Serum Chorionic Gonadotropin Research Articles

Integrative transcriptomics and proteomics analyses to reveal the therapeutic effect and mechanism of Buxue Yimu Pills in medical-induced incomplete abortion rats

Ethnopharmacological relevanceMedical abortions using mifepristone and misoprostol have been approved in many countries for early pregnancy loss. Despite its high success rate, this medication regimen can result in incomplete abortion, which is responsible for endometrial damage, prolonged uterine bleeding, abdominal pain, etc. Buxue Yimu Pills (BYP) is a famous Chinese medicine prescription that is widely used in the field of gynecology and obstetrics for treating patients with postpartum complications. However, the therapeutic effect and mechanism of BYP remain to be explored. Aim of the studyThis study aimed to clarify the therapeutic effect and mechanism of action of BYP in postpartum complications using mifepristone and misoprostol-induced incomplete abortion in rats. Materials and methodsExperimental medical-induced incomplete abortion model rats were constructed using mifepristone and misoprostol, and further treated with saline or BYP by intragastric administration. Detailed information regarding the changes in mRNA and protein levels in the uterine tissues of rats regulated by BYP was illustrated by RNA sequencing (RNA-seq) analysis and quantitative proteomics analysis. The differentially expressed genes and proteins were further subjected to Gene Ontology (GO) and pathway enrichment analyses and further verified using quantitative Real-time PCR (qRT-PCR) analysis and western blot assay. ResultsBYP administration markedly alleviated the increase in serum prostaglandin F2α (PGF2α) and expression of PGF2α receptor (PGF2αR) in uterine tissues and inhibited the decrease in serum chorionic gonadotrophin (CG). Compared with the model group, 674 genes were upregulated and 344 genes were downregulated by BYP administration; 108 proteins were upregulated and 48 proteins were downregulated by BYP administration. qRT-PCR analysis of the uterine tissues showed that BYP treatment reversed the variation tendency of genes, including Mmp7, Mmp14, Timp2, Col6a4, Jak2, Wnt7a, and Mylk compared with the model group. Western blot analysis showed that BYP administration affected PKCδ, Collagen VI, MMP7, TIMP2, MLCK, and p-MLC protein levels. ConclusionBYP administration facilitated uterine recovery in medical-induced incomplete abortion rats, and this therapeutic effect involved various targets and biological processes, including the TIMP2/MMP7 and MLCK/p-MLC signaling pathways, etc.

Association of hyperemesis gravidarum with the risk of development of small for gestational age fetus

The goal of this study was to determine the association of hyperemesis gravidarum with the risk of development small for of fetus gestational age (SGA). Materials and methods. There were studied 327 pregnant women. The main group included 218 women with hyperemesis gravidarum, who were divided into two groups: 140 patients who were first hospitalized with hyperemesis gravidarum in the first trimester (up to 12 weeks of pregnancy) and 78 - who were first hospitalized with hyperemesis gravidarum in the second trimester (12-21 weeks of pregnancy). 109 pregnant women without vomiting were at control group. The diagnosis of SGA fetus was established on the basis of standard ultrasonic fetometry on the ALOKA SSD-1700. Determination of human serum chorionic gonadotropin (HCG) levels was performed at 15-20 weeks and was evaluated as MoM. The results were statistically analyzed using Statistica 10 (Serial Number: STA999K347150-W) and MEDCALC®. Results. In the main group, the SGA fetus was 3.4-fold more frequent compared with pregnant women in the control group (9.6% vs. 2.8%, p<0.05; OR=3.77; 95%CI:1,10-12.92). It was found that hyperemesis gravidarum in the first trimester does not affect the deviation of fetal weight deviations (p>0.05). However, hyperemesis gravidarum in pregnant women in the second trimester increases the risk of developing SGA fetus (OR=6.42; 95%CI 1.75-23.62; p<0.01) compared with control. Pregnant women with HCG≥2.5 MoM were 3.0-fold more likely to be diagnosed SGA fetus than with HCG<2.5 MoM (75.0% vs. 25.0%, p<0.001; OR=9.00; 95%CI:1.42-57.12) and 2.3-fold compared with the development of the normal fetus (75.0% vs. 33.3%, p<0.001; OR=6.00; 95%CI:1.47-24,4). Conclusion. Hyperemesis gravidarum in the second trimester of pregnancy and elevation of HCG level in the second trimester (≥2,5 МоМ) can be seen as markers of placental disfunction and high risk for SGA fetus.

