Chorionic Gonadotropin Concentrations Research Articles

Off-label letrozole for tubal pregnancy monotherapy is not an alternative to methotrexate: a prospective cohort study.

Inhibition of estradiol production by letrozole may interfere with physiological effects of progesterone necessary to maintain the pregnancy. Treatment of tubal pregnancy (TP) with letrozole would allow to avoid the disadvantages of methotrexate (MTX). The aim was to compare the effectiveness of letrozole with MTX in the management of TP. A prospective open-label cohort study was conducted among women with TP and increasing B-human chorionic gonadotropin (B-hCG) concentrations. MTX was administered in a single dose of 100 mg intravenously, while letrozole in a dose of 5 mg orally for 10 days. Blood parameters (B-hCG, hemoglobin, creatinine, urea, transaminases, bilirubin) were tested on days 0, 4 and 7. Out of 22 eligible women, 14 received MTX and received 8 letrozole. Mean age, lesion diameter, gestation age in the MTX vs letrozole arm were: 31 vs 32 years (p = 0.3), 13.2 vs 16.3 mm (p = 0.1), 7 + 1 vs 7 + 0 weeks (p = 0.6), respectively. In case of 4 women treated with letrozole and in 2 treated with MTX (4/8, 50% vs 2/14, 14.3%, p = 0.07) the treatment was unsuccessful. There were no significant differences in blood parameters on days 0, 4 and 7 between both arms, except for the increasing urea concentration in the letrozole arm (p = 0.01). Even though the results did not reach statistical significance, it is likely that a larger study sample would confirm the trend of letrozole being less effective. The results did not support the use of letrozole in the studied regimen as an alternative to MTX.

Evaluating the predictive efficacy of first trimester biochemical markers (PAPP-A, fβ-hCG) in forecasting preterm delivery incidences

In this investigation, we explored the correlation between first-trimester biochemical markers and the incidence of preterm birth (PTB), irrespective of the cause, spontaneous preterm birth (sPTB), and preterm premature rupture of membranes (pPROM) within a cohort comprising 1164 patients. It was discovered that diminished levels of Pregnancy-Associated Plasma Protein-A (PAPP-A) between 11 and 13 + 6 weeks of gestation significantly contributed to the risk of preterm deliveries both before 35 and 37 weeks, as well as to pPROM instances. Furthermore, women experiencing sPTB before the 37th week of gestation also exhibited lower concentrations of PAPP-A. Moreover, reduced first-trimester concentrations of free beta-human chorionic gonadotropin (fb-HCG) were identified as a risk factor for deliveries preceding 37 weeks, pPROM, and sPTB before 35 weeks of gestation. Despite these correlations, the area under the curve for these biochemical markers did not surpass 0.7, indicating their limited diagnostic potential. The most significant discriminatory capability was noted for PAPP-A levels, with a threshold of < 0.71 multiples of the median (MoM) predicting PTB before 37 weeks, yielding an odds ratio of 3.11 (95% Confidence Interval [CI] 1.97–4.92). For sPTB, the greatest discriminatory potential was observed for PAPP-A < 0.688, providing an OR of 2.66 (95% CI 1.51–4.66). The cut-off points corresponded to accuracies of 76.05% and 79.1%, respectively. In regression analyses, the combined predictive models exhibited low explanatory power with R2 values of 9.2% for PTB and 7.7% for sPTB below 35 weeks of gestation. In conclusion, while certain biochemical markers demonstrated associations with outcomes of preterm birth, their individual and collective predictive efficacies for foreseeing such events were found to be suboptimal.

Fiber-laser based on D-shaped fiber biosensor for prostate cancer biomarker detection

This work describes the development of a fiber laser-based biosensor using a D-shaped fiber for detecting prostate cancer biomarkers. The biosensor probe was fabricated by coating the D-shaped fiber with gold using sputter coater with deposition time of 6 min and current of 40 mA. Then, the gold-coated D-shaped fiber was inserted inside the single ring cavity for biosensing. The antibody-antigen interaction was conducted using layer-by-layer (LbL) immobilization method. The antibodies were then immobilized on the biosensor, followed by the immunoassay, which involves detecting various concentrations of human chorionic gonadotropin (hCG) antigen. The performance of the biosensor was evaluated in terms of sensitivity, which are determined to be 0.2171 nm/(µg/mL). As a results, this biosensor able to improve the prostate cancer monitoring, diagnosis and early identification. It also suggests that this study paves the way for personalized health strategies and advancements in prostate cancer diagnostics.

Levels of serum β-human chorionic gonadotropin after embryo transfer and subsequent miscarriage, pre-eclampsia, and intrauterine growth restriction.

