Chorionic Gonadotropin Levels Research Articles

Laparoscopically diagnosed invasive mole presenting as acute hemoperitoneum.

A young multipara presented with acute abdominal pain. She had history of dilatation and evacuation for a missed miscarriage 2 months back. The diagnosis of ectopic pregnancy was made on the basis of clinical presentation and laboratory investigations. Laparoscopy was performed which revealed features of invasive mole. The procedure was converted to laparotomy and hysterectomy was performed. Patient recovered well. Histopathology confirmed the diagnosis of invasive mole. Follow-up till 12 weeks reported return to normal ßhCG (beta subunit of human Chorionic Gonadotropin) levels.

ß-hCG and prediction of therapeutic success in ectopic pregnancies treated with methotrexate, results from a prospective observational study

Objective: To evaluate the diagnostic accuracy of different beta-human chorionic gonadotrophin (ß-hCG) levels measurement, for predicting success of medical treatment in cases diagnosed as tubal ectopic pregnancy (TEP).Design: Five-year prospective observational study.Setting: Prenatal Diagnosis Unit, Vall d'Hebron University Hospital – Barcelona.Patients: TEP cases fulfilling criteria for medical treatment with Methotrexate.Interventions: ß-hCG levels were measured on d 0, 4 and 7 of treatment. Results were compared by non-parametrical tests. A ROC curve was plotted to define cut-off points. Diagnostic accuracy of the different measurements was evaluated.Main outcome measure: Failure of treatment defined as need for surgical treatment or persistence of high ß-HCG levels despite treatment.Results: 126 women were diagnosed as TEP, eligible for medical treatment. There were no differences in parity, age, previous TEP, or adnexal mass size. Success rate was 88%. ß-HCG decreased significantly more, between days 0–7 and 4–7, in the successful cases. LR for success prediction was 6.2 and 7.8 for ß-HCG levels at days 4 and 7 respectively, 4.02 and 2.47 for decrement between days 0–7 (25%) and 4–7 (20%), respectively.Conclusion: ß-hCG cutoff values have a potential for predicting a successful medical treatment of TEP.

Abnormal liver function test in hydatidiform moles: a retrospective study comparing the hyperthyroid state and the euthyroid state

Introduction: The effect of a hyperthyroid or euthyroid state on liver function tests in patients with hydatidiform moles (HM) is not known. The aim of this study was to determine the effect of hyperthyroidism on liver transaminases in HM.Patients and methods: We retrospectively reviewed aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in 80 patients with HM (23 complete moles and 57 partial moles).Results: Of the 80 HM patients, 52 (65%) were euthyroid and 28 (35%) were hyperthyroid.The number of gravida and the levels of serum β-human chorionic gonadotropin (β-HCG), AST, and ALT were significantly higher in the hyperthyroid state than in the euthyroid state (p = 0.033, p = 0.001, p = 0.001 and p = 0.001; respectively). Number of gravida, serum TSH and total T4 were significantly higher in complete HM than partial HM (p < 0.05, p < 0.001, p < 0.05; respectively).Conclusions: Our results demonstrated that HM-related β-HCG may activate thyroid cells via TSH-related signalling, resulting in the release of high levels of FT4, FT3, TT3 and TT4, and a subsequent decrease in TSH.

Conservative management of placenta accreta with injection methotrexate to preserve fertility

