin B12 concentration. ConclusionThe current data showed that the midtrimester maternal serum free β-human chorionic gonadotropin levels increased in vegetarian pregnancies and led to an elevated false-positive rate in screening for Down syndrome compared with pregnant women with regular diet and resulted in unnecessary invasive procedures. It is necessary to establish vegetarian pregnancy α-fetoprotein and β-human chorionic gonadotropin reference levels to correct increased false-positive screening results.

The prognostic value of serum inhibin, 17β-estradiol and progesterone in cases of hydatidiform mole

The purpose of this study was to provide a diagnostic and a prognostic variable that could easily be measured in the laboratory, and that would predict the need for future therapy of persistent gestational trophoblastic disease. There would no longer be a need to treat all cases of hydatidiform mole prophylactically, to improve the outcome in only about 20% predicted to develop malignant gestational trophoblastic tumors. Circulating β-human chorionic gonadotropin (β-hCG), progesterone, 17β-estradiol and inhibin levels were measured using standard radioimmunoassays in 60 patients with complete hydatidiform mole and in 20 normal pregnant women of a corresponding duration of pregnancy and having a maternal indication for therapeutic abortion. There were no significant statistical differences between the two groups as regards gravidity, parity and gestational age. There was a significant statistical difference between patients with a molar pregnancy who developed gestational trophoblastic tumors (GTT) and those who did not develop GTT as regards pre-evacuation and follow-up mean serum β-hCG, mean serum progesterone and mean serum 17β- estradiol levels. These findings together with the persistently elevated mean serum progesterone and mean serum 17β-estradiol levels at 6 weeks after evacuation in all cases who developed GTT suggested that progesterone as well as 17β-estradiol serum levels might be of prognostic value in cases of molar pregnancy. However, larger numbers of cases are required to correlate findings to β-hCG serum level. Although mean serum inhibin level was significantly higher in women with hydatidiform mole than in normal pregnant women, it lacks any prognostic value for detection of subsequent gestational trophoblastic tumors.

Pure ovarian choriocarcinoma: a difficult diagnosis of an unusual tumor presenting with acute abdomen in a 13-year-old girl

A 13-year-old girl before sexual debut presented with lower abdominal pain and a positive urine pregnancy test. On admission her face was very pale, and a physical examination revealed an acute abdomen with rigidity and tenderness. She was in intermediate shock. Ultrasound examination showed presence of fluid arising from the posterior cul-de-sac up to the liver, consistent with a possible hemoperitoneum, and identified a 68 × 78-mm mass in the right adnexa. Laboratory studies revealed the following values: white blood cells 12 × 109/L, hemoglobin 5.2 g/L and hematocrit 0.16. Liver function results were within normal limits. Because of the suspected intraperitoneal bleeding and adnexal mass, an exploratory laparotomy was urgently performed. Two litres of blood was aspirated and the abdomen was explored. The uterus, left ovary and left tube were normal. As the right fallopian tube could not be separated from the right ovary, a right salpingo-oophorectomy was performed, i.e. removal of a single mass of approximately 7 × 8 cm. She was transfused with three units of whole blood. The hemoglobin value rose to 8.5 g/L and the hematocrit value to 0.26. The postoperative course was uneventful and she discharged on the fourth day. Pathologically, the mass was a pure choriocarcinoma (Fig.1). Chest X-ray and a computerized tomography (CT) scan of the brain, abdomen and chest all failed to demonstrate metastasis. The serum β-hCG level the day after surgery was 91028 mIU/L, the level on the third and seventh days was 23016 mIU/L and 8119 mIU/L, respectively. Pure choriocarcinoma. Characteristic changes of choriocarcinoma, cytotrophoblasts and syncytiotrophoblasts with necrosis and haemorrhage (H & E × 100). Treatment with triple chemotherapy consisting of methotrexate, actinomycin and cyclophosphamide was started 2 weeks following the surgery at an oncology center. There were no complications or side-effects associated with this treatment. By the end of the fourth course, serum β-human chorionic gonadotropin (β-hCG) levels were undetectable, and the patient received one additional course of chemotherapy. Consequently, five courses of chemotherapy were given. In the 9 month follow-up period, thoracic and abdominal CT scans showed no recurrence of the tumor. Pure nongestational choriocarcinoma of the ovary is an extremely rare tumor, and most cases occur in children and adolescents. Our case illustrates the importance of considering ovarian choriocarcinoma in young girls because of its great rarity and its interesting features. Because the tumor secretes β-hCG in large quantities, its diagnosis may often be confused with pregnancy, including ectopic pregnancy (1). It is essential to distinguish between gestational choriocarcinoma and nongestational choriocarcinoma because of possible differences in treatment and prognosis. Unfortunately, when only a choriocarcinoma is present, it is impossible to distinguish the etiology on routine histologic examination (2). However, a patient sexually immature, unable to conceive or not engaged in sexual intercourse must have nongestational choriocarcinoma (2). Therefore, we considered that our case, a 13-year-old girl without a sex life, had nongestational choriocarcinoma, and the pathologic report also confirmed a pure form of this tumor. The most confusing aspect of this case was the difficulty in determining the true diagnosis before and at the time of the laparotomy. Acute symptoms of severe pain and peritonitis or intraperitoneal fluid may lead to a diagnosis of appendicitis or intussusception (3). Because of a positive pregnancy urine test, a tumor may often be diagnosed as an ectopic pregnancy with an adnexal mass. Like our case, some cases may present with an acute abdomen because of excessive intraperitoneal bleeding. Obstetricians must be aware of ovarian choriocarcinoma in adolescent girls who present with hemoperitoneum if the diagnosis of ectopic pregnancy is excluded. Therefore, investigations for metastasis must be carried out during the laparotomy. Haemorrhage and the resulting complications of tumor cell implantation as well as metastatic involvement of other organs require rapid diagnosis and treatment.