This study aimed to examine maternal serum concentration of β-human chorionic gonadotropin(β-hCG) on Day 16 after embryo transfer and risk of miscarriage, pre-eclampsia, and intrauterine growth restriction (IUGR). In this study, we evaluated 125 pregnancies following in vitro fertilization (IVF). β-hCG concentrations were measured on the morning of Day 16 after embryo transfer. Baseline characteristics of the study participants were also recorded. Concentrations of β-hCG on Day 16 after embryo transfer were inversely associated with the higher risk of miscarriage (p < 0.001), but did not with pre-eclampsia and IUGR (p > 0.05). Spearman's correlation coefficient showed a reverse and significant association between β-hCG and higher risk of miscarriage (σ = 0.531andp < 0.001). There was a significant association between frozen embryo transfer and the risk of IUGR and pre-eclampsia (p = 0.005and p = 0.023, respectively). Maternal serum concentrations of β-hCG on Day 16 after IVF/embryo transfer were associated with the higher risk of miscarriage, but not pre-eclampsia and IUGR.

A combination of laparoscopy and bilateral uterine artery occlusion for the treatment of type II cesarean scar pregnancy: a retrospective analysis.

We investigated the efficacy of a combination of laparoscopy and bilateral uterine artery occlusion (BUAO) for the treatment of type II cesarean scar pregnancy (CSP). Patients with type II CSP underwent laparoscopy + bilateral uterine artery embolization (control group) or laparoscopy + BUAO (study group). Data regarding the duration of surgery, intraoperative hemorrhage, postoperative complications, the duration of the hospital stay, and the costs of hospitalization were retrospectively collected. One year later, the time to the return of the β-human chorionic gonadotropin (β-hCG) concentration to normal and to the return of menstruation were compared. The duration of surgery, time to the return of menstruation, and incidence of postoperative complications in the study group were significantly less than in the control group, but there was no significant difference in the time for β-hCG to return to normal or the volume of intraoperative hemorrhage. The duration of hospitalization and costs for the control group were higher than those for the study group. Laparoscopy in combination with BUAO is associated with minimal trauma, rapid recovery, a short duration of surgery, low cost of hospitalization, and a low postoperative complication rate. Thus, it represents a useful new surgical treatment for type II CSP.

Risk factors for methotrexate resistance in low-risk gestational trophoblastic neoplasia patients (FIGO score 0-4).

The challenge of methotrexate (MTX) resistance among low-risk gestational trophoblastic neoplasia (GTN) patients has always been prominent. Despite the International Federation of Gynaecology and Obstetrics (FIGO) score of 0-4 patients comprising the majority of low-risk GTN patients, a comprehensive exploration of the prevalence and risk factors associated with MTX resistance has been limited. Therefore, we aimed to identify associated risk factors in GTN patients with a FIGO score of 0-4. Between January 2005 and December 2020, 310 low-risk GTN patients received primary MTX chemotherapy in two hospitals, with 265 having a FIGO score of 0-4. In the FIGO 0-4 subgroup, 94 (35.5%) were resistant to MTX chemotherapy, and 34 (12.8%) needed multi-agent chemotherapy. Clinicopathologic diagnosis of postmolar choriocarcinoma (OR = 17.18, 95% CI: 4.64-63.70, P < 0.001) and higher pretreatment human chorionic gonadotropin concentration on a logarithmic scale (log-hCG concentration) (OR = 18.11, 95% CI: 3.72-88.15, P < 0.001) were identified as independent risk factors associated with MTX resistance according to multivariable logistic regression. The decision tree model and regression model were developed to predict the risk of MTX resistance in GTN patients with a FIGO score of 0-4. Evaluation of model discrimination, calibration and net benefit revealed the superiority of the decision tree model, which comprised clinicopathologic diagnosis and pretreatment hCG concentration. The patients in the high- and medium-risk groups of the decision tree model had a higher probability of MTX resistance. This study represents the investigation into MTX resistance in GTN patients with a FIGO score of 0-4 and disclosed a remission rate of approximately 65% with MTX chemotherapy. Higher pretreatment hCG concentration and clinicopathologic diagnosis of postmolar choriocarcinoma were independent risk factors associated with resistance to MTX chemotherapy. The decision tree model demonstrated enhanced predictive capabilities regarding the risk of MTX resistance and can serve as a valuable tool to guide the clinical treatment decisions for GTN patients with a FIGO score of 0-4.