Placenta accreta is described as anchoring placental villi directly contact the myometrium resulting in firm attachment of the placenta to the myometrium. The incidence of placenta accreta is increasing parallel to raising cesarean section rate. Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with either an anterior or posterior placenta previa overlying uterine scar. Control of bleeding is the main goal in such cases, which usually necessitates hysterectomy or hypogastric artery ligation; embolization of uterine artery that is done by expert interventional radiologists. However, alternative methods are useful when retaining fertility is important in young women with low parity. We present a 28-year old G5P2+0+2+2 who was admitted at 33 weeks of period of gestation for antepartum hemorrhage (APH) with previous cesarean. Even after conservative treatment for APH, she delivered still born preterm baby at 34 weeks with retained placenta where manual removal of placenta failed to remove the placenta. Placenta was removed piecemeal leaving major portion of placenta, which was morbidly adherent. After 13 days of delivery ultrasonography (USG) showed plenty of placental tissue in the uterine cavity with peripheral vascularity and increased serum beta-human chorionic gonadotrophin (β-hCG) level (1980mIU/ml). Injection methotrexate was administered on the 18 th post-partum day following the regime of 1, 3, 5 and 7 days. Repeat USG after 1 week of treatment showed decrease size in placental mass with a decrease in serum β-hCG level and after 6 th post-partum week D&E done with complete removal of placental tissue and at 8 th post-partum week USG shows normal with no retained products of conception and the patient was stable. Hence, methotrexate can thus be helpful as conservative treatment for placenta accreta in conserving the uterus and hence, the fertility.

Conservative management of abnormally invasive placenta after vaginal delivery

SirWe have reviewed the conservative management of abnor-mally invasive and adherent placenta (1,2). In women with pla-centa accreta, the placenta may be left in place to try to preservethe uterus, but this management is not typical. We wish toreport a case involving a woman who underwent conservativemanagement comprising uterine artery embolization and admin-istration of methotrexate, a folate antagonist, for the treatmentof placenta accreta after vaginal delivery.A 29-year-old woman (gravida 1, para 1) was referred to theemergency department because of a retained placenta. She haddelivered a 3000-g male by vaginal delivery at a local clinic. Onadmission, her blood pressure was 100/60 mmHg and her pulserate was 106/min. Laboratory findings revealed a hemoglobinlevel of 9.7 g/dL and b-human chorionic gonadotropin (b-hCG)level of 62 420 mIU/mL. Attempted manual removal of the pla-centa was unsuccessful. A CT scan revealed a postpartum statewith a retained placenta underlying placenta accreta (Figure 1).We performed bilateral uterine artery embolization and subse-quently administered antibiotics for 7 days. After six cycles ofmethotrexate the b-hCG level was 188.5 mIU/mL. MRI showedthat the uterus and placental size were slightly decreased com-pared with the previous CT findings.One month after bilateral uterine artery embolization, theb-hCG level was negative. Vaginal culture revealed nonspecificfindings. Two months later, the woman complained of lowerabdominal pain. After a pelvic examination, she expelled theremnant placenta, a whitish remnant mass. CT subsequentlyrevealed a decrease in the size of the uterus and endometrialcavity and an irregular endometrial margin at the site of theretained placenta.Obstetricians can now predict the occurrence of placenta pre-via and accreta by ultrasonography or Doppler ultrasonographybefore delivery. In our case, the placenta accreta was notpredicted. CT or MRI after delivery is helpful to predict theplacental implantation site and degree of myometrial invasion.Uterine artery embolization is a safe, effective, and conserva-tive method by which to preserve the uterus. Nonremoval of theplacenta previa or accreta after cesarean section with postopera-tive uterine artery embolization is an alternative to cesareanhysterectomy (3), but a remnant placenta is still a risk factor forpostpartum hemorrhage, infection, and rarely choriocarcinoma(1,4). The effectiveness of methotrexate in cases of remnantplacenta has not been confirmed, although some reportshave revealed its effectiveness for preserving the uterus in suchcases (2).If manual removal fails after vaginal delivery, the placentaimplantation site should be confirmed by CT or MRI. We shouldconsider combination management comprising uterine arteryembolization and methotrexate. However, the amount of bloodloss, vital signs, and fertility-preservation wishes are decision fac-tors for conservative management or hysterectomy. After man-agement with uterine artery embolization and methotrexate,obstetricians should follow up the woman in terms of the b-hCGlevel, presence of infection, and development of delayed bleedingand women should be informed about the need for this.