Correlation between clinical and laboratory parameters and early pregnancy loss in assisted reproductive technology cycles: A cross-sectional study.

BackgroundThe miscarriage rate after pregnancy resulting from assisted reproductive technology (ART) is about 20%, roughly half of which is biochemical. The correlations between the number and quality of oocytes, estradiol level and early pregnancy loss have not been fully clarified.Objective This study aimed to examine the clinical and laboratory parameter effects on early abortion in ART cycles.Materials and MethodsIn this cross-sectional study, 408 women who were ART candidates and were referred to the Yazd Infertility and Research Center, Yazd, Iran during March 2017 to March 2020 participated. Women who had a fresh embryo transferred and who had a positive beta human chorionic gonadotropin serum test were included in the study. The Anti-Müllerian hormone (AMH) level, embryo quality, oocyte number, progesterone level, estradiol level, and maternal age were extracted from the medical records.ResultsNo significant difference was observed in the age, mean estradiol and progesterone levels on trigger day, number of MII oocytes, and embryo quality between the groups (p = 0.19, 0.42, 0.07, 0.34 and 0.20, respectively). No statistically significant difference was found between the 3 groups of AMH level (p = 0.20). After evaluation using logistic regression, the rate of negative clinical pregnancies was higher in the group with AMH 1 ng/ml. However, this was not found to be statistically significant.ConclusionWe did not find any correlation between early abortion and AMH levels, embryo quality, oocyte number, progesterone level, estradiol level, or maternal age.

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.

How to Optimize Laparoscopic Management of Cornual Pregnancy

We report a case of a 32-year-old woman, gravida 6 para 3, with a history of 2 previous miscarriages. She presented with a pelvic pain to our emergency department. She was hemodynamically stable with a β-human chorionic gonadotropin serum level of 26 342 IU/L. Ultrasound was suspicious for an interstitial pregnancy (Fig. 1). After patient consent, surgical management was decided considering her obstetric history. She underwent an explorative laparoscopy; a nonruptured left cornual pregnancy was found (Fig.

Gestational trophoblastic neoplasia: Novelties and challenges.

Gestational trophoblastic diseases are a group of pregnancy-related disorders, originated from trophoblast cells. They include benign and aggressive tumors, such as the invasive mole, the choriocarcinoma, the placental site trophoblastic tumor (PSTT), and the epithelioid trophoblastic tumor (ETT). These malignancies are characterized as gestational trophoblastic neoplasm (GTN), rarer, although more dangerous. The diagnosis of GTN is made in most cases by monitoring serum chorionic gonadotropin (hCG) with histological confirmation. The use of specific tissue biomarkers has been increasingly employed as a differential diagnosis, leading to more accurate results and different therapy protocols and prognosis for each GTN. The treatment is based on the International Federation of Gynecology and Obstetrics anatomical staging system and the World Health Organization prognostic score system. If an accurate diagnosis is made and the guidelines followed, the cure for choriocarcinoma and invasive mole cases can reach 98%, whereas PSTT and ETT still present mild success rates. The improved knowledge about GTN and its peculiarities allows physicians to efficiently achieve the differential diagnosis and choose the best available therapy protocol, thus increasing the overall survival of affected women. Nevertheless, obtaining epidemiological data and improving knowledge through basic and translational research are essential to answer open questions on GTN physiopathology, their causes, and cellular behavior.

