Human Chorionic Gonadotropin Levels Research Articles

Kiaušintakinio nėštumo gydymas metotreksatu LSMUL Kauno klinikose

Tyrimo tikslas. Nustatyti kiaušintakinio nėštumo gydymo metotreksatu rezultatus Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų (toliau – Kauno klinikų) Akušerijos ginekologijos klinikoje. Tyrimo metodai. Atlikta retrospektyvi Kauno klinikų Akušerijos ir ginekologijos klinikos informacinės sistemos duomenų analizė. Analizuoti visi 2018–2019 m. diagnozuoti kiaušintakinio nėštumo atvejai, kai gydymui buvo skirtas metotreksatas (n=40). Buvo vertinti moterų demografiniai rodikliai, kiaušintakinio nėštumo rizikos veiksniai ir simptomai, ultragarsinio tyrimo radiniai, žmogaus chorioninio gonadotropino (hCG) kiekis, metotreksato dozių skaičius, gydymo veiksmingumas ir ar metotreksatas buvo skirtas pagal pastaruoju metu rekomenduojamus kriterijus. Rezultatai. Dažniausiai moteris buvo pirmą kartą pastojusi, vidutiniškai apie šeštą nėštumo savaitę besiskundžianti pilvo skausmu ir kraujavimu iš genitalijų, kuriai ultragarsinio tyrimo metu dažniausiai buvo matytas įvairaus dydžio, heterogeninės struktūros darinys gimdos priedų srityje. Dauguma atvejų (92,5 proc.) metotreksatas buvo skirtas pagal rekomenduojamus kriterijus. Iš viso 35 proc. moterų gydymo metotreksatu baigtis nežinoma. Kiaušintakinio nėštumo gydymas metotreksatu buvo veiksmingas 76,9 proc. atvejų. Trims iš keturių moterų (75 proc.) metotreksatas buvo skirtas vieną kartą, likusioms reikėjo antros dozės. Skubi operacija atlikta 23,1 proc. moterų, tačiau, kai metotreksatas skirtas pagal rekomenduojamus kriterijus, – 17,4 proc. moterų. Visos operacijos atliktos po pirmos vaisto dozės. Išvados. Kauno klinikose kiaušintakinio nėštumo gydymas metotreksatu buvo sėkmingas 76,9 proc. moterų. Nors rezultatai labai panašūs į mokslinėje literatūroje nurodomus duomenis, reikalingi tolesni perspektyvūs tyrimai.

Uterine rupture and shock: an unusual presentation of gestational trophoblastic neoplasm

We report a case of a 47-year-old woman, gravida 4 para 3, with a history of 3 vaginal deliveries and recent surgical evacuation of complete mole. Five weeks later, an invasive mole was diagnosed because of a raised human chorionic gonadotropin level. Monoagent chemotherapy was planned. She presented to our emergency department with acute abdominal pain and distension. Clinical examination suggested hemorrhagic shock (heart rate was 145 beats per minute and blood pressure was 80/40 mm Hg). Uterine rupture was suspected, and the patient immediately underwent explorative laparotomy.

Ultrasonographic technique to differentiate enhanced myometrial vascularity/arteriovenous malformation from retained products of conception.