The relationship between maternal serum prenatal screening combined with epidemiological study and early onset preeclampsia

To explore the major risk factors and early prediction methods in the pathogenesis of early onset preeclampsia through combining prenatal screening markers and epidemiological characteristics. Prenatal screening was performed in second trimester using enzyme-linked immunosorbent assay in 1,011 gravidas and epidemiological correlation factors were got by telephone with prospective cohort study. Predictive model of early onset preeclampsia was established and evaluated by single and multiple factor logistic analysis in 30 cases of preeclampsia and 867 cases of normal gravidas. As compared with the control group, the maternal serum level of human chorionic gonadotropin (hCG) in second trimester of patients with early onset preeclampsia elevated significantly (P<0.001). Pregestational BMI≥24kg/m(2) (OR=3.649, 95% CI 1.600-8.321, P=0.002), history of hypertension, diabetes and nephritis (OR=55.724, 95% CI 8.223-377.614, P<0.001), family history of hypertension (OR=6.777, 95% CI 2.917-15.742, P<0.001), and risk coefficient for trisomy 21 (OR=3.688, 95% CI 1.013-13.429, P=0.048) were major risk factors of early onset preeclampsia. The sensitivity and specificity of predictive model were 70.0 and 75.1%, when cutoff point was 0.249. The diagnostic accuracy of the logistic model was better than hCG. In order to early prevent the onset and development of EOPE, it is necessary to strengthen pregestational and prenatal care for women in these aspects including pregestational BMI ≥ 24 kg/m(2), history of hypertension, diabetes, nephritis, family history of hypertension, and high risk for trisomy 21 syndrom.

More than just morning sickness

### Learning Point for Clinicians Hyperemesis gravidarum occurs in ∼1% of all pregnancies. One- to two-thirds of these women develop gestational hyperthyroidism due to β-human chorionic gonadotropin (β-hCG)- mediated activation of the thyroid stimulating hormone (TSH) receptor. Thiamine has a limited storage pool of only a few weeks and an acute deficiency leading to Wernicke’s encephalopathy can occur in the setting of hyperemesis gravidarum and gestational hyperthyroidism. An 18-year-old primigravida presented with a fall at 16 weeks gestation. She had experienced persistent nausea, vomiting and weight loss since conception. On examination, angular stomatitis, confusion, ataxia, horizontal nystagmus, ophthalmoplegia and bilateral lower limb weakness were noted. Investigations revealed ketonuria but with normal blood chemistry. β Human chorionic gonadotropin (β-hCG) levels (81 290 IU/L) were consistent with gestation and abdominal ultrasound confirmed a 16-week singleton pregnancy. A provisional diagnosis of hyperemesis gravidarum with Wernicke’s encephalopathy was made. Consistent with this, magnetic resonance imaging (MRI) of the brain revealed bilateral …

Spermatocytic seminoma in a 92-year-old man: report of a case in which SALL4, a potential novel marker for testicular germ cell tumors, was useful for the diagnosis

Spermatocytic seminoma (SS) is a rare testicular germ cell tumor (TGCT), occurring exclusively in the testes. Diagnosis of SS is important because, unlike other testicular tumors, SS must be treated by orchiectomy alone without further adjuvant therapy owing to its inability to metastasize. However, an accurate diagnosis of SS is often difficult given its rarity and the lack of a reliable marker. We report the occurrence of SS in a 92-year-old man—one of the oldest SS patients reported thus far. The patient presented with a painful right scrotal mass, which had been present for 6 months. A computed tomography scan revealed a testicular mass. There was no significant increase in the serum levels of alpha-fetoprotein (AFP) or human chorionic gonadotropin (hCG). A right orchiectomy was performed, which showed a well-circumscribed white-gray mass. A histological examination revealed sheets of non-cohesive cells with little intervening stroma. The tumor consisted of small, medium, and large cells with frequent mitoses, which is suggestive of SS. Whereas common TGCT markers including AFP, hCG, CD30, and placental alkaline phosphatase were all negative, nuclear reactivity for SALL4, a new TGCT marker, and positivity for CD117 (c-kit) finally helped establish the diagnosis of SS. We conclude that SALL4 immunostaining can be helpful for the diagnosis of TGCT when tumors are negative for conventional TGCT markers.