Assessment of kisspeptin and trappin level in Iraqi women with early pregnancy loss: a cross sectional study

Background: Early pregnancy loss (EPL) is a prevalent medical condition that can have significant and long-lasting impacts on an individual's life. At present, the determination of the feasibility of initial gestation is ascertained through the measurement of serum human chorionic gonadotropin (hCG) concentrations. Notwithstanding, an elevated hCG level in women during their initial trimester who exhibit bleeding does not constantly imply a sustainable pregnancy. Kisspeptin, a well-established regulator of maturation that is widely present in the placenta, represents a valuable biomarker for the assessment of miscarriages and placental dysfunction. The objective of this investigation was to ascertain key biomarkers (namely kisspeptin, trappin, and hCG) in females who have experienced a previous miscarriage. Methods: The study included 90 participants, including 60 pregnant women having a history of abortion in the first trimester and 30 healthy individuals who attended Al Kadhimiya Teaching Hospital and Abu Ghraib Hospital Baghdad Governorate, and ranged in age from 18 to 38 years. Sera from all participants were tested to evaluate various research parameters. Results: Trappin levels were less crucial to hCG than kisspeptin levels. The risk of miscarriage decreases as kisspeptin levels increase. Conclusions: The development of a preliminary screening test aimed at identifying patients who are at risk of miscarriage could potentially offer benefits in terms of offering supplementary emotional assistance and continuation of medical care. Kisspeptin has been identified as a prospective indicator for placental performance. Kisspeptin exhibits potential as a biomarker for assessing the viability of pregnancy and holds promise for clinical utility in the development of a precise diagnostic tool for early pregnancy outcome prediction.

Post-trigger luteinizing hormone concentration to positively predict oocyte yield in the antagonist protocol and its association with genetic variants of LHCGR

BackgroundThe concentration of human chorionic gonadotropin (hCG)/ luteinizing hormone (LH) after triggering is generally accepted as a predictor of the normal ovarian response to the trigger, but few studies have explored the distribution model of concentration and its impact on oocyte yield. Genetic variations in LHCGR, known as a receptor for hCG and LH, also play a role in oocyte maturation and retrieval. The objective of the study was to investigate the impact of concentrations of hCG/LH after triggering on oocyte yield and its association with genetic variants of LHCGR.MethodsA retrospective cohort study including 372 antagonist IVF cycles, in which 205 received the recombinant hCG trigger and 167 received the gonadotropin-releasing hormone agonist (GnRH-a) trigger, was conducted. The post-trigger concentrations of hCG/LH and the LHCGR N312S (rs2293275) genotype were evaluated in patients to analyse the impact of these factors on oocyte yield.ResultsThe oocyte retrieval rate (ORR) increased significantly among the low-, medium- and high-hCG-concentration groups (0.91 ± 0.25, 0.99 ± 0.23 and 1.08 ± 0.19, P < 0.001) and among the low-, medium- and high-LH-concentration groups (0.80 ± 0.29, 0.95 ± 0.21 and 1.07 ± 0.19, P < 0.001). The Pearson correlation coefficient between the post-trigger hCG concentration and ORR was 0.242 (P < 0.001), and that between the LH concentration and ORR was 0.454 (P < 0.001). After adjustment for confounding factors, high post-trigger LH concentrations remained associated with the significantly higher ORRs (adjusted R2 = 0.541, P < 0.001). Patients with the AG genotype of LHCGR N312S were more likely to have low post-trigger LH concentrations (46.10 IU/L versus 60.91 IU/L, P < 0.001) and a significantly lower ORR (0.85 versus 0.96, P = 0.042) than patients with the GG genotype after the GnRH-a trigger.ConclusionsThe post-trigger LH concentration can positively predict oocyte yield in antagonist IVF cycles, and patients with the AG genotype of LHCGR rs2293275 could have a suboptimal oocyte yield using the GnRH-a trigger.

Association of endocrine disrupting chemicals exposure with human chorionic gonadotropin concentrations in pregnancy

BackgroundHuman chorionic gonadotropin (hCG) is produced by the placenta and plays an essential role in the maintenance of pregnancy. Endocrine disrupting chemicals (EDCs) have the potential to interfere with functions related to the production and secretion of hCG; however associations between exposure to EDCs and hCG concentrations in humans remain to be elucidated. ObjectivesTo investigate the association of urinary, serum and plasma concentrations of EDCs during pregnancy with serum hCG concentrations. MethodsWe utilized data form the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy (SELMA) study. We investigated the association of 26 EDCs measured in early pregnancy urine or blood with serum hCG concentrations using multi-variable adjusted linear regression models per EDC and Weighted Quantile Sum (WQS) regression with repeated holdout validation for the EDCs mixture. ResultsIn 2,039 included women, higher exposure to bisphenol A was associated with lower hCG (beta [95% CI]: −0.06 [−0.11 to −0.002]) while higher triclosan exposure was associated with a higher hCG (0.02 [0.003 to 0.04]). Higher exposure to several phthalates, including mono-ethyl and mono-butyl phthalates (MEP and MBP) as well as metabolites of di-2-ethylhexyl phthalate (DEHP) was associated with a lower hCG (beta [95% CI] for sum of DEHP metabolites: −0.13 [−0.19 to −0.07]). Likewise, higher exposure to several polychlorinated biphenyls (PCBs) was associated with a lower hCG. In the WQS regression, each quartile increase in the EDCs mixture was associated with −0.27 lower hCG (95% CI: −0.34 to −0.19). DiscussionHigher exposure to several EDCs during pregnancy was associated with a lower hCG; and despite the small effect sizes, still indicating that the exposure may negatively affect production or secretion of hCG by the placenta. Our results provide the impetus for future experimental studies to investigate the placenta as a target organ for adverse effects of EDCs.