To objective of this study is to discuss the ultrasonographic technique to diagnose uterine enhanced myometrial vascularity/arteriovenous malformation (EMV/AVM) and differentiate it from retained products of conception. The study also reviews the management and outcome of EMV/AVM. We present a series of three women who developed EMV after early pregnancy loss and a control case of incomplete abortion, where colour Doppler ultrasound was used to distinguish retained products of conception from features of EMV. Clinical status and imaging findings, including peak systolic velocity (PSV), were used for the initial risk stratification of the patients. All cases with EMV/AVM were managed expectantly with serial ultrasound imaging and trending human chorionic gonadotropin levels. The patient with retained products of conception was managed by hysteroscopy and curettage. In all cases, presentation was suggestive of incomplete abortion with retained products of conception. However, colour Doppler ultrasound demonstrated hypoechoic areas within the endometrium extending into the myometrium with a high maximum PSV. In the control case, colour Doppler ultrasound noted a heterogeneous area in the left uterine cavity; however, vascular flow in this area was distinct from the endometrium, suggesting retained products of conception. All three women with EMV were managed expectantly with close monitoring and good outcomes. In patients with early pregnancy loss and bleeding or persistently elevated human chorionic gonadotropin levels, clinical status and appropriate use of ultrasound imaging with colour Doppler, including PSV measurement, can assist in recognition of EMV/AVM. Expectant management with serial ultrasound evaluation is a safe treatment option for EMV/AVM with low PSV and can minimise complications such as need for blood transfusion, uterine artery embolization, and hysterectomy.

Adverse effects of maternal rheumatoid arthritis during pregnancy on children.

Adverse effects of maternal rheumatoid arthritis during pregnancy on children.

Role of Serum β-HCG Doubling in Diagnosis of Early Pregnancy and its Management Strategy

Background: Pregnancy of unknown location (PUL) is defined as the absence of intrauterine or extrauterine sac and Beta Human Chorionic Gonadotropin levels (β-HCG) above the discriminatory zone of 1500 mIU/ml. It should be noted that PUL is not always an ectopic; however, by measuring the trends of serum β-HCG, we can determine the outcome of a PUL. Objective: This study aims to identify the various trends of β-HCG levels in early pregnancy and evaluate the role of β-HCG in the management strategy. Methods: We conducted a prospective observational study of pregnant women suspected of early pregnancy. Cases were classified as having a pregnancy of unknown location (PUL) by transvaginal ultrasound and ß -HCG greater than 1000 mIU/ml. Expectant management was done until there was a definite outcome. All the collected data were analyzed by employing the chi-square test using SPSS version 20. Results: Among the 1200 women who had early first trimester scans, 70 women who fulfilled our criteria of PUL and ß -HCG > 1000 mIU/ml were recruited in this study. In our study, the mean age of the participants was 30±5.6yrs, and the overall mean serum ß -HCG was 3030±522 mIU/ml. The most common outcome observed was an ectopic pregnancy, 47% in our study. We also found that the rate of failing pregnancy was 27%, and that of intrauterine pregnancy (IUP) was 25%. Overall, in PUL patients diagnosed with ectopic pregnancy, 9% behaved like IUP, and 4% had an atypical trend in their ß -HCG. Those who had an IUP, 11% had a suboptimal increase in ß-HCG. Conclusion: PUL rate in our unit was 6%. The majority of the outcome of PUL was ectopic in our study. Every case of PUL should be managed based on the initial ß -HCG values, clinical assessments and upon the consent of the patient.

Does the Addition of Serum PAPP-A and β-hCG Improve the Predictive Value of Uterine Artery Pulsatility Index for Preeclampsia at 11–14 Weeks of Gestation? A Prospective Observational Study

To study the role of uterine artery Doppler pulsatility index (UtA-PI), serum pregnancy-associated plasma protein-A (PAPP-A) and free beta human chorionic gonadotropin (fβ-hCG) levels, individually and in combination with each other, at 11-14 weeks of gestation for prediction of preeclampsia (PE).In a prospective observational study, a total of 100 low-risk gravid females were recruited at 11-14-weeks of gestation. UtA-PI, PAPP-A and fβ-hCG levels were estimated. These women were followed up until delivery for the development of PE and gestational hypertension (GH).The best individual marker for screening PE and GH was UtA-PI with ROC AUC (± standard error) = 0.934 ± 0.028, p < 0.0001. UtA-PI at a cutoff value of ≥ 2.8 (95th percentile) had 77.8% sensitivity, 98.9% specificity, 97.8% NPV and 87.5% PPV in detecting PE. PAPP-A (MoM) at a cutoff value of ≤ 0.27 (5th percentile) demonstrated 44.4% sensitivity, 95.6% specificity, 94.5% NPV and 50% PPV. fβ-hCG (MoM) at a cutoff value of ≤ 0.5 (5th percentile) had a specificity of 94.5%. Among the combined markers, UtA-PI along with PAPP-A estimation served best with a sensitivity and specificity of 44% and 100%, respectively. Addition of fβ-hCG to either UtA-PI or PAPP-A levels was not found sensitive for detecting PE but yielded 100% specificity and 96% NPV.UtA-PI as a stand-alone test was found most useful for the prediction of PE. Addition of either or both of PAPP-A and fβ-hCG to UtA-PI did not improve the sensitivity of combined test with only a slight improvement in specificity and NPV. Their routine addition to UtA-PI studies is not recommended for prediction of PE at 11-14 weeks of gestation in low- and lower-middle-income countries (LMIC).

