Human Chorionic Gonadotropin Concentrations Research Articles

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.

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.

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.

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

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.

Enzyme Immunoassay for the Detection of Human Chorionic Gonadotropin (HCG) and Placental MRNA Marker a Practical Technique for Forensic Pregnancy Identification in Bloodstains

Introduction: The diagnosis of pregnancy from forensic bloodstains can be useful in cases of infanticide, criminal abortions and missing person identification. Objective: This research illustrated the use of a rapid, precise, and tremendously responsive enzyme immunoassay kit designed for medical usage, which is put to good use in our lab for qualitative HCG detection in blood stains and has proven to be a useful tool in forensic pregnancy identification. Methods: HCG concentrations had previously been generally known, and total eighty whole blood samples were taken: forty expectant females (every single one between months one to six of pregnancy), twenty healthy young males, and twenty postmenopausal females with good health ration has been cleared in all data. Results: Enzyme immunoassay is a useful forensic technique for detecting human chorionic gonadotropin hormone in pregnant women. In the forty sample batch that was dated for six months, 37 samples (92.5%) yielded positive results, 38 of which (95%) yielded good outcomes in the qualitative analysis, most of them within the sensitivities boundary. The samples that were diluted to 1/100 and 1/200 and kept at room temperature for one week and six months period, respectively, produced just two (5.0%) and five (12.5%) successful results and the samples showed negative results when diluted to 1/200 and stored for six months. Practical implication This paper reports on human chorionic gonadotropin (HCG) detection in bloodstains based on enzyme immunoassay. Conclusion: Enzyme immunoassay has proven to be a suitable method intended for detecting an hCG hormone in blood stains, allowing for the qualitative assessment of hCG, and making it particularly interesting for use in forensic science applications. Keywords: Enzyme immunoassay, human chorionic gonadotropin (hCG), pregnancy, bloodstain

High concentration of first-measured HCG after embryo transfer is associated with subsequent development of pre-eclampsia

Research questionAre outlier high values of first-measured human chorionic gonadotrophin (HCG) following embryo transfer related to pregnancy complications, specifically pre-eclampsia? DesignThis retrospective cohort study screened 3448 women aged 18–45 years who underwent IVF between 2014 and 2019 and evaluated 614 women who had an intrauterine pregnancy following single embryo transfer (SET), 423 of whom had a live birth. Pregnancy and birth outcome information was available for final analysis in 280 cases. The setting was a university-based IVF centre. HCG was measured at a standardized time after the embryo transfer and the values correlated with adverse pregnancy outcomes associated with poor placentation. ResultsWomen with first-measured HCG in the highest quintile had a higher incidence of pre-eclampsia than those with lower HCG concentrations (odds ratio [OR] 4.08, 95% confidence interval [CI] 1.41–11.82) even after controlling for age, body mass index, parity and type of embryo transfer. Additionally controlling for embryo stage at embryo transfer did not change the results (OR 3.97, 95% CI 1.37–11.46). No differences were found in the incidence of fetal growth restriction. ConclusionsThis is the first known report that links high first-measured HCG after SET to an adverse pregnancy outcome. If confirmed by future studies, initiation of preventive interventions at a very early stage of pregnancy merits further evaluation in this cohort of patients.

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.

Differences in Outcomes in Obese (≥30), Morbidly Obese (≥40), and Super Morbidly Obese (≥50) Pregnancies