Persistent low hCG levels beyond pregnancy: report of two cases and review of the literature

Unexpected finding or persistence of low human chorionic gonadotropin (hCG) levels is not a rare situation. It requires a clinico-biological approach in order to avoid misunderstandings that could lead to inappropriate diagnostic or therapeutic attitudes. Beyond pregnancy, persistent low levels of hCG may be associated with various benign and malignant conditions, i.e. quiescent gestational trophoblastic disease (QTD), raised pituitary hCG or false positive elevation caused by circulating heterophile antibodies. We report the cases of two non-pregnant patients with low serum hCG. In the first case, hCG levels raised during several years following a spontaneous abortion. The likelihood of heterophilic antibodies interference was ruled out and extensive clinical investigation excluded the presence of a tumour. The diagnosis was QTD. In the second case, elevated hCG came to light as an incidental finding in a women with chronic renal failure and led the clinicians to question the laboratory. The cause was probably an increase in pituitary hCG consecutive to terminal renal failure. These cases illustrate the importance of understanding the biology of the hCG and the causes of its persistent low elevation, which are reviewed in this article. It is essential to demonstrate clinically the presence of a tumour in order to avoid unnecessary and ineffective chemotherapy and/or hysterectomy.

Severe Hyperemesis Gravidarum Masking the Presentations of Hyperthyroidism

Hyperemesis gravidarum may present with weight loss and tachycardia secondary to dehydration. Its severity correlates with the level of the serum chorionic gonadotropin which can interfere with the assay of the thyroid stimulating hormone. Therefore, hyperemesis gravidarum are at times difficult to be distinguished from hyperthyroidism. Missing hyperthyroidism during pregnancy results not only in inappropriate maternal care, but adverse neonatal outcomes including low birth weight. The authors report a case of hyperemesis gravidarum complicated by the concurrence of hyperthyroidism. Goiter and refractory tachycardia are the useful clues to detect occult hyperthyroidism in patients with hyperemesis gravidarum.

Caesarean scar pregnancy (CSP): a rare case of complete scar dehiscence due to scar ectopic pregnancy and its management

We present a rare case of Caesarean scar pregnancy (CSP) in which the embryo implants within the myometrium at the site of a previous caesarean scar with complete scar dehiscence and its distinctive management. A 38-year-old G8P1 woman presented with vaginal bleeding following 6 weeks of amenorrhoea following IVF. Serum b-human chorionic gonadotropin (HCG) level was 9166 mIU/mL and transvaginal ultrasound (TVS) revealed (Fig. 1) an inhomogeneous fixed mass, 5 cm in size within the myometrium at her previous caesarean scar site extending outside the uterus through the caesarean scar and adjacent to the bladder; on the basis of this diagnosis CSP was made. Systemic methotrexate (MTX) was administered, (1 mg/kg intramuscular) and b-HCG level fell to 18.0 mIU/mL over 3 months follow-up. However, the patient continued to have lower abdominal pain and a repeat TVS showed the mass had reduced in size to 3.5 cm. Because of drawn out recovery period and as she wanted to go for another IVF cycle, laparoscopy was undertaken. After reflection of the bladder peritoneum, it was noted that the previous caesarean section scar had dehisced completely (Fig. 2a, b). The CSP mass was thus excised and the edges of the defect approximated in two layers. Postoperative course was unremarkable, and her b-hCG levels were \5 mIU/mL. The histopathology report confirmed diagnosis of CSP with evidence of placenta percreta. The first ever case of CSP was reported in 1978, and since then only 19 cases were reported until 2001 [1, 2], followed by sudden increase to 751 cases by 2011 [3]. With no evident mechanism for CSP yet understood, the finding in most of the cases reflect that implantation occurs at the site of a micro or macroscopic defect in the scar [4]. Commonest presentation of CSP is abdominal pain and bleeding [5]. CSP is a diagnosis on ultrasound visualisation of gestational sac at the level of internal os, penetrating the anterior uterine wall approaching the bladder [6]. CSP is more challenging to diagnose if only inhomogeneous mass of products of conception is present such as in this case, where use of Doppler helps [3, 4]. Possibility of CSP should be considered in women who have had a previous caesarean [7], as delay in diagnosis can lead to uterine rupture causing serious maternal morbidity and loss of future fertility. There is no consensus on the preferred mode of treatment [3, 8]. After discussing the various treatment modalities in the literature [2, 3, 5], as per patients choice our management started with a single dose of systemic MTX. But later laparoscopy showed a silent complete scar dehiscence, which could have possibly resulted in rupture and intraperitoneal bleeding. There are no other published case reports of concomitant CSP and silent scar dehiscence. Our case brings to light the possibility of dehiscence after MTX therapy that could have implications for future fertility. It highlights the importance of post treatment long term surveillance following MTX and in cases where there is slow resolution of the CSP mass. The incidence of CSP is likely to rise substantially in the near future as caesarean delivery rates continue to increase. Setting up multicentre collaboration would encourage robust evidence-based studies essential for making recommendations for practice. Until then, one has to rely on N. Agarwal A. Shahid (&) F. Odejinmi Whipps Cross University Hospital, Barts Health NHS Trust, London, UK e-mail: anupamashahid@gmail.com; anupamashahid@yahoo.com

