Human Chorionic Gonadotropin Test Research Articles

Tubal superfetation following frozen-thawed single-embryo transfers in two separate cycles: Case report and literature review.

Superfetation is a very rare occurrence. In the context of assisted reproduction, it has been reported only as an intrauterine pregnancy after ovarian stimulation and/or embryo transfer in the presence of an undiagnosed ectopic pregnancy. Here we report a case of a 27-year-old anovulatory patient, gravida 1 para 1, who underwent two frozen-thawed single-blastocyst transfers in separate cycles. The patient reported that 12 days after the first transfer, she had menstrual bleeding and stopped her estradiol and progesterone supplementation without undergoing a blood human chorionic gonadotropin (βhCG) test. At her request, a second cycle was immediately initiated, with endometrial thickness measuring 4 mm. Eleven days after the second transfer, the βhCG value was inappropriately high. A right tubal pregnancy corresponding to 8 gestational weeks was diagnosed. Laparoscopy revealed a prominent right tubal pregnancy in addition to a significantly smaller left tubal pregnancy. The discordant tubal pregnancies were confirmed histologically. To our knowledge, superfetation involving a second ectopic pregnancy coexistent with a first, contralateral ectopic pregnancy consequent to consecutive in vitro fertilization procedures has not previously been described in the medical literature. This case emphasizes the importance of routine βhCG testing after every IVF cycle, even if apparently unsuccessful.

A-350 Myth Debunked: Same UrineAliquot is not Suitable for hCG Test AfterMicroscopic Analysis

Abstract Background It has been imparted in the laboratories that the suspending fluid, Lamina, from Iris IQ 200 Analyzer system is prone to interfere with urine human chorionic gonadotropin (hCG) test, especially on a small volume urine specimen. The myth is that the sample is diluted or contaminated by Lamina, which gives falsely negative result for hCG test. An add-on urine pregnancy test was ordered for a specimen, which was completed urinalysis and microscopic analysis. This is the only urine aliquot available, and it is approximately 2mL. This order raised many concerns among laboratory technicians regarding the accuracy of the result. However, no documents or articles were found to support the suspicions. In this study, A serial of experiments was completed to address this concern. Methods Known pregnant patients were confirmed their pregnancies with serum hCG tests prior to collecting the urine specimens. The experiment was conducted with 4 positive patient urines. A series of samples ran on DXI 800 system and the point-of-care (POC) Alere hCG combo cassettes. Then the same specimen performed urinalysis and microscopic analysis on Iris IQ 200 Analyzer. To evaluate the Lamina impact, the sample concentrations were verified with point-of-care (POC) Alere hCG combo cassettes and later DXI 800 system. Meantime, the significance of sample size was also evaluated in the study. Results The final concentrations of the samples were at <5, 5, 10, 15, 20, 25, 30, 40, 50, and 60 mIU/mL. The cutoff for Alere hCG combo cassettes was verified at 20 mIU/mL for urine, the assay gives the accurate result at and above that value. The results are consistent between immunoassay and POCT prior to and after microscopic analysis. Therefore, no significant interferences were identified with the desired sample volume, 3 mL, or short sample volume, 2mL. The volume usage by iQ 200 Analyzer was less than 500 uL. Conclusion In this study, Lamina doesn't cause any interference with hCG values using Alere hCG combo cassettes despite the short sample volume. However, variations between POC urinary hCG devices may contribute to different outcomes. Therefore, a separate validation is highly recommended if a different POC urinary hCG device is involved.