BackgroundObesity in pregnancy is an increasing problem in the United States. Obesity in pregnancy can result in dangerous complications such as premature birth, cesarean delivery, gestational diabetes, and preeclampsia. Little is currently known about outcomes in the morbidly (body mass index (BMI) ≥40 kg/m2) and super morbidly obese (BMI ≥50 kg/m2) in pregnant patients. Consequently, it is difficult to adequately counsel patients and plan for delivery care. Most current data groups outcomes for obese patients in general, however, some aspects such as reductions in hormone concentrations in pregnancy vary markedly with increasing weight. Obesity can alter hormone concentrations in pregnancy. For example, significantly lower beta human chorionic gonadotropin concentrations and progesterone are observed with increasing weight. Thus, we hypothesized that there are differences outcomes between obese, morbidly obese, and super morbidly obese pregnancies. The purpose of this study (IRB #202004178) is to analyze pregnancy outcomes of women with body mass index (BMI) ≥40 kg/m2 in comparison to obese women with a BMI of 30‐35 kg/m2 with a more rigorous BMI classification system than has been previously used. Our hypothesis is that morbidly obese and super morbidly obese pregnant women will have significant differences in adverse outcomes compared to obese women.MethodsA retrospective cohort study was performed comparing pregnancy outcomes of women with a BMI ≥ 30kg/m2 who delivered at the University of Iowa Hospitals and Clinics (UIHC) between 2009 and 2020. Data were extracted from the electronic health record (Epic) using the Intergenerational Health Knowledgebase, an enterprise data warehouse for research containing validated data from all pregnancies receiving care at UIHC. Additional data was extracted directly from the medical record. Women were included if they were ≥18 years old, had a singleton pregnancy and BMI ≥ 30 kg/m2, and delivered at UIHC (N=6445). Women were stratified into cohorts based on BMI (35‐39.9, 40‐49.9, 50‐59.9, 60‐69.9, 70‐79.9, ≥80 kg/m2) and compared to women with a BMI of 30‐35 kg/m2. Categorical variables were analyzed by chi square and continuous variables by t‐test. Regression models were created to control for confounding.ResultsStatistically significant increased incidences for gestational diabetes, preeclampsia, newborn hypoglycemia, number of days in the hospital post‐delivery, birthweight, and a composite poor neonatal outcome (P&lt;0.001 for each outcome) were associated with increasing BMI. Both the 1‐ and 5‐minute APGAR scores worsened with increasing BMI (P&lt; 0.001). However, there were decreased rates of caesarean section (P&lt;0.001) and pre‐term birth (P=0.02) associated with increasing BMI. There were no statistically significant differences in neonatal ICU admission, death, respiratory distress, and pulmonary hypoplasia.ConclusionBy identifying pregnancy outcomes using classifications with a smaller BMI range, it will be possible to develop more specific counseling and effective care plans for obese, morbidly obese, and super morbidly obese patients in the future.

Health Supervision for Children and Adolescents With Down Syndrome.

Health Supervision for Children and Adolescents With Down Syndrome.

Pregnancy outcome prediction after embryo transfer based on serum human chorionic gonadotrophin concentrations.

The aim of the study was to evaluate the predictive value of the human chorionic gonadotropin (hCG) concentration on the 14th and 16th post-ovulation day after embryo transfer/cryoembryo transfer as well as the dynamics of its increase with respect to the outcome of pregnancy. In total, 130 embryo transfers and cryoembryo transfers in women aged 22 to 38 years who experienced a single embryo transfer or single cryoembryo transfer with confirmed pregnancy (hCG level over 15 IU/l on 14th post-ovulation day - D14) were selected. The input parameters (hCG D14, hCG D16, hCG D16-D14, hCG D16/D14 and positivity of at least 2.5-fold increase in hCG D16 compared to hCG D14) were evaluated by regression analysis in relation to the outcome parameters (bio-chemical pregnancy, clinical pregnancy, clinical pregnancy terminated by abortion up to 12 weeks of gestation, clinical pregnancy terminated by childbirth). Single concentrations of hCG D14 and D16, as well as the difference between these concentrations, were a statistically significant indicator of the prediction of bio-chemical pregnancy (P = 0.000215, P = 0.000227 and P = 0.000421). Contrary to expectations, the proportion of hCG D16 and D14 concentrations did not show statistical significance for either parameter, as well as the fulfilment of the condition of at least a 2.5fold increase in hCG D16 compared to D14. None of the studied input parameters was confirmed as a statistically significant marker for the prediction of miscarriage in the whole group of patients. However, in the group of confirmed clinical pregnancies, the serum concentration of hCG D16 (P = 0.0248) and the difference between concentrations D16 and D14 (P = 0.0185) were confirmed as a positive predictor of the progression of pregnancy until delivery. Single hCG concentrations are a good prognostic factor for predicting the outcome of pregnancy, but the determination of the cut-off limit is limited by inter-laboratory deviation as well as by timing of blood collection for hCG determination on the exact post-ovulatory day. The results of individual studies are therefore difficult to use in clinical practice. The dynamics of hCG concentrations appear to be a more reliable predictor of pregnancy outcome. In our cohort, we confirmed the statistical significance of the difference in hCG concentration between the 16th and 14th post-ovulation day not only for the prediction of bio-chemical pregnancy, but also as a predictor of the progression of clinical pregnancy into childbirth. To determine the optimal values of this difference, it is necessary to evaluate a larger group of patients. Conversely, the statistical significance of the proportion of hCG concentrations between the 16th and 14th post-ovulation day was not confirmed.

Laparoscopic Removal of an Abdominal Ectopic Pregnancy Requiring Partial Cecectomy

A 37-year-old gravida 3, para 1011 presented with abdominal pain and lightheadedness. Her serum human chorionic gonadotropin concentration was 15 917 U/mL. On examination, her abdomen was tender with positive peritoneal signs. Transvaginal ultrasound showed an empty uterus with blood in the pelvis concerning for ectopic pregnancy. The patient was transfused 1 unit of packed red blood cells and brought to the operating room for diagnostic laparoscopy. Upon intubation, the patient was hypotensive so a massive transfusion protocol was initiated.