Clinical manifestations of placental mesenchymal dysplasia in Japan: A multicenter case series.

This study aimed to evaluate the clinical features and pregnancy outcomes of placental mesenchymal dysplasia (PMD) in Japan. We requested detailed clinical information and placental tissue of PMD cases in 2000-2018 from Japanese facilities with departments of obstetrics and gynecology and analyzed the pregnancy course and neonatal outcomes. We collected 49 cases of PMD. Of 18 patients with measured maternal serum alpha-fetoprotein (MSAFP) levels, 15 (83.3%) had elevated levels. Maternal serum human chorionic gonadotropin (MShCG) levels were transiently elevated in five (17.8%) of 28 patients. Forty-seven patients continued their pregnancies. All pregnancies were singleton and 40 (85.1%) were associated with adverse events including fetal growth restriction (FGR), threatened premature delivery, fetal demise, and hypertensive disorder of pregnancy in 34 (72.3%), 14 (29.8%), eight (17.0%), and six (12.8%) patients, respectively. Of 47 infants, there were eight stillbirths. There were 40 (85.1%) female infants, and eight (17.0%) had Beckwith-Wiedemann syndrome. Of 39 live births, 23 (59.0%) were associated with premature induction of labor or cesarean section for obstetric indications related to FGR. Eighteen (46.2%) neonates had complications. PMD-affected placentas were pathologically heterogeneous in both grossly PMD-affected and non-affected areas. Our study included the largest number of PMD cases with detailed clinical information. PMD is a high-risk condition for both the mother and the child. Elevated MSAFP levels with normal MShCG levels indicate PMD. Conventional perinatal management of FGR in Japan might be effective in reducing the fetal mortality rate.

Progesterone levels predict pregnancy outcomes in individuals with fallopian tube associated infertility

BackgroundThis study aimed at determining the predictive value of human chorionic gonadotropin and progesterone levels on pregnancy outcomes in patients receiving in vitro fertilization due to fallopian tube associated infertility.MethodsWe retrospectively analyzed the clinical data of 854 cycles due to fallopian tube associated infertility in vitro fertilization fresh embryo transfer. The clinical data had been collected from January 2010 to December 2018 and was divided into 7 groups depending on the progesterone level on human chorionic gonadotropin administration day. Live birth rates and observation trends were calculated. The receiver operating characteristic curve was established to determine the optimal cutoff value for progesterone, which was used to further divide the data into 3 groups; Group 1 (progesterone ≦ 1.0 ng/ml), Group 2 (1.0 ng/ml ≤ progesterone ≤ 1.25 ng/ml), and Group 3 (progesterone ≥ 1.25 ng/ml). We then compared the ovulation results and clinical outcomes among the 3 groups.ResultsThere were no significant differences in age, infertility years, gonadotropin dosage, gonadotropin days, Luteinizing hormone level on human chorionic gonadotropin day, 2 pronuclear fertilization rates, clinical pregnancy rates, live birth rates, full-term birth rate, and preterm birth rates among the three groups. However body mass index (p = 0.001), basal luteinizing hormone (p = 0.034), estrogen peak (p < 0.001), number of oocytes obtained (P < 0.001) were significantly different.ConclusionsProgesterone level on human chorionic gonadotropin day does not affect the clinical pregnancy rate and live birth rates after in vitro fertilization. However, progesterone levels between 1.0 and 1.25 ng/ml may lead to good clinical pregnancy outcomes.