P-496 The effect of adding letrozole to the combined treatment of caesarean scar pregnancy with methotrexate followed by hysteroscopic evacuation of products of conception

Abstract Study question Does adding letrozole to combined cesarean scar pregnancy (CSP) treatment cause a greater decrease in B-human chorionic gonadotropin (B-hCG) concentrations and less blood loss? Summary answer The addition of letrozole to the combined CSP treatment does not result in a greater decrease in B-hCG concentrations or less blood loss. What is known already There is no reference treatment for CSP as the limited number of cases precludes the extrapolation of results. In our center we successfully use two-step treatment with methotrexate followed by hysteroscopic removal of products of conception (POC). The time in between is needed to achieve a decrease in the trophoblast's vital potential (B-hCG fall) and its vascularization. The suppression of estradiol production by letrozole may interfere with the physiological effect of progesterone, which is essential for the maintenance of pregnancy. Additional administration of letrozole could further reduce the vital potential of the pregnancy, resulting in a lower rate of complications. Study design, size, duration A prospective cohort tertiary single-center study (consent no. 1072.6120.321.2020) was conducted among women with CSP from January 2021 to December 2022. Only women with increasing concentrations of B-hCG and consent of the Bioethics Committee for termination of pregnancy were included. Women with decreasing B-hCG concentrations were excluded. All enrolled women gave informed written consent to participate in the study. Participants/materials, setting, methods All women received a single dose of 100 mg MTX intravenously and 50 mg MTX in intra-amniotic injection (day 0), along with 30 mg potassium chloride in case of positive fetal heartbeat (FH). Women who consented were additionally given letrozole 5 mg orally (day 0) for 10 days. B-hCG concentration was measured on day 0,4,7. After obtaining satisfactory decrease in B-hCG and POC vascularization, women underwent hysteroscopic evacuation of POC. Blood loss parameters were measured. Main results and the role of chance The study included 28 women aged 27-41, with a gestational age of 6-12 weeks. FH was present in 17/28 (60.7%) women. Of the 28 women, 16 (57.1%) received additional letrozole (arm 1). There was no significant difference between arm 1 vs. arm 2 (without letrozole) in terms of gestational age (7.69±1.54 vs. 8.00±2.09 weeks, p = 0.85), FH positivity (10/16, 62.5% vs. 7/12, 58.33%; p = 1), BMI (25.39±5.08 vs. 26.24±6.51; p = 0.82), day 0 B-hCG (47656.89± 37747.87 vs. 51870.83± 45838.87 mIU/ml; p = 0.89) and day 0 hemoglobin (Hb) (12.98±0.74 vs. 12.74±1.26 g/dl; p = 0.57). Timing of hysteroscopy was not significantly different between arm 1 vs. arm 2 (day 22.19± 14.44 vs. 31.42± 25.83; p = 0.42). The dynamics of B-hCG decline in arm 1 vs. arm 2 between days 4-0 (-3295.67± 15133.13 vs. −6883.00± 20029.88 mIU/ml; p = 0.71) and 7-4 (-13137.82± 13765.14 vs. −19145.75± 23526.70 mIU/ml; p = 0.68) was not significantly different. There were no differences between arm 1 vs. arm 2, in decrease in Hb concentration on day 1 post-hysteroscopy (-1.79± 1.67 vs. −2.19± 1.68 g/dl, p = 0.53), blood loss volume (318.75± 437.37 vs. 591.67 ± 744.02 ml; p = 0.29) and rate of hemorrhage (4/16, 25% vs. 3/12, 25% cases, p = 1). Limitations, reasons for caution The limitations of the study are the small sample size, the single-center nature of the study, and the arbitrarily set dosing regimen of letrozole. Wider implications of the findings The results do not support the use of letrozole in the above regimen as an adjunct to combined CSP treatment. Trials with a larger sample size and with a different letrozole dosing regimen are needed to confront the results. Trial registration number 072.6120.321.2020

Assessing the risk factors and management outcomes of ectopic pregnancy: A retrospective case-control study.