Improving Surgical Delays Related to Pediatric Preoperative Pregnancy Testing

Abstract Introduction Preoperative pregnancy status is a vital measure necessary for patient safety. At our institution, missing or delayed pregnancy test results, measured by human chorionic gonadotropin (HCG) levels, were identified as a contributing factor to surgical delays. Methods A quality improvement project was initiated in 2020 at a free-standing children’s hospital after missing or delayed HCG results were identified as a cause of surgical delays. A team was created to specifically evaluate this problem and devise an intervention. As a result, an automatically generated HCG test order was established to address surgical delays associated with missing or delayed HCG test results. The automatic order is triggered when the patient’s initial admission order is activated. For female patients 9 through 11 years of age, an order is automatically generated only if the admitting physician answers “No” to the question “Is the patient premenses?” when prompted. The system automatically generates an order for all female patients greater than 12 years of age regardless of menstruation. Results Pre-intervention data revealed approximately 6% of surgical cases were delayed because of pregnancy test results; post-intervention data revealed approximately 2.6% of surgical cases were delayed because of pregnancy test results. Conclusion Initiation of an automatically generated HCG test order helped achieve the overall goal of reducing surgical delays linked to missing or delayed HCG results. Continued education and collective efforts are underway to help ensure the automatic order’s continued success.

Diagnostic value of a urine test in pregnancy of unknown location

Pregnancy of unknown location (PUL) is a term used when there is a positive pregnancy test but no sonographic evidence for an intrauterine pregnancy (IUP) or ectopic pregnancy (EP). This term is a classification and not a final diagnosis. This study aimed to evaluate the diagnostic value of the Inexscreen test on the outcome of patients with pregnancies of unknown location. In this prospective study, a total of 251 patients with a diagnosis of pregnancy of unknown location at the gynecologic emergency department of the La Conception Hospital, Marseille, France, between June 2015 and February 2019 were included. The Inexscreen (semiquantitative determination of intact human urinary chorionic gonadotropin) test was performed on patients with a diagnosis of pregnancy of unknown location. They participated in the study after information and consent collection. The main outcome measures (sensitivity, specificity, predictive values, and the Youden index) of Inexscreen were calculated for the diagnosis of abnormal pregnancy (nonprogressive pregnancy) and ectopic pregnancy. The sensitivity and specificity of Inexscreen for the diagnosis of abnormal pregnancy in patients with pregnancy of unknown location were 56.3% (95% confidence interval, 47.0%-65.1%) and 62.8% (95% confidence interval, 53.1%-71.5%), respectively. The sensitivity and specificity of Inexscreen for the diagnosis of ectopic pregnancy in patients with pregnancy of unknown location were 81.3% (95% confidence interval, 57.0%-93.4%) and 55.6% (95% confidence interval, 48.6%-62.3%), respectively. The positive predictive value and negative predictive value of Inexscreen for ectopic pregnancy were 12.9% (95% confidence interval, 7.7%-20.8%) and 97.4% (95% confidence interval, 92.5%-99.1%), respectively. Inexscreen is a rapid, non-operator-dependent, noninvasive, and inexpensive test that allows the selection of patients at high risk of ectopic pregnancy in case of pregnancy of unknown location. This test allows an adapted follow-up according to the technical platform available in a gynecologic emergency service.

Efficacy of transvaginal ultrasound-guided local injections of absolute ethanol for ectopic pregnancies with intrauterine implantation sites.

Cervical pregnancies, interstitial tubal pregnancies, and cesarean scar pregnancies, which are ectopic pregnancies with intrauterine implantation sites exhibit increasing trends with the recent widespread use of assisted reproductive technologies and increased rate of cesarean deliveries. The development of high-sensitivity human chorionic gonadotropin testing reagents and the increased precision of transvaginal ultrasonic tomography have made early diagnosis possible and have enabled treatment. Removal of ectopic pregnancies using methotrexate therapy and/or uterine artery embolization has been reported. However, delayed resumption of infertility treatments after methotrexate therapy is indicated, and negative effects on the next pregnancy after uterine artery embolization have been reported. To examine the efficacy and safety of ultrasound-guided topical absolute ethanol injection in ectopic pregnancies with an intrauterine implantation site. In this study, we retrospectively examined the medical records of 21 patients who were diagnosed with an ectopic pregnancy with an intrauterine implantation site at our hospital, between April 2010 and December 2018, and underwent transvaginal ultrasound-guided local injections of absolute ethanol to determine the treatment outcomes. We evaluated the treatment methods, treatment outcomes, presence of bleeding requiring hemostasis measures and blood transfusion, complications, and treatment periods. Successful treatment was defined as the completion of treatment using transvaginal ultrasound-guided local injections of absolute ethanol alone. There were 21 total cases comprising 10 cervical pregnancies, 10 interstitial tubal pregnancies, and 1 cesarean scar pregnancy. All patients completed treatment with this method. No massive hemorrhaging or serious adverse reactions were observed during treatment. The mean gestation ages at the time of diagnosis were 5.9 wk (SD, ± 0.9 wk) for cervical and 6.9 wk (SD, ± 2.1 wk) for interstitial tubal pregnancies. The total ethanol doses were 4.8 mL (SD, ± 2.2 mL) for cervical pregnancies and 3.3 mL (SD, ± 2.2 mL) for interstitial pregnancies. The treatment period was 28.5 days (SD, ± 11.7 d) for cervical pregnancies and 30.0 ± 8.1 d for interstitial pregnancies. Positive correlations were observed between the blood β- human chorionic gonadotropin level at the beginning of treatment and the total ethanol dose (r = 0.75; P = 0.00008), as well as between the total ethanol dose and treatment period (r = 0.48; P = 0.026). Transvaginal ultrasound-guided local injections of absolute ethanol could become a new option for intrauterine ectopic pregnancies when fertility preservation is desired.