Возможности ультразвуковой эластографии и трехмерной эхографии в диагностике трубной беременности

A clinical case describing the potential of elastography and three-dimensional echocardiography in tubal pregnancy in a patient who was not initially diagnosed during laparoscopy is presented. The dynamic observation showed an increase in serum chorionic gonadotropin; the postoperative follow-up with elastography and three-dimensional echocardiography revealed signs of initially progressive and subsequently interrupted tubal pregnancy (the patient refused a second laparoscopy). Threedimensional echocardiography contributed to better visualization of the ovum compared to the B-mode image; the sign of tubal pregnancy (a vascular “ring of fire”) was clearly identified in the glass-body mode. A laparoscopic tubal ligation was then performed. The diagnosis was confirmed histologically. Conclusion. Ultrasound elastography and three-dimensional echocardiography contribute to better diagnosis of tubal pregnancy in complicated clinical situations. Key words: tubal pregnancy, ectopic pregnancy, elastography, three-dimensional echocardiography, vascular “ring of fire”

Interstitial Ectopic Pregnancy and Laparoscopic Removal of the Interstitial Portion of the Tube: the New Frontier?

We present a case of a 40-year-old lady with 9 weeks of amenorrhea diagnosed with an interstitial pregnancy and multiple uterine fibroids. She underwent laparoscopic salpingectomy including the interstitial part of fallopian tube with products of conception without myomectomy and cornuostomy. Intra-operative blood loss was minimal. She was followed up post-operatively with weekly serum beta human chorionic gonadotropin (serum beta-hCG), which down-trended optimally at day 23 of surgery. Histopathology confirmed ectopic pregnancy with underlying salpingitis isthmica nodosa. Patient recovered well. J Med Cases. 2020;11(8):229-233 doi: https://doi.org/10.14740/jmc3317

A comparison of in vitro fertilization-embryo transfer outcome by two types of soft embryo transfer catheters

Introduction: One of the remaining challenges in assisted reproductive procedures, especially in vitro fertilization (IVF), is proper embryo transfer. The aim of this clinical trial was to compare IVFembryo transfer outcome by two types of soft embryo transfer catheters in Hamadan Endometrics and Endometriosis Research Center (Iran).
 Methods: In this clinical trial study, 100 patients who were candidates for IVF were evaluated. Patients were randomly assigned into two groups (A=50 and B=50). The IVF was identical for both groups until the embryo transfer stage. For group A, soft catheter CH3 PM TRANS SET MINI was used and in group B, KITAZATO soft catheter was used for embryo transfer. All transfers were performed by one person. Patients were recruited using checklists, demographic information, infertility history, beta-human chorionic gonadotropin (ß-hCG) serum levels at day 14 post-transfer, and pregnancy bag 28 days after transfer. The results were analyzed by SPSS software version 16 and using descriptive statistics, chi-square and t-test. The significance level was < 0.05.
 Results: The mean age of group A and group B was 30.12 and 29.24 years, respectively (p=0.341). The mean duration of infertility in both groups was not statistically significant, and in groups A and B were 4.89 and 4 years, respectively. Ninety % of group A experienced their first IVF experience, while in group B it was slightly lower than 86%, which was not statistically significant. The mean number of eggs obtained in group A was 9.84 and in the group B was 9.88 (p=0.962). The mean number of embryos formed in group A was 6.24 and in group B was 5.72 (p=0.405). There was no statistically significant difference between the two groups in using of Tenaculum, the quality of transmission, and the contamination of the catheter head into the blood or mucus.
 Conclusion: According to the findings of the present study, the use of KITAZATO catheter compared to PM TRANS SET MINI CH3 catheter for fetal transfer in IVF patients showed no significant difference in pregnancy success rate. However, patients who received the KITAZATO catheter had a slightly higher chance of pregnancy that could be clinically valuable.