Ectopic pregnancy (EP) is the implantation of a fertilized egg outside the uterine cavity or in an unusual location. According to the clinical case reports, hormonal contraceptive failures may be related to emergency contraceptives and EP. EP may be treated medically, surgically, or expectantly. Currently, there is no consensus regarding whether a multiple- or double-dose regimen with methotrexate (MTX) or an additional dose could be more effective than a single-dose regimen. This study aimed to assess risk factors and treatment outcomes for EP. This case-control study was conducted in Tehran, Iran from March 2020 to March 2021. The case group was comprised of all EP-diagnosed cases (n = 191). Based on the levels of β-human chorionic gonadotropin, MTX was administered to stable individuals with no surgical indications. Risk factors were assessed through 2 control groups: intrauterine pregnancy (n = 190) and nonpregnant groups (n = 180). The medical treatment significantly improved with an extra dose of MTX, especially in individuals with higher β-human chorionic gonadotropin concentrations and gestational age 7.5 wk (p = 0.002). Considering risk factors, it is assumed that hormonal contraceptive failures, including both oral and emergency contraceptives, may increase the EP likelihood (p 0.001). Based on our findings, we recommended an additional dose of MTX for subjects who are further along in their pregnancy. It is also concluded that failure of contraceptive pills increases the chances of EP.

Persistently elevated serum concentrations of human chorionic gonadotropin (hCG).

We describe a woman with constantly elevated hCG levels in serum. Since assay interference, pregnancy or cancer did not explain the elevated levels, we measured the concentrations of hCG, its β subunit (hCGβ) and its core fragment (hCGβcf) in serum and urine using specific assays, to understand the nature of the elevated hCG levels. We used 3 assays for total hCG (these assays also recognize hCGβ and to various degrees hCGβcf), 3 for intact hCG heterodimer, 3 for free hCGβ and one for hCGβcf. With an hCG assay detecting total hCG the serum concentrations were in the range of 150-260 IU/L for the whole study period of almost 5 years, except for a peak of 1,200 IU/L, coinciding with a spontaneous abortion. Quantitation of different forms of hCG with specific immunoassays showed that the immunoreactivity in serum consisted of hCGβ. Urine contained hCGβ and hCGβcf. The laboratory findings are in keeping with familial hCG syndrome. However, so far the condition remains to be determined in any family members. Elevated hCG levels without any explanation are problematic as they cause suspicion of cancer or ectopic pregnancy and may lead to harmful therapy. Specific assays, as used here, will aid in diagnosis of such cases.

THE LEVEL OF TROPHOBLAST HORMONES IN EARLY PREMATURE TERMS OF GESTATION

Abstract. The trophoblast hormones of the chorionic villi (CV) of the placenta play a signifi cant role in the processes of formation of structures and functions of the fetus. Disorders of microcirculation also lead to disturbances in metabolism and oxygenation, which causes fetal distress. Microcirculation disorders also aff ect the hormone- producing function of the placental complex. Disorders of fetoplacental blood fl ow at the beginning of the second trimester lead to a drop in the synthesis of hormones by half compared to the norm and the appearance of clinical manifestations of placental dysfunction. There is a pronounced drop in the hormoneproducing function of the placenta in pregnant women with miscarriage and disorders in the mother- placentafetus system at 30-32 weeks, which confi rms the failure of compensation of the placental system.The purpose. The aim of the study was to quantitatively establish the concentration of chorionic gonadotropin and placental lactogen in the trophoblast of the chorionic villi of the placenta in the early stages of pregnancy in pregnant women with miscarriage in order to understand the pathogenesis of placental insu ffi ciency in the fi rst trimester of pregnancy.Research material and methods. The immunohistochemical quantitative investigations of hormones of trophoblast of chorial villi were made at early stages of pregnancy (5-12 weeks). The material of spontaneous miscarriages of 5-12 weeks of gestation was studied (28 observations – the main group). The material of abortions from practically healthy women for social reasons (16 cases) served as a control. Scientifi c studies passed the bioethics commission, no violations were found. Scientifi c research passed the bioethics commission, no violations were found (protocol N 4 dated December 16, 2021). Standard methods of mathematical analysis using Student’s and Fisher’s criteria, standard and specialized computer programs were used for statistical processing of the obtained data. Pairwise correlation indicators were used to study the nature and degree of relationship between various parameters.Results and their discussion. It was established that the signifi cant fl uctuations of the «optical density» indicator in relation to the content of CHT in the trophoblast of HC in the main group are actually caused by two types of pathology, one of which is accompanied by a decrease in the concentration of CHT (13 observations – main group A), and the other – on the contrary, by its increase (15 observations – main group B).It was established that in principle may developed two types of placental (villous) insu ffi ciency, and the common sings of its are decreased of vascularization of chorial villi. The fi rst type is described as decreased concentration of chorionic gonadotropin and placental lactogen in the trophoblast, morphological sings of slowdown of development of chorial villi with increasing formation of cytotrophoblast of chorial villi. The second type show itself increasing of concentration of this hormones in the trophoblast and decreasing of processes of formation of cytotrophoblast of chorial villi.Conclusions. Both variants of the described pathology in relation to CHT and PLH (lower and higher concentration of them in the trophoblast of HC) in combination with a certain morphological picture, in our opinion, are the molecular and structural basis of the two types of placental (villous) insu ffi ciency in the early stages of gestation, respectively.