Conformity Test of Human Chorionic Gonadotropin (HCG) Test Results Using Immunochromatographic Method between Various Brands

Human Chorionic Gonadotropin (HCG) is a hormone produced by the placental tissue in early pregnancy. This hormone is excreted in the urine or when there is an abnormal proliferation of the chorionic epithelial tissue, such as moles or choriocarcinoma. The problem formulation in this study is that there is a match between the results of the HCG examination using the immunochromatographic method on three different brands at the Kabila Health Center, Bone Bolango District. This study aims to determine the suitability of the results of the HCG examination with the Immunochromatographic Method on three different brands.
 The method in this study used a quantitative approach. The type of data used was primary data in the form of research results and secondary data in the form of data from literature, books and documents. The sampling technique in this study used an accidental sampling technique with a sample of 30 people.
 From the research that has been conducted on 30 urine samples of pregnant women using three brands of Human Chorionic Gonadotropin (HCG) kits, namely: 1) one med test. 2) medical sterile test. 3) the accurate strip; shows the results that there was no significant difference to the results of the suitability test of HCG using these three brands.

Esketamine use for anesthesia induction in an ectopic pregnancy patient with hemorrhagic shock: a case report

Abstract Background Anesthesia induction is challenging in patients with hemodynamic instability. Esketamine has hypnotic, analgesic, and sympathomimetic effects and is the only anesthetic that can increase sympathetic tension. Therefore, it may be more suitable for patients with hypovolemic shock. Case summary A 40-year-old female patient presented to the emergency department with new-onset abdominal pain and vaginal bleeding for 2 hours. Menstruation of the patient was regular, her self-reported urine pregnancy test was positive half a month earlier, and she had been diagnosed at another hospital 12 days earlier based on a positive blood human chorionic gonadotropin test. Gynecological ultrasonography demonstrated no pregnancy sac in utero, confirming ectopic pregnancy. Emergency laparoscopy for ectopic pregnancy should be performed immediately. We administered esketamine for induction. Conclusion Esketamine-based total intravenous anesthesia results in mild hypotension in ectopic pregnancies with hemorrhagic shock.

Uterine niche is associated with adverse in vitro fertilization and intracytoplasmic sperm injection outcomes: a retrospective cohort study