Exclusion of pregnancy in dialysis patients: diagnostic performance of human chorionic gonadotropin

BackgroundA positive pregnancy test in acute or chronically ill patients has implications for the use of potentially mutagenic or teratogenic products in urgent medical therapies such as the use of chemotherapies or therapies with immunosuppressants, for anesthesia, and for time-sensitive indications like urgent surgery or organ Transplantation.Despite a lack of evidence, it is currently believed that human chorionic gonadotropin serum concentrations are always elevated in female dialysis patients even without pregnancy. It is also believed that human chorionic gonadotropin cannot be used to confirm or exclude pregnancy.MethodsHuman chorionic gonadotropin was examined in female dialysis patients (18–50 years of age), and was classified as positive above 5 mlU/ml. In addition, fertility status was determined. For an enhanced index test, the cut-off of 5 mIU/ml was used for potentially fertile patients and 14 mIU/ml for infertile patients to calculate diagnostic test accuracy. The ideal cut-off for human chorionic gonadotropin was estimated using Liu’s method with bootstrapped 95% confidence intervals. Predictors of human chorionic gonadotropin increase were analyzed using multivariable linear regression.ResultsAmong 71 women, two (2.8%) were pregnant, 46 (64.8%) potentially fertile, and 23 (32.4%) infertile. We observed human chorionic gonadotropin concentrations > 5 mIU/ml in 10 patients, which had a sensitivity of 100% (95% confidence interval: 100 to 100), a specificity of 86% (95% confidence interval: 77 to 94), a positive predictive value of 17% (95% confidence interval: 8 to 25) and a negative predictive value of 100% (95% confidence interval: 100 to 100) for the diagnosis of pregnancy. Using a cut-off > 14 mIU/ml for infertile patients or the exclusion of infertile patients increased specificity to 93% or 98%, respectively. The ideal cut-off was 25 mIU/ml (95% confidence interval: 17 to 33). Pregnancy and potential fertility, but not age, were independent predictors of human chorionic gonadotropin.ConclusionHuman chorionic gonadotropin is elevated > 5mIU/ml in 14.5% of non-pregnant dialysis patients of child-bearing age. In potentially fertile women, this cut-off can be used to exclude pregnancy. In case of an unknown fertility status, the ideal human chorionic gonadotropin cut-off was 25 mIU/ml.

Successful Management of Live Ectopic Pregnancy with High B-Hcg Titres by Systemic Methotrexate Injection: A Case Report

Background: Use of methotrexate (MTX) as a nonsurgical management of unruptured ectopic pregnancies has been well accepted. However, use of it in high serum chorionic gonadotropin concentration and in live fetus has been considered as relative contraindication for medical therapy. The aim of this report is to emphasize that these contraindications can be revisable in some situations and discuss about this fact that the success rate can be affected by the type of protocols used for medical treatment. Case presentation: A 31 years old primigravid woman was admitted to our hospital due to a sonogram's report of ectopic pregnancy with a high initial serum B-hCG concentration (26900) and presence of fetal cardiac activity. Her vital signs were stable and she did not agree with operative intervention. Two-dose protocol was scheduled but appropriate response to treatment was obtained after receiving the third dose of methotrexate. Negative serum B-hCG (< 1 mIu/ml) was achieved on day 80 without any related treatment complication on follow up. Conclusions: Use of double- dose protocols of MTX in medical treatment of ectopic pregnancy increase the chance of successful and nonsurgical treatment even in live fetus with high B-hCG titers.

First comprehensive view on a magnetic separation based protein purification processes: From process development to cleaning validation of a GMP-ready magnetic separator.

Magnetic separation processes are known as integrated bioanalytical protein purification method since decades and are well described. However, use of magnetic separation processes in a regulated industrial production environment has been prevented by the lack of suitable process equipment and prejudice against the productivity of the process and its qualification for cleaning-in-place operation. With the aim of overcoming this prejudice, a comprehensive process development approach is presented, based on a GMP-compliant magnetic separator, including an optimization of the batch adsorption process, implementation into a technical-scale, and the development and validation of cleaning routines for the device. By the implementation of a two-step counter-current binding process, it was possible to raise the yields of the magnetic separation process even for very low concentrated targets in a vast surplus of competing proteins, like the hormone equine chorionic gonadotropin in serum, from 74% to over 95%. For the validation of the cleaning process, a direct surface swabbing method combined with a total organic carbon analysis was established for the determination of two model contaminants. The cleanability of the process equipment was proven for both model contaminants by reliably meeting the 10ppm criteria.