Cesarean scar pregnancy: presentation of a clinical case and literature review

Gabija Barkauskaitė1, Gabija Didžiokaitė2, Agnė Marcinkutė3, Gediminas Mečėjus1,3 1Vilnius university, Faculty of Medicine, Vilnius, Lithuania 2Vilnius university hospital Santaros clinics, Vilnius, Lithuania 3Vilnius city clinical hospital, Vilnius, Lithuania Abstract Bacground. Pregnancy in the cesarean section scar is one of the rarest forms of ectopic pregnancy accounting for about 6.1% of all ectopic pregnancies in women who have previously had a cesarean section. Removal of the condition can be treated with medication, surgery, or a combination of the two. Case report. A forty-year-old woman presented to the Emergency Department for lower abdominal pain. A life history marks one pregnancy completed by caesarean section. The pregnancy test was positive. The concentration of human chorionic gonadotropin (hCG) was 1810 IU/l. A vaginal ultrasound performed at the next visit revealed a 1.0 cm diameter gestational sac at the isthmus of the uterus. 5 weeks pregnancy was confirmed, hCG-5391 IU/l. 3 weeks later a transvaginal ultrasound examination revealed a 10 mm diameter echonegative shadow with a thick capsule in the cesarean section site. Caesarean scar pregnancy was diagnosed. Surgical laparoscopy was performed to remove the cesarean scar pregnancy. Within 24 hours after the operation, hCG levels decreased from 5391 to 1189 IU/l. Conclusion. Minimally invasive intervention laparoscopy is an effective treatment method with a low risk of complications in the case of pregnancy in the cesarean section scar. Universal treatment guidelines could ensure more successful treatment of this condition. Keywords: ectopic pregnancy, caesarean section, laparoscopy. Full article https://doi.org/10.53453/ms.2023.2.8

Does mRNA COVID-19 vaccination in oocyte donors impact ovarian stimulation parameters or IVF outcomes for recipients?

Research questionWhat is the effect of mRNA severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in young oocyte donors in terms of ovarian response to stimulation, fertilization rate, embryo development and clinical outcomes in recipients? DesignThis retrospective, multicentre cohort study evaluated 115 oocyte donors who had undergone at least two ovarian stimulation protocols (before and after complete SARS-CoV-2 vaccination) between November 2021 and February 2022. Comparisons were made of the primary outcomes of days of stimulation, total dose of gonadotrophins and laboratory performance in ovarian stimulation in oocyte donors before and after vaccination. A total of 136 cycles in matched recipients were analysed as secondary outcomes and, from those, 110 women received a fresh single-embryo transfer, with analysis of biochemical β-human chorionic gonadotrophin concentrations and rates of clinical pregnancy with heartbeat. ResultsLonger stimulation was required in the post-vaccination than pre-vaccination group (10.31 ± 1.5 versus 9.51 ± 1.5 days; P < 0.001) along with higher gonadotrophin consumption (2453.5 ± 740 versus 2235.5 ± 615 IU; P < 0.001) with a similar starting dose of gonadotrophins in both groups. More oocytes were retrieved in the post-vaccination group (16.62 ± 7.1 versus 15.38 ± 7.0; P = 0.02). However, the number of metaphase II (MII) oocytes was similar between groups (pre-vaccination 12.61 ± 5.9 versus post-vaccination 13.01 ± 6.6; P = 0.39) and the ratio of MII/retrieved oocytes favoured the pre-vaccination group (0.83 ± 0.1 versus 0.77 ± 0.2 post-vaccination; P = 0.019). In recipients with a similar number of provided oocytes, the fertilization rate, total number of obtained blastocysts, number of top-quality blastocysts, and rates of biochemical pregnancy and clinical pregnancy with heartbeat were not significantly different between groups. ConclusionsThis study shows no adverse influence of mRNA SARS-CoV-2 vaccination on ovarian response in a young population.