Combined analysis of human chorionic gonadotrophin concentrations at different time points after frozen-thawed blastocyst transfer can improve our ability to predict the pregnancy outcomes of single gestations

In this study, we conducted a retrospective single-centre study of 1664 singleton pregnancies derived from frozen-thawed blastocyst transfer between January 2017 and December 2018. Analysis showed that there were 596 early pregnancy losses and 1068 ongoing pregnancies. We compared serum HCG (human chorionic gonadotophin) concentrations on days 12, 14, 19, and 21, between the pregnancy loss group and the ongoing pregnancy group. The cut-off level of HCG at each time point was calculated to predict pregnancy outcome. Joint analysis of two single HCG levels taken one week apart was carried out to improve predictive accuracy. The levels of HCG at four time points were significantly lower in the early pregnancy loss group than in the ongoing pregnancy group. According to the area under ROC (receiver operating characteristic curve) curves, all levels of HCG taken at four time points showed good ability to predict the outcome of pregnancy. The joint analysis of two single HCG levels taken one week apart further improved the accuracy of prediction. Impact statement What is already known on this subject? Multiple studies have shown that the maternal level of serum HCG is the best parameter for predicting the course of pregnancy. What do the results of this study add? The levels of HCG on days 12, 14, 19 and 21 were significantly lower in the early pregnancy loss group than in the group of ongoing pregnancies. According to the area under ROC curves, all levels of HCG taken at four time points showed a good ability to predict the outcome of pregnancy. What are the implications of these findings for clinical practice and/or further research? The joint analysis of two single HCG levels, taken one week apart, further improved the accuracy of prediction.

Alterations of DNA methylation were associated with the rapid growth of cortisol-producing adrenocortical adenoma during pregnancy

BackgroundCortisol-producing adrenocortical adenoma (CPA) during pregnancy rarely occurs in clinic. Growing evidence suggests that DNA methylation plays a key role in adrenocortical adenomas. The present study aims to examine the genome-wide DNA methylation profiles and identify the differences in DNA methylation signatures of non-pregnant and pregnant patients with CPA.ResultsFour pregnant and twelve non-pregnant patients with CPA were enrolled. The pregnant patients with CPA had higher serum cortisol, Estradiol, Progesterone, and human chorionic gonadotropin concentration, while having lower serum FSH (follicle-stimulating hormone) and luteinizing hormone concentrations (P < 0.01). Compared with the non-pregnant patients, the duration is shorter, and the growth rate of the tumor is faster in pregnant patients with CPA (P < 0.05). Morphology and cell proliferation assay showed that the percentage of Ki-67 positive cells in CPA were higher in pregnant group than non-pregnant group (8.0% vs 5.5%, P < 0.05). The DNA methylation analysis showed that Genome-wide DNA methylation signature difference between pregnant and non-pregnant with CPA, that the pregnant group had more hypermethylated DMPs (67.94% vs 22.16%) and less hypomethylated DMPs (32.93% vs 77.84%). The proportion of hypermethylated DMPs was relatively high on chromosomes 1 (9.68% vs 8.67%) and X (4.99% vs 3.35%) but lower on chromosome 2(7.98% vs 12.92%). In pregnant patients with CPA, 576 hypomethylated DMPs and 1109 hypermethylated DMPs were identified in the DNA promoter region. Bioinformatics analysis indicated that the Wnt/β-Catenin pathway, Ras/MAPK Pathway and PI3K-AKT Pathway were associated with the development of CPA during pregnancy.ConclusionsGenome-wide DNA methylation profiling of CPA in non-pregnant and pregnant patients was identified in the present study. Alterations of DNA methylation were associated with the pathogenesis and exacerbation of CPA during pregnancy.

Medical abortion in primary care.

SUMMARYEarly medical abortion is a safe, cost effective and acceptable alternative to surgical abortion. It offers privacy and autonomy and can be provided by general practitioners who have completed an online training module.Abortion can be induced with mifepristone and misoprostol up to nine weeks of gestation. Apart from anticoagulation and severe anaemia, there are few contraindications and precautions for medical abortion.Obtaining informed consent requires the provision of information on expected effects, adverse effects and complications. The woman must know when to present to an emergency department.Follow-up must be arranged to ensure the abortion is complete. A serum human chorionic gonadotropin concentration or a low-sensitivity urine pregnancy test is used to confirm completion.Most contraceptive methods can be started immediately following medical abortion. If an intrauterine device is preferred, it should be inserted after confirming the abortion is complete.