To investigate the relationship between uterine niche and reproductive outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). A retrospective cohort study in the Reproductive Medicine Center of Tongji Hospital, Wuhan, China. A total of 2449 women with cesarean section history who underwent 2874 IVF/ICSI cycles between January 2015 and December 2019. A defect deeper than 2 mm under three-dimensional (3D) transvaginal sonography (TVS) or visible under hysteroscopy was defined as uterine niche. IVF/ICSI outcomes of the first embryo transfer were obtained by telephone interview 1 year regardless of fresh embryos or frozen-thawed embryos. Generalized estimating equations (GEE), logistic regression analyses, and propensity score matching were applied to clarify the relationship between uterine niche and IVF/ICSI outcomes. Primary outcome was live birth rate. Secondary outcomes were positive human chorionic gonadotropin (hCG) test results, clinical pregnancy rate, implantation rate, miscarriage rate and ectopic pregnancy rate. After excluding 48 cycles for uterine malformation, 18 cycles for chromosome abnormality, 281cycles for no available embryo or no embryo transfer, 5 cycles for oocyte donation and 7 cycles for loss of follow-up, we finally included 2231 women with 2515 cycles in our study. Compared with women without niche, women with niche had reduced live birth rate (18.99% vs. 31.51%, adjusted OR: 0.51, 95% CI: 0.34-0.77), positive hCG test rate (34.08% vs. 46.40%, adjusted OR: 0.61, 95% CI: 0.43-0.87), clinical pregnancy rate (29.05% vs. 42.25%, adjusted OR: 0.57, 95% CI: 0.39-0.82) and implantation rate (25.87% vs. 36.95%, adjusted OR: 0.53, 95% CI: 0.38-0.76). In all the sensitivity analyses, the niche group had an 7.28%-18.22% increase in miscarriage rate even not all of them were statistically significant. Uterine niche may have a detrimental effect on subsequent fertility of women with cesarean section history undergoing IVF/ICSI treatment. Practitioners should be noted that women with uterine niches may associated with adverse IVF/ICSI outcomes.

Is Preoperative Urine Human Chorionic Gonadotropin (hCG) Testing Necessary for Pediatric Patients Before Oral and Maxillofacial Surgery Procedures With Sedation?

Human chorionic gonadotropin (hCG) testing is performed prior to surgical procedures to ensure patient and fetal safety. The purpose of this study was to evaluate the utility of routine pregnancy testing prior to elective outpatient oral and maxillofacial surgery procedures being performed with intravenous sedation (IVS). A retrospective cohort study was implemented assessing hCG testing in postmenarche females who underwent elective outpatient oral surgery procedures scheduled with IVS at a tertiary care institution. Medical records were used to identify eligible subjects aged 12 to 45years. The primary predictor variable was age, and the primary outcome variable was urine hCG test result. Age was divided into groups to reflect early adolescence (12 to 14years), mid-adolescence (15 to 17years), late adolescence/early adulthood (18 to 24years) and adulthood (25+ years). Secondary outcome variables included inability to void for hCG testing, change in anesthetic, case cancellation or rescheduling and were measured over a 2year period. Descriptive statistics were performed. Relative risk (RR) and Cochran-Armitage test for trend were calculated to determine the statistical significance of age on inability to void. The sample consisted of 5,006 females, with a median age (IQR, range) of 18.0 (3.6, 12.0 to 43.6) years. There was one positive urine hCG result providing a preoperative pregnancy rate of 0.02%. Fourteen of 1,195 subjects (1.2%) over a 2year period were unable to provide a urine hCG sample. There was a statistically significant trend in inability to void as age groups got older (P=.001). Patients aged 12 to 17years had an increased risk of being unable to void compared to patients 18years and older (RR: 14.30, 95% CI: 1.88 to 108.99, P=.01). The total cost of testing over the 11year observation period was $9,019.59. The risk of surgical cancellations and delayed care due to patients' inability to void preoperatively plus a lack of any positive preoperative urine hCG findings in patients under 18years of age in this study, call into question the necessity of routine preoperative hCG screening in pediatric patients presenting for IVS for elective outpatient oral and maxillofacial procedures.