Evaluation of serum anti-Müllerian hormone (AMH) and equine chorionic gonadotrophin (eCG) concentrations in pregnant mares in relation to foetal sex

The aim of this study was to investigate the foetal sex related difference and progression in maternal serum anti-Müllerian hormone (AMH) and equine chorionic gonadotrophin (eCG) concentrations during different points of time in pregnant Arabian mares. The study groups formed by 12 healthy male offspring- and 12 healthy female offspring-foaling mares, designated as group MFM and group FFM, respectively. Peripheral blood samples were collected on the day of natural mating and then monthly until the 6thmonth (mo) of gestation. Serum AMH was measured in all serum samples; eCG was measured in samples collected from 2 to 5 months Of gestation. Serum AMH concentrations of group FFM at mo 4 and mo 5 (3.89 ± 0.49 ng/ml; 2.89 ± 0.32 ng/ml), were significantly higher than in group MFM (2.11 ± 0.46 ng/ml; 1.87 ± 0.32 ng/ml), (P&lt; 0.05). The mo of gestation (mo 1–6) had no effect on serum AMH concentrations of either group MMF or FFM (P&gt; 0.05). Serum eCG concentrations of group FFM at mo 2 (359.73 ± 41.51 mIU/ml), were significantly higher than in group MFM (255 ± 21.18 mIU/ml) (P&lt; 0.05). Group-time interaction for eCG concentrations at mo 2–4 was non-significant (P&gt; 0.05). Concentrations of serum AMH showed no relationship with corresponding eCG levels at mo 2–4 (P&gt; 0.05). Individual variations in AMH and eCG concentrations and the inability to determine a cut-off point for determination of foetal sex make these hormones unlikely candidates for determining foetal sex in the mare.

Nausea and vomiting in pregnancy: literature review

Inga Vasilevskytė1,2 1Vilnius University, Faculty of Medicine, Vilnius, Lithuania 2 Vilnius University Hospital Santaros Klinikos, Centre of Obstetrics and Gynecology, Vilnius, Lithuania Summary Background. More than half of pregnant women suffer from nausea and vomiting, which typically begins by the fourth week and disappears by the 16th week of pregnancy. In 1 in 200 women, the condition progresses to hyperemesis gravidarum (HG). The cause of nausea and vomiting in pregnancy is unknown, but may be due to the rise in human chorionic gonadotrophin concentration, neuromuscular factors. Therefore, treatment may be difficult because are the full effect of possible treatment on the fetus is not known. This article reviews the epidemiology, risk factors, diagnosis and various treatments for NVP. Aim.To review the risk factors for nausea and vomiting during pregnancy, diagnosis, possible treatments, their safety. Methods. To review of the literature was performed based on the scientific databases of PubMed, Medline, Web of Science. The publications were selected using the following keywords: “Nausea”, “Vomiting”, “Treatment”, „Pregnancy“. A total of 47 articles were reviewed, 10 of which were rejected, published between 2009 and 2021. Results. NPV is probably the most common pregnancy disorder. The pathogenesis of NVP remains unclear, but it is thought that it may be multifactorial and genetically predisposed. NVP therapy depends on the severity of the disorder to improve symptoms while reducing the risk to the mother and fetus. Treatment includes dietary changes, pharmacological treatment, and acupuncture and acupressure. Conclusions. The literature review provides information on the risk factors, diagnosis and the efficacy and safety of the various interventions: acupuncture; ginger; metoclopramide; ondansetron; and pyridoxine. Keywords: nausea, vomiting, pregnancy, hyperemesis gravidarum, treatment.

The efficiency of using maternal markers in early detection and management of congenital anomalies in Majmaah city, KSA

Nowadays the serum analytic investigations have become the first step, noninvasive, detecting method of choice of foetal abnormalities specially for at-risk patients.This study volenteers were Saudi pregnant women in King Khalid General Hospital (KKGH) at Majmaah city, Riyadh, Saudi Arabia.The study intended to judge and evaluate using the concentrations of Beta Human Chorionic Gonadotropin (βHCG) in serum as efficient maternal markers for early detection as well as management of foetal abnormalities and pregnancy complications.A total of 201 serum samples were studied. 101 sera of pregnant women were taken in the first trimester, while the other 100 non-pregnant females were acted as control volenteers. The sensitive Enzyme immunoassay (ELISA) method was applied for quantitative scoring of beta HCG levels. Pregnant women were followed up by a consultant obstetrician till delivery. Trisomy 21 and blighted ovum disorders were selected as cases of interest.Serum βHCG concentrations multiple of median (MoM) for the mothers of affected babies compared with the healthy ones. Defrences were significant as p: value showed 0.001 for each appraisal.Non-pregnant serum beta HCG (2.1 IU/ml) compared with only three weeks of gestation (576 IU/ml) for early detection of pregnancy. Upon comparison a significant high level of β HCG was recorded for the three weeks gestation with (p,value:0.001) which clearly indicates the existence of pregnancy.The use of β HCG could be the method of choice for early detection of pregnancy. This will save the embryo life during the first trimester of gestation especially in the radiology departments.