Total Hysteroscopic Treatment of Cervical Pregnancy: The 2-step Technique

To evaluate the efficacy of total surgical treatment of ectopic cervical pregnancy [1] with a minimally invasive approach performed by hysteroscopy [2]. Step-by-step video demonstration of the surgical technique using 5 mm hysteroscopy followed by 10 mm resectoscopy. A research and university hospital (IRCCS Burlo Garofolo, Trieste, Italy). A 41-year-old woman with an ultrasound diagnosis of ectopic cervical pregnancy at 6 + 6 weeks of gestation with a beta human chorionic gonadotropin serum level of 55.951 mUI/mL. We performed a 2-step technique using 5- and 10-mm hysteroscopy (Video 1). During the first step, a 5-mm Bettocchi hysteroscope (Karl Storz, Tuttlingen, Germany) with a 5F bipolar electrode Versapoint Twizzle (Gynecare, Menlo Park, CA) was used. In this phase, the gestational sac was identified in order to confirm the diagnosis and its site of implantation. Later, the gestational sac was opened, and the pregnancy was terminated by cord section under an embryoscopic view (Fig. 1). Finally, a partial vessel coagulation was performed. Afterward, the cervix was dilated, and a resectoscopy was performed. During the second step, a 10-mm Gynecare resectoscope with the bipolar Gynecare Versapoint was used and the gestational sac with the embryo was removed; subsequently, a complete chorial villi resection was achieved. At last, a coagulation of bleeding vessels on the implantation site in order to control the hemostasis was performed (Fig. 2). The study was approved by the institutional review board. The patient was discharged 24 hours after the procedure with an uneventful postoperative course, and the beta human chorionic gonadotropin serum level became negative in 20 days. After 40 days, the ultrasound cervical findings were regular, whereas office hysteroscopy showed the implantation site scar. After 5 months, the patient was pregnant with regular intrauterine implantation (Fig. 3). The total hysteroscopic approach with a 2-step technique offers an effective, safe, and minimally invasive surgical treatment to ectopic cervical pregnancy. Considering that our method, in contrast with the recent literature [3-5], is performed without any medical treatment, we reported for the first time an approach, that deserve more clinical data to confirm its effectiveness.

Resultados del tratamiento con metotrexate local bajo guía ecográfica en pacientes con embarazo ectópico no complicado con indicación quirúrgica, en el servicio de ginecología del Instituto Nacional Materno Perinatal

Objetivo. Evaluar los resultados de una serie de casos consecutivos de embarazos ectópicos con indicación quirúrgica de acuerdo a nuestras guías actuales de manejo del embarazo ectópico en el Institutito Nacional Materno Perinatal (INMP) que fueron manejadas con inyección local de metotrexate (MTX) guiado por ecografía transvaginal, además de la aplicación del mismo por vía intramuscular. Materiales y métodos. Es un estudio prospectivo, longitudinal, de la intervención. Se estudiaron nueve pacientes con diagnóstico de embarazo ectópico (EE) no complicado con indicación quirúrgica en el servicio de hospitalización de ginecología en el INMP, a quienes se les ofreció tratamiento mediante la administración de MTX local bajo guía ecográfica e intramuscular y realizar el seguimiento tanto ecográfico como de la hormona gonadotrofina coriónica fracción beta (hCG Beta) sérica hasta la resolución completa del embarazo ectópico. Se estimaron las frecuencias absolutas y relativas para las variables categóricas y medidas de tendencia central y de dispersión para las variables continuas.

A Rare Case of an Arteriovenous Malformation Scar Pregnancy Treated With a Combined and Conservative Approach

A Rare Case of an Arteriovenous Malformation Scar Pregnancy Treated With a Combined and Conservative Approach

Hormone Levels in Pregnancy and Subsequent Risk of Maternal Breast and Ovarian Cancer: A Systematic Review.