Combination of PLGF and PAPPA as a biochemical markers to the first trimester maternal screening

Screening of fetal chromosomal abnormalities is an essential part of antenatal care. Effective first trimester screening involves PAPP-A (pregnancy associated plasma protein A) and free HCG (human chorionic gonadotropin) levels in the maternal serum along with ultrasound examination. The objective of this study is to investigate whether the measurement of PLGF (Placental Growth Factor) can improve the performance of first trimester combined screening for Trisomy 21, 18 and 13. A total of 350 samples were collected from pregnant women during the first trimester between 10 to 14 weeks of gestation. The ultrasound (US) data were collected from all cases which include US gestational age, NT value, CRL, and fetus number, if any. Blood samples were collected and tested for PAPP-A and free HCG tests. The combined risk of trisomy 21, 18 and 13 were calculated using PRISCA software. The screen positive cases (more than a defined cutoff rate) were stored at -20oC for PLGF testing. A total of 97 cases, including low and high risk patients were analyzed for PLGF. A significant reduction was observed among the risk group p ≤ 0.005 when compared to the negative control group. A positive correlation between PLGF and PAPPA was identified (r=0.69) p ≤0.001. In conclusion the study provide data indicating that inclusion of serum PLGF improve the performance of first trimester combined test for screening of Trisomy 21, 18 and 13 risk

Pregnancy among adolescent girls in humanitarian settings: a case in refugee camp of Gambella regional state, community-based cross-sectional study, Southwest Ethiopia, 2021

ObjectiveThe aim of this study was to assess the prevalence of pregnancy and associated factors among adolescent girls in Nguenyyiel Refugee Camp.DesignCross-sectional study was employed to conduct this study.SettingA community-based...

Is Preoperative Urine human Chorionic Gonadotropin (hCG) Testing Necessary for Pediatric Patients Before Oral and Maxillofacial Surgery Procedures?

Is Preoperative Urine human Chorionic Gonadotropin (hCG) Testing Necessary for Pediatric Patients Before Oral and Maxillofacial Surgery Procedures?

Serum vascular endothelial growth factor as a marker for tubal pregnancy.

SUMMARYOBJECTIVE:The objective of this study was to evaluate whether a single measurement of vascular endothelial growth factor could distinguish between intrauterine pregnancy and ectopic pregnancy and to correlate the levels of vascular endothelial growth factor with serum levels of progesterone andβ-human chorionic gonadotropin in each subgroup.METHODS:Ninety patients with a positive human chorionic gonadotropin test and either abdominal pain or vaginal bleeding were selected; pregnancies were singletons, spontaneously conceived, 42–56 days of gestational age. All patients had a transvaginal ultrasound examination and were divided into three subgroups: abnormal intrauterine pregnancy, tubal pregnancy, and normal intrauterine pregnancy. Tubal pregnancies were surgically treated and histologically confirmed. Blood samples were collected for the determination of β-human chorionic gonadotropin, progesterone, and vascular endothelial growth factor and their concentrations were compared in each subgroup. Receiver operating characteristic curve was calculated by comparing the subgroup of tubal pregnancy to the other groups. A Fisher discriminant function analysis was performed. The level of significance was 5%.RESULTS:One-way analysis of variance revealed a significant correlation between the different subgroups and β-human chorionic gonadotropin, progesterone, and vascular endothelial growth factor serum levels (p<0.001). Vascular endothelial growth factor concentration was significantly higher for patients with tubal pregnancy than for other subgroups (p<0.05). β-Human chorionic gonadotropin and progesterone levels were higher in the subgroup with normal intrauterine pregnancies compared with the subgroups with tubal and abnormal intrauterine pregnancies (p<0.05). Serum vascular endothelial growth factor level >188.7 ng/mL predicted tubal pregnancy with 96.7% sensitivity, 95.0% specificity, 90.6% positive predictive value, and 98.3% negative predictive value.CONCLUSIONS:Serum vascular endothelial growth factor could be a marker in discriminating intrauterine pregnancy from tubal pregnancy; its levels are increased in women with ectopic pregnancy compared with women with normal and abnormal intrauterine pregnancies.

46, XY 5-Alpha Reductase Deficiency in a 36-Year-Old Phenotypic Female Patient

46, XY 5-Alpha Reductase Deficiency in a 36-Year-Old Phenotypic Female Patient

Mifepristone and Misoprostol for Undesired Pregnancy of Unknown Location.