Urothelial carcinoma of the prostate with raised β-hCG levels: a case report

BackgroundTrophoblastic differentiation in primary urothelial carcinoma of the prostate is extremely rare. An increased level of β-subunit human chorionic gonadotropin in serum in urothelial carcinoma is detected in approximately 30% of cases. To our knowledge, increased concentration of β-subunit human chorionic gonadotropin in serum in prostatic urothelial carcinoma has never been reported and its clinical significance is not evaluated yet.Case reportHere we present the case of a 67-year-old European patient who was admitted to the hospital with hematuria, dysuria, and enlarged painful testis. Ultrasonographic examination of the testis did not reveal any focal lesion. Magnetic resonance imaging of the pelvis showed a tumor of 62 mm diameter mainly located in the posterior part of the prostatic gland. A pathological examination from cystoscopy biopsy allowed us to set the diagnosis of high-grade invasive urothelial carcinoma with trophoblastic differentiation. The patient received neoadjuvant treatment. Nonetheless, after a short period of disease stabilization, he developed progression and brain metastasis. He died 9 months after diagnosis. During the disease course, his β-human chorionic gonadotropin level was measured repeatedly and analyzed in relation to disease progression. The level of serum β-human chorionic gonadotropin corresponded with the therapy response; it was at its lowest during stabilization and the highest in the metastatic stage.ConclusionOur case study provides the first report of urothelial cancer of the prostate, with a concomitant increase of β-subunit human chorionic gonadotropin level with testis enlargement. Besides its rarity, it constitutes an interesting observation of increasing β-subunit human chorionic gonadotropin concentration with concomitant disease progression.

Indicators of angiogenesis and hormonal profile in pregnant women with chronic hypertension in the first trimester

The role of angiogenesis factors and hormonal profile in pregnant women with arterial hypertension has not been detailed studied, and their interaction in such patients has not been determined at present time.The objective: to determine the features of angiogenesis factors and hormonal profile in pregnant women with arterial hypertension of the 1and 2 grade. Materials and methods. A prospective study was conducted in 88 pregnant women, which included: analysis of clinical and anamnestic characteristics and the study of pregnancy characteristics in women with chronic arterial hypertension (CAH) in the I trimester of pregnancy (11–12 weeks). The open prospective controlled study involved 61 pregnant women with CAH of the 1 and 2 stages which consisted the main group. The control group included 27 healthy pregnant women with physiological pregnancy. Concentrations of human chorionic gonadotropin (hCG), progesterone (PG), estradiol (E) and markers of angiogenesis – placental growth factor (PlGF) as a proangiogenic factor and soluble fms-like tyrosine kinase (sFlt-1) as an antiangiogenic factor were determined in the blood serum of all patients, sFlt-1/PGF ratio was also estimated (K). Statistical analysis was performed using «STATISTICA® for Windows 13.0».Results. In the I trimester of pregnancy in women with CAH, a shift in the balance between pro- and anti-angiogenic factors is determined, which is manifested by a statistically significant (p&lt;0.05) increase sFlt-1 level (1700.9 pg/ml) and a decrease PlGF level in 3.7 times (9.1 pg/ml) and, accordingly, an increase K coefficient (sFlt-1/PlGF) by 5.3 times (184.5). The mean concentrations of E, PG and hCG in pregnant women of the main group did not differ statistically significantly from those in the control group. However, according to the results of the correlation analysis, PlGF and PG indicators have feedback in pregnant women with CAH (r=-0.29; p&lt;0.05). When calculating the correlation of PlGF and hormones, it was found that in pregnant women with CAH there is their growth according to the control group, namely the indicator hCG correlates with PlGF (51.8 units vs. 14.8 units) 3.5 times, E correlates with PlGF (309.7 units vs. 70.0 units) 4.4 times and PG correlates with PlGF (4.8 units vs. 1.0 units) 4.8 times (p&lt;0.001 for all indicators). These changes indicate the presence of angiogenesis disorders in pregnant women with chronic hypertension, starting from the I trimester of gestation.Conclusions. Pregnant women with CAH in the I trimester have disturbances in balance between pro-angiogenic and anti-angiogenic factors with prevalence of sFlt-1 and decrease of PlGF in blood serum. Because of such imbalance in pregnant women with CAH of the 1 and 2 grade, the interaction of angiogenesis factors and hormones changed from direct to inverse. It may lead to the development of placental dysfunction in the future, so treatment and prevention should be provided for the pregnant women with CAH in the I trimester.