Placental polyp - a rare case report

Placental polyp is the retained fragment of placental tissue after the parturition or abortion for indefinite period which forms a polypoidal mass in the uterus. It is predominantly composed of necrotic and hyalinized chorionic villi (ghost chorionic villi). We report a case of 26-year-old G2P2 woman presenting with vaginal bleeding. Her last pregnancy had occurred five years ago. Laboratory investigations revealed a positive urine pregnancy test and serum levels of beta-human chorionic gonadotrophin (β-hCG) was elevated. Ultrasonography revealed hyperechoic mass in uterine cavity. She underwent total abdominal hysterectomy and the pathological diagnosis was of a placental polyp.

Ovarian Endometrioid Adenocarcinoma with Functioning Stroma Accompanied with Endometrial Endometrioid Adenocarcinoma: Immunohistochemical Study and Literature Review

Background: The ovarian tumors with functioning stroma are defined by the morphological presence of endocrine active cells in stroma, and the clinical, biochemical or pathological evidence of endocrine function. Case Report: The ovarian endometrioid adenocarcinoma with functioning stroma accompanied with endometrial endometrioid adenocarcinoma was found in 64-year-old post-menopausal woman complaining abnormal genital bleeding and mammary distention. Her preoperative serum 17?-estradiol level was high (53.2 pg/ml) while human chorionic gonadotropin (hCG) level was within normal limit. Her right ovary with 8.8 × 5.3 cm in size and tan-yellow in color mostly consisted of solid tumor. Histologically, tumor was composed of estrogen receptor (ER)- and progesterone receptor (PgR)-positive, and androgen receptor (AR)-negative cancerous endometrial cells with aggregates of vacuolated foamy stromal cells resembling luteinized cells. These stromal cells contained lipid droplets, and was immunopositive for α-inhibin and 17?-estradiol. After surgery, serum 17?-estradiol level decreased and became normal (14.2 pg/ml). These findings indicate the production of steroid hormone (17?-estradiol) from the foamy stromal cells and may be correlated with the clinical symptoms. Furthermore, ER- and PgR-positive endometrial endometrioid adenocarcinoma developed synchronously. However, ovary and uterus were totally immunonegative for human chorionic gonadotropin (hCG). Four other cases from the literature including ours are reviewed. Conclusion: Cancer cells were positive for ER and PgR in both ovary and uterus responded to steroid hormone produced by foamy stromal cells, which played a role in proliferation and progression of ovarian and endometrial endometrioid adenocarcinoma, respectively.

Extrauterine pregnancies-risk factors and management

Objective: To study the clinical progress, risk factors, management, and outcomes of suspected ectopic pregnancy (EP). Design: Retrospective clinical case study. Population: All 184 patients hospitalized for suspected EP during the period 1.1.2008-31.12.2011. Setting: Oulu University Hospital, Finland. Methods: The clinical progress, risk factors, management, complications and outcomes were based on studies of hospital records. Main outcome measures: Symptoms, serum quantitative human chorionic gonadotropin (hCG) levels, management, complications and outcome of patients. Results: At least one of the risk factors was found in 117 women (66%). There were 11 patients without symptoms. In the initial visit, the median hCG concentration was 1915 (20 - 73,000) IU/l. The most common treatment was surgical, 137/181 (76%), followed with medical treatment, 22/181 (12%) and expectant management, 22/181 (12%). Conclusions: Surgery was the most widely used treatment for EP. We might thus draw attention to more conservative management.