Delay of embryo transfer to day 5 results in decreased initial serum β-human chorionic gonadotropin levels

Objective To investigate the impact of delaying the transfer of in vitro fertilized embryos to day 5 on embryo development by comparing serum β-hCG levels in pregnancies established after day 3 embryo transfers and those after day 5 blastocyst transfers at equivalent time intervals after fertilization. Design A retrospective analysis. Setting Assisted reproductive technology center in an academic research environment. Patient(s) Women who had an embryo transfer procedure performed after in vitro fertilization (IVF) at Northwestern University's IVF Program between January 1999 and December 2001 were included in this study. Intervention(s) Embryo transfer was performed either on day 3 or day 5 after oocyte retrieval for IVF (day 0), depending on the availability of good-quality embryos on day 3. Main outcome measure(s) Serum β-hCG concentrations determined 13 and 15 days after fertilization in pregnancies established by transferring cleavage-stage embryos on day 3 or blastocysts on day 5. Result(s) In singleton pregnancies, serum β-hCG concentrations were 75 ± 54 (mean ± SD, n = 203) or 62 ± 41 (n = 109) IU/mL after day 3 or day 5 transfers, respectively. In twin pregnancies, the β-hCG concentrations were 162 ± 105 (n = 52) or 109 ± 55 (n = 49) after day 3 or day 5 transfers, respectively. The percentage increases in β-hCG concentrations between the first and second measurements were similar in the two groups (day 3: 144 ± 109, day 5: 142 ± 63, not statistically significant). Conclusion(s) Initial β-hCG concentrations in pregnancies resulting from day 5 transfers were lower than those from day 3 transfers when assessed at equivalent intervals from fertilization. This suggests that embryo development or implantation may be impaired by the additional 2 days in culture.

An initial Glasgow score of 4 and Apgar scores of 9 and 9: A case report of a pregnant comatose woman

A 28-year-old woman admitted to the emergency department with a Glascow Coma Scale score of 4 after a closed head injury resulting from a motor vehicle crash was found to have a positive serum β-human chorionic gonadotropin level of 27 mIU/mL. After stabilization and treatment for her closed head injury, she remained in a comatose state for more than 240 days. At 36 to 37 weeks' gestation, she had contractions and elevations in her blood pressure. A healthy female infant was born by an operative vaginal delivery with Apgar scores of 9 and 9.