To compare immediate initiation with delayed initiation of medication abortion among patients with an undesired pregnancy of unknown location. This retrospective cohort study used electronic medical record data from the Planned Parenthood League of Massachusetts (2014-2019) for patients who requested medication abortion with a last menstrual period (LMP) of 42 days or less and pregnancy of unknown location (no gestational sac) on initial ultrasonogram. Clinicians could initiate medication abortion with mifepristone followed by misoprostol while simultaneously excluding ectopic pregnancy with serial serum human chorionic gonadotropin (hCG) testing (same-day-start group) or establish a diagnosis with serial hCG tests and repeat ultrasonogram before initiating treatment (delay-for-diagnosis group). We compared primary safety outcomes (time to diagnosis of pregnancy location [rule out ectopic], emergency department visits, adverse events, and nonadherence with follow-up) between groups. We also reported secondary efficacy outcomes: time to complete abortion, successful medication abortion (no uterine aspiration), and ongoing pregnancy. Of 5,619 medication abortion visits for patients with an LMP of 42 days or less, 452 patients had pregnancy of unknown location (8.0%). Three patients underwent immediate uterine aspiration, 55 had same-day start, and 394 had delay for diagnosis. Thirty-one patients (7.9%), all in the delay-for-diagnosis group, were treated for ectopic pregnancy, including four that were ruptured. Among patients with no major ectopic pregnancy risk factors (n=432), same-day start had shorter time to diagnosis (median 5.0 days vs 9.0 days; P=.005), with no significant difference in emergency department visits (adjusted odds ratio [aOR] 0.90, 95% CI 0.43-1.88) or nonadherence with follow-up (aOR 0.92, 95% CI 0.39-2.15). Among patients who proceeded with abortion (n=270), same-day start had shorter time to complete abortion (median 5.0 days vs 19.0 days; P<.001). Of those who had medication abortion with known outcome (n=170), the rate of successful medication abortion was lower (85.4% vs 96.7%; P=.013) and the rate of ongoing pregnancy was higher (10.4% vs 2.5%; P=.041) among patients in the same-day-start group. In patients with undesired pregnancy of unknown location, immediate initiation of medication abortion is associated with more rapid exclusion of ectopic pregnancy and pregnancy termination but lower abortion efficacy.

Evaluation of a cardiac troponin process flow at the chest pain center with the shortest turnaround time.

BackgroundEarly diagnosis of myocardial infarction is crucial in chest pain management and cardiac troponin (cTn) test is an important step in it. Process improvement to shorten the test turnaround time (TAT) may improve patients’ outcomes. The cTn test at chest pain center (CPC) of Zhongshan Hospital had the shortest TAT ever reported, but its process flow was not fully evaluated.MethodsWe performed a stepwise evaluation of CPC cTn TAT and explored the potential factor that might cause delay. The performance of CPC cTn test was also compared with cTn test and human chorionic gonadotropin (HCG) test ordered from emergency department (ED).ResultsAt least 95% of CPC cTn tests were completed in 60 min, while 62% in 30 min. The medians of monthly order‐to‐collect time, collect‐to‐received time, and received‐to‐result time were ~7 min, ~3 min, and ~13 min, respectively. The samples collected at the bedside had longer collect‐to‐received time than the ones collected at the blood draw site next to the laboratory. Compared to ED cTn test and ED HCG test, CPC cTn test took less time in each step. A combination of the sample type switch and the centrifugation time reduction contributed the most to the shortening of TAT, which was reflected in the received‐to‐result time.ConclusionsThe current process flow of CPC cTn test satisfied the requirements of chest pain management, giving an example of how to implement process improvement for emergency medicine to shorten TAT of laboratory tests.

Results of an advanced nursing triage protocol in emergency departments.