Some maternal hormone levels in pregnancy are associated with a higher risk of breast and ovarian cancer. This study systematically assessed the association between blood hormone levels measured in pregnancy and future risk of these cancers. Two reviewers independently conducted a literature search of MEDLINE and EMBASE databases from January 1970 to August 2017. Studies were included that measured one or more serum hormone levels in pregnancy and later assessed for cancer. Cancer outcomes were considered by cancer type, each in relation to a specific maternal hormone. Eleven studies were included, comprising a total of 57 967 women. The interval between pregnancy and cancer onset varied from 4.1 to 20.5 years. Elevated serum chorionic gonadotropin (two of four studies) and alpha fetoprotein (two of three studies) were each associated with a lower risk of maternal breast cancer, whereas elevated estrone levels suggested a higher risk (one of three studies). Elevated testosterone (one of one study) and androstenedione (one of one study) were each associated with a significantly greater risk of sex-cord stromal ovarian tumours. Higher serum 17-hydroxyprogesterone was associated with an increased risk of sex-cord stromal (one of one study) and epithelial (one of one study) ovarian cancer. Observational studies suggest some degree of association between serum hormones measured in pregnancy and a woman's future risk of breast and ovarian cancer. More data are needed to determine sufficiently whether certain blood hormone levels measured in pregnancy are predictive of future cancer risk.

Human chorionic gonadotropin serum levels following ovulation triggering and IVF cycle outcome.

The clinical significance of serum hCG levels after ovulation triggering was studied previously with conflicting results. Our aim was to study the correlation of hCG levels on the day after ovulation triggering using recombinant hCG (r-hCG) with treatment outcome. A prospective observational study of all fresh IVF/ICSI cycles in a single medical center, between January 2015 and June 2016, was performed. hCG serum levels were obtained 10-12h following ovulation triggering with 250mcg r-hCG. Clinical and laboratory outcome parameters were compared between cycles with serum hCG above and below median level. A multivariate regression analysis was performed in order to study the association between hCG levels and live birth rate, after controlling for confounders. Overall, 326 cycles were included. Median serum hCG level was 91.35IU/L. hCG levels were lower as age and BMI were higher (p = 0.004, p < 0.001, respectively). The study groups did not differ with regard to clinical pregnancy rate (p = 0.14), live birth rate (p = 0.09), fertilization rate (p = 0.45), or metaphase II oocyte rate (p = 0.68). On multivariate regression analysis, hCG level was not associated with live birth (aOR 0.99, 95% CI 0.98-1.005), after controlling for patient's age and BMI. hCG levels on the day after ovulation triggering with 250mcg r-hCG are inversely correlated with patient age and BMI. However, they are not correlated with any clinical or laboratory outcome parameter. Therefore, testing for hCG levels after ovulation induction seems futile and cannot be recommended.

Comparison of two assays measuring human chorionic gonadotrophin serum concentrations in pregnancy termination and trophoblastic or non-trophoblastic tumours

Background: Differences in human chorionic gonadotrophin (hCG) results provided by the commercial immunoassays reflect the heterogeneity of antibodies and the use of suboptimal standards. As a consequence, the principal forms of hCG and metabolites are differentially detected and the hCG tests are not suited for the same clinical applications. Conflicting results are available in the literature regarding which hCG variants are recognized by the Roche Elecsys hCG + β test. The aim of our study was to compare the hCG concentrations provided by the Siemens Immulite 2000 test and the Roche test as well as to assess the concordance between both assays.Methods: In this purpose, 152 samples obtained from women and 44 samples from men were analysed by both tests during the follow-up of pregnancy termination, gestational trophoblastic disease and malignancies. The intermediate precision of the Roche test was also investigated on a pool with a low hCG concentration.Results and conclusions: The hCG concentrations measured with the Roche test were slightly lower compared with the Siemens assay; mean biases of −34.2% and −8% were respectively obtained for hCG values ≤100 UI/L and higher than 100 UI/L. The overall agreement between both assays was 96.1% for women and 97.7% for men. By using an upper reference limit of 3.2 UI/L for women and 1.6 UI/L for men, the Roche test demonstrated a respective concordance of 98.7% and 100%. This test also yielded an excellent precision with a coefficient of variation of 2.8% at a mean hCG concentration of 7 UI/L.