A rare case report of 46XY mixed gonadal dysgenesis

A 16-year-old person, reared as female presented with complaints of genital ambiguity and primary amenorrhoea along with lack of secondary sexual characters, but without short stature and Turner's stigmata. She was taking steroids after being misdiagnosed as congenital adrenal hyperplasia (CAH). Karyotype analysis revealed 46XY karyotype. There was no evidence of hypocortisolemia (cortisol 9.08 μg/dl, adrenocorticotropic hormone [ACTH] 82.5 pg/ml) or elevated level of 17-OH-progesterone (0.16 ng/ml). Pooled luteinizing hormone (LH) was 11.79 mIU/ml and follicle-stimulating hormone (FSH) was 66.37 mIU/ml. Serum estradiol level was 25 pg/ml (21-251). Basal and 72 h post beta-human chorionic gonadotropin (hCG) levels of androstenedione and testosterone levels were done (basal testosterone of 652 ng/dl and basal androstenedione of 1.17 ng/ml; 72 h post hCG testosterone of 896 ng/dl and androstenedione of 1.34 ng/ml). Magnetic resonance imaging (MRI) pelvis (with ultrasonogrphy [USG] correlation) revealed uterus didelphys with obstructed right moiety and bilateral ovarian-like structures. Right sided gonads and adjacent tubal structures were visualized laparoscopically and removed. Left sided gonads were not visualized and Mullerian remnants were adhered to sigmoid colon. Histopathological examination revealed presence of testicular tissue showing atrophic seminiferous tubules with hyperplasia of Leydig cells. No ovarian tissue was seen. Based on these results a diagnosis of 46XY mixed gonadal dysgenesis (MGD) was made, which is rare and is difficult to distinguish from 46XY ovotesticular disorder of sexual differentiation (OT-DSD). The patient was managed with a multidisciplinary approach and fertility issues discussed with the patient's caregivers.

Conservative management of cervical pregnancy: The utility of methotrexate treatment and uterine artery embolization

The aim of this retrospective case series report is to evaluate systemic methotrexate therapy in conjunction with uterine artery embolization (UAE) in the conservative management of cervical pregnancy. We examined clinical presentations, treatments, and therapeutic outcomes in fifteen patients with a cervical pregnancy who wished for preservation of fertility, treated at Okayama University Hospital between 1998 and 2012. Twelve patients received systemic methotrexate including five treated with UAE. One was treated with UAE alone. Two patients received neither UAE nor methotrexate because of a low human chorionic gonadotropin (hCG) level and poor blood flow around the gestational sac (GS). An increased GS size and the elevated hCG level during methotrexate therapy might be risk factors for emergent UAE. Two of six patients treated with UAE had subsequent confirmed viable pregnancies. In patients with a cervical pregnancy, methotrexate therapy in combination with UAE can be considered as an option before performing a hysterectomy with suitable counseling about the risk of loss of fertility. Careful observation of the GS size and hCG level during methotrexate therapy might be important for management.

Second trimester maternal serum markers and a predictive model for predicting fetal hemoglobin Bart’s disease