The increasing number of patients admitted to emergency departments (EDs) and overcrowding of EDs lead to a global problem. Advanced nursing triage is an important solution in facilitating patient and time management, also increasing the efficiency of the ED. This study was conducted to predict the possible effects of applying advanced nursing triage modeling with predetermined protocols during the current nursing triage in the ED. This was a descriptive and cross-sectional study. An advanced "triage assessment protocol," which was developed previously, was hypothetically applied for 5 days by triage nurses in the adult ED of a university hospital. The hypothetical application was tested by triage nurses in all shifts. The nurses recorded the examination or treatment options which they thought to apply for the patient on the study form. The data recorded on the advanced triage evaluation protocol form by the triage nurses were compared with the patient outcomes and physician examination/treatment requests in the Hospital Information Management System by the researchers. In the study, it was determined that the rate of examination/treatment that could be requested according to the advanced nursing triage protocol was 46%. There were a good level of agreement on X-ray and a moderate level of agreement on urinary test and urinary beta- Human chorionic gonadotropin (hCG) test between physicians and triage nurses regarding examination/treatment requests. In addition, it was found that there was a 61.2% of agreement on decisions made for patients aged between 18 and 35. The rate of agreement between doctors and nurses regarding a gluco-stick request for patients admitted outside the prime time (92.2%) was found to be significantly higher (87.9%) than for patients admitted during prime time (P = 0.046). "Advanced triage" practices recommended for busy EDs were tested "hypothetically" at the national level due to the lack of legal regulations and were found to be compatible with the actual results of physicians' practices at an acceptable level, especially for selected medical conditions. The method used in this study can be useful in planning the transition to "advanced triage" practices. These results can show the readiness of nurses for the transition to this practice.

The sensitivity, specificity, and accuracy of Creatinine test and human chorionic gonadotropin (HCG) test of cervical mucus discharge to diagnose preterm premature rupture of membranes (PPROM)

Introduction: Premature Rupture of Membranes (PROM) is one of the common problems of midwifery, which its early diagnosis is essential in the process of treatment and prevention of pregnancy adverse outcomes. Therefore, this study was performed with aim to evaluate the diagnostic accuracy of Creatinine and human chorionic Gonadotropin (HCG) test of cervical mucusdischarge to diagnose PROM in pregnant women. Methods: This prospective study was conducted in 2017-2018 on 150 pregnant women with gestational age of 24 to 37 weeks and suspected to PROM. The subjects were divided into two groups of Rupture Membranes (Pooling and Fern test both of them were positive) and control group (Pooling and Fern test both of them were negative and AFI was normal). Creatinine was measured with Automated Analyzer method (Prestige device) and βHCG with Chemi-luminescence Signal Band method (Abbott device). Cut-off point and diagnostic accuracy were measured for two tests by rock curve. P-value<0.05 was considered statistically significant. Results: The highest sensitivity and specificity for creatinine in the diagnosis of PPROM was obtained at cut-off point 0.135 and for βHCG at cut-off point 26.78, with sensitivity of 91.7% and specificity 56.1%, and positive predictive value of 39.75% and negative predictive value of 95.52% and overall accuracy was 64.66% and the agreement rate was 0.33 (P <0.001). For βHCG, the sensitivity 58.3% and specificity 63.2%, and positive predictive value 33.33%, and negative predictive value of 82.75% and overall accuracy was 62% and the agreement rate was 0.171 (P=0.023). Conclusion: The sensitivity and diagnostic power of Creatinine in preterm women was higher than βHCG. Reasonable price, simplicity, and safety are the advantages of both methods. The diagnostic accuracy obtained in this study was low, but due to the limited studies in preterm patients, the clinical use of these markers cannot be recommended or rejected; therefore, more studies are suggested.

Surveillance for gestational trophoblastic neoplasia following molar pregnancy: a cost-effectiveness analysis