Follow-up of gestational trophoblastic disease/neoplasia via quantification of circulating nucleic acids of placental origin using C19MC microRNAs, hypermethylated RASSF1A, and SRY sequences.

The aim of the study was to evaluate the effectiveness of placental-specific markers, extracellular fetal DNA (sex-determining region Y and hypermethylated RASSF1A sequences) and circulating C19MC microRNAs (miR-516-5p, miR-517-5p, miR-518b, miR-520a-5p, miR-520h, miR-525, and miR-526a) for the diagnosis and consecutive follow-up of gestational trophoblastic disease/neoplasia. Increased levels of extracellular fetal DNA and C19MC microRNAs were detected in patients with active disease when compared with the period when the patients reached remission of the disease. The positive correlation between plasma levels of hypermethylated RASSF1A sequence, C19MC microRNAs, and human chorionic gonadotropin serum levels was found. MiR-520a-5p had the best performance to detect patients with active disease (a positive predictive value of 100% at a null false positive ratio (FPR)). MiR-516-5p and miR-525 were able to diagnose 100% of women with active disease at the FPR 3.9%/7.7%. The overall predictive capacity of single miR-526a (81.8% at null FPR), miR-517-5p (90.9% at 15.4% FPR), miR-518b (100% at 38.5% FPR), and miR-520h (90.9% at 26.9% FPR) biomarkers to detect active disease cases was slightly lower. Transient increase in C19MC microRNA plasma levels after the first cycle of chemotherapy indicated the decay of placental trophoblast residual tissue. The increased levels of extracellular fetal DNA and placental-specific C19MC microRNAs are associated with gestational trophoblastic disease/neoplasia. Screening of extracellular placental-specific biomarkers may represent an additional option to identify a significant proportion of women with active disease and to monitor the therapy response. Non-invasive follow-up of the decomposing residual tissue in the form of extracellular nucleic acids of placental origin packed into apoptotic bodies derived from placental trophoblasts is available.

Is chemotherapy necessary for patients with molar pregnancy and human chorionic gonadotropin serum levels raised but falling at 6 months after uterine evacuation?

ObjectiveTo compare the outcomes of Brazilian patients with molar pregnancy who continue human chorionic gonadotropin (hCG) surveillance with those treated with chemotherapy when hCG was still positive, but falling at 6months after uterine evacuation. MethodsRetrospective chart review of 12,526 patients with hydatidiform mole treated at one of nine Brazilian reference centers from January 1990 to May 2016. ResultsAt 6months from uterine evacuation, 96 (0.8%) patients had hCG levels raised but falling. In 15/96 (15.6%) patients, chemotherapy was initiated immediately per FIGO 2000 criteria, while 81/96 (84.4%) patients were managed expectantly. Among the latter, 65/81 (80.2%) achieved spontaneous remission and 16 (19.8%) developed postmolar gestational trophoblastic neoplasia (GTN). Patients who received chemotherapy following expectant management required more time for remission (11 versus 8months; p=0.001), had a greater interval between uterine evacuation and initiating chemotherapy (8 versus 6months; p<0.001), and presented with a median WHO/FIGO risk score higher than women treated according to FIGO 2000 criteria (4 versus 2, p=0.04), but there were no significant differences in the need for multiagent treatment regimens (1/15 versus 3/16 patients, p=0.60). None of the women relapsed, and no deaths occurred in either group. ConclusionIn order to avoid unnecessary exposure of women to chemotherapy, we no longer follow the FIGO 2000 recommendation to treat all patients with molar pregnancy and hCG raised but falling at 6months after evacuation. Instead, we pursue close hormonal and radiological surveillance as the best strategy for these patients.