Objective: To compare the levels of maternal serum α-fetoprotein (AFP), unconjugated estriol (uE3) and free β-human chorionic gonadotropin (free β-hCG) between pregnancies with fetal Hb Bart’s disease and unaffected pregnancies. Methods: 148 pregnancies at risk of fetal Hb Bart’s disease scheduled for cordocentesis at 18 to 22 weeks were prospectively recruited into the study. AFP, uE3 and free β-hCG concentrations were measured before cordocentesis and the final fetal diagnosis of Hb Bart’s disease was based on fetal Hb typing using high-performance liquid chromatography. Results: AFP and free β-hCG were significantly higher whereas uE3 was lower in women with fetal Hb Bart’s disease than those with unaffected fetuses (1.94 MoM, 1.38 MoM and 0.81 MoM respectively). Hb Bart’s predictive model; probability = 1/1+e−[2.876 + 1.333(AFP) − 6.310(uE3)], effectively predicted fetal Hb Bart’s disease (AUC ROC 0.91, 95% CI 0.84–0.97) with 61.5% sensitivity and 98.1% specificity using a cut-off probability at greater than 0.5. Conclusions: In triple test, serum AFP and hCG levels are significantly higher while serum uE3 is significantly lower in pregnancies with fetal Hb Bart’s disease. Hb Bart’s predictive model included AFP and uE3 is relatively effective and may be helpful in Hb Bart’s prenatal screening.

Can first-trimester screening program detect women at high risk for gestational diabetes mellitus?

This study was designed to compare first-trimester maternal serum biochemical markers of aneuploidy and fetal nuchal translucency in pregnancies complicated by gestational diabetes mellitus and those of a control group. The study included 60 gestational diabetic and 60 control women who attended the first-trimester combined screening program for Down syndrome between 11 and 14 gestational weeks with complete follow-up data and delivered in our institution. Maternal serum free β-human chorionic gonadotropin, pregnancy-associated plasma protein-A and fetal nuchal translucency were investigated. The combined risks, double test risks and age risks were calculated by PRISCA software version 4.0. Comparison of the results between the two groups yielded no significant differences in serum levels of free β-human chorionic gonadotropin and fetal nuchal translucency. However, women who developed gestational diabetes mellitus had significantly lower pregnancy-associated plasma protein-A. And also, the combined risks and double test risks calculated by PRISCA software were statistically higher in gestational diabetic women than normal pregnant women. These results suggest that differences can be seen between diabetic and healthy pregnant women in first-trimester maternal serum biochemical markers of aneuploidy.

A case of pulmonary choriocarcinoma metastasis with unusual FDG-PET and CT findings: correlation with pathology

A 26-year-old female who had had a hydatidiform mole at 20 years of age showed high levels of serum human chorionic gonadotropin. Because pelvic ultrasound did not show any gestational sac in her uterus, she was suspected to have had an extrauterine pregnancy and a spontaneous abortion. About 6 months later, a pulmonary nodule in the patient's right upper lung field was found on a routine chest X-ray film. Contrast- enhanced CT scans revealed a solitary lobulated nodule 2.0 × 1.3 × 3.0 cm in diameter in the S2 segment of the right lung. CT suggested a vessel malformation. Positron emission tomography using 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG-PET) was performed and showed weak FDG accumulation (SUVmax = 2.0) in the nodule, which did not positively indicate malignancy. Because a follow-up CT showed a rapid increase in the size of the nodule, partial resection of S2 segment in the right upper lobe was performed. The histopathological diagnosis was a metastasis from choriocarcinoma. The tumor consisted largely of necrosis and hemorrhage, and it was considered to be a major cause of the unusual FDG-PET and CT findings.

Does Salpingotomy for Tubal Ectopic Pregnancy Always Require Methotrexate Prophylaxis?

Abstract Objective: Some surgeons accept the concept of prophylactic methotrexate immediately post-linear salpingotomy for tubal ectopic pregnancy against odd of persistent trophoblast tissue (PTT); however, to avoid one case of PTT, 8 women would need to be treated with methotrexate. The aim of this study was to ascertain whether methotrexate is required immediately in all cases postoperatively. Methods: Women who underwent linear salpingotomy for unruptured ectopic pregnancy and who agreed to participate in this pilot study were assigned to postpone the prophylactic methotrexate that is given to patients with suspected PTT. PTT was suspected if there was a rise, plateau, or decline of <50% at 2 days and 75% at 4 days post-surgery in the serum β-human chorionic gonadotrophin (hCG) levels. All women were followed with serial serum β-hCG levels; titers were measured on the 2nd and 4th postoperative days, and then weekly until they become undetectable. Results: A total of 22 women completed the postoperativ...