Historically, published guidelines for care after molar pregnancy recommended monitoring human chorionic gonadotropin levels for the development of gestational trophoblastic neoplasia until normal and then for 6 months after the first normal human chorionic gonadotropin. However, there are little data underlying such recommendations, and recent evidence has demonstrated that gestational trophoblastic neoplasia diagnosis after human chorionic gonadotropin normalization is rare. We sought to estimate the cost-effectiveness of alternative strategies for surveillance for gestational trophoblastic neoplasia after human chorionic gonadotropin normalization after complete and partial molar pregnancy. A Markov-based cost-effectiveness model, using monthly cycles and terminating after 36 months/cycles, was constructed to compare alternative strategies for asymptomatic human chorionic gonadotropin surveillance after the first normal (none; monthly testing for 1, 3, 6, and 12 months; or every 3-month testing for 3, 6, and 12 months) for both complete and partial molar pregnancy. The risk of reduced surveillance was modeled by increasing the probability of high-risk disease at diagnosis. Probabilities, costs, and utilities were estimated from peer-reviewed literature, with all cost data applicable to the United States and adjusted to 2020 US dollars. The primary outcome was cost per quality-adjusted life year ($/quality-adjusted life year) with a $100,000/quality-adjusted life year willingness-to-pay threshold. Under base-case assumptions, we found no further surveillance after the first normal human chorionic gonadotropin to be the dominant strategy from both the healthcare system and societal perspectives, for both complete and partial molar pregnancy. After complete mole, this strategy had the lowest average cost (healthcare system, $144 vs maximum $283; societal, $152 vs maximum $443) and highest effectiveness (2.711 vs minimum 2.682 quality-adjusted life years). This strategy led to a slightly higher rate of death from gestational trophoblastic neoplasia (0.013% vs minimum 0.009%), although with high costs per gestational trophoblastic neoplasia death avoided (range, $214,000 to >$4 million). Societal perspective costs of lost wages had a greater impact on frequent surveillance costs than rare gestational trophoblastic neoplasia treatment costs, and no further surveillance was more favorable from this perspective in otherwise identical analyses. No further surveillance remained dominant or preferred with incremental cost-effectiveness ratio of <$100,000 in all analyses for partial mole, and most sensitivity analyses for complete mole. Under the assumption of no disutility from surveillance, surveillance strategies were more effective (by quality-adjusted life year) than no further surveillance, and a single human chorionic gonadotropin test at 3 months was found to be cost-effective after complete mole with incremental cost-effectiveness ratio of $53,261 from the healthcare perspective, but not from the societal perspective (incremental cost-effectiveness ratio, $288,783). Largely owing to the rare incidence of gestational trophoblastic neoplasia after human chorionic gonadotropin normalization after molar pregnancy, prolonged surveillance is not cost-effective under most assumptions. It would be reasonable to reduce, and potentially eliminate, current recommendations for surveillance after human chorionic gonadotropin normalization after molar pregnancy, particularly among partial moles. With any reduction in surveillance, patients should be counseled on symptoms of gestational trophoblastic neoplasia and established in routine gynecologic care.

Intramuscular progesterone optimizes live birth from programmed frozen embryo transfer: a randomized clinical trial

To determine whether vaginal progesterone for programmed endometrial preparation is noninferior to intramuscular progesterone in terms of live birth rates from frozen embryo transfer (FET). Three-armed, randomized, controlled noninferiority trial. Multicenter fertility clinic. A total of 1,346 volunteer subjects planning vitrified-warmed transfer of high-quality nonbiopsied blastocysts were screened, of whom 1,125 subjects were ultimately enrolled and randomly assigned to treatment. The subjects were randomly assigned to receive, in preparation for FET, 50 mg daily of intramuscular progesterone (control group), 200 mg twice daily of vaginal micronized progesterone plus 50 mg of intramuscular progesterone every third day (combination treatment), or 200 mg twice daily of vaginal micronized progesterone. The primary outcome was live birth rate per vitrified-warmed embryo transfer. The secondary outcomes were a positive serum human chorionic gonadotropin test 2 weeks after FET, biochemical pregnancy loss, clinical pregnancy, clinical pregnancy loss, total pregnancy loss, serum luteal progesterone concentration 2 weeks after FET, and patient's experience and attitudes regarding the route of progesterone administration, on the basis of a survey administered to the subjects between FET and pregnancy test. A total of 1,060 FETs were completed. The live birth rate was significantly lower in women receiving only vaginal progesterone (27%) than in women receiving intramuscular progesterone (44%) or combination treatment (46%). Fifty percent of pregnancies in women receiving only vaginal progesterone ended in miscarriage. The live birth rate after vaginal-only progesterone replacement was significantly reduced, due primarily to an increased rate of miscarriage. Vaginal progesterone supplemented with intramuscular progesterone every third day was noninferior to daily intramuscular progesterone, offering an effective alternative regimen with fewer injections. NCT02254577.