Is suction curettage an effective treatment alternative for cesarean scar pregnancies?

ObjectivesThe study aims to evaluate the success rate of suction curettage (SC) as a first line treatment with or without use of foley balloon tamponade for cesarean scar pregnancy (CSP) and to determine the risk factors for failure of treatment. Study DesignThe study was retrospective and included 36 CSP cases who underwent SC for treatment. Presence of pain with active bleeding and > 10 weeks of gestation were taken as the exclusion criterion. The procedure was performed under sonographic guidance. After the procedure, in patients who had a hemorrhage foley catheter was inserted into the uterine cavity. SC failure was defined as a requirement of secondary intervention. CSP types, myometrial thickness in the scar area, fetal cardiac activity, initial Beta human chorionic gonadotropin levels (β−HCG), history of vaginal delivery were compared between successful and failed groups. ResultOf 36 patients, 31 had favorable results with SC ± foley balloon tamponade. Success rate was found to be 86 % (31/36) as the first line therapy. Foley catheter was applied for 23 patients, among them, four were in the failed group and 19 were in the favorable group. In the failed group, two patients had emergent laparotomy, two had repeat SC the day after the initial treatment and one patient was treated with systemic MTX. Fetal cardiac activity and presence of embryonic pole were not different between the groups (p = 1.000, p = 0.829 respectively). Myometrial thickness in the failed group was less than the successful group, this difference was significant (p = 0.033). CSP types, initial β−HCG levels and history of vaginal delivery were not different between the groups (p = 0.149, p = 0.372 and p = 0.404 respectively). ConclusionSC may be considered as a first line therapy for CSPs, and and in patients complicated with hemorrhage foley balloon tamponade can be used easily. Thinner myometrium at previous cesarean scar can be considered as a risk factor for failure of SC in patients with CSP.

The effect of single dose Methotrexate in the treatment of scar ectopic pregnancy

Background: Cesarean scar ectopic pregnancy is a novel and rare disease that is increasing across the globe at a threatening rate. Thus, this study aimed to assess the effect of a single dose of methotrexate (MTX) to treat the scar ectopic pregnancy (SEP) and to compare its effects with the treatment by multiple doses of MTX. Methods: A retrospective cohort study was conducted in Security Forces Hospital in Riyadh, Saudi Arabia from 2016 to 2020. The study included 13 pregnant women with history of cesarean section, diagnosed by official pelvic ultrasound or pelvic magnetic resonance imaging with SEP. Participants were sampled using a convenient non-probability sampling technique and data were collected via phone interviews. Results: In the selected cohort, around 10 (76.9%) women reported a complete and uncomplicated resolution within a few months with a single dose of MTX, whereas, three women (23.1%) were successfully treated with multiple doses of MTX. However, seven (53.8%) had symptoms after taking MTX (which included vaginal bleeding, pain, fever, headache, diarrhea, low mood, and stomatitis), where the other six (46.2%) had no symptoms. For all participants, the level of beta human chorionic gonadotropin became normal after an average of 61 days from administration of MTX and six (46.2%) of them conceived with normal pregnancy. Conclusion: MTX therapy seems to be an effective and safe approach for SEP treatment, especially in women who want to conceive successfully.

Positive Association of the Number of Oocyte Retrievals With the Maternal hCG Concentration in Early Pregnancy After &lt;i&gt;in vitro&lt;/i&gt; Maturation

In vitro maturation (IVM), which is widely used for infertile women, offers many benefits, and it does not involve ovarian hyperstimulation. In addition, the serum human chorionic gonadotropin (hCG) level is significantly higher in women with early pregnancies achieved by IVM than in those with pregnancies achieved by traditional IVF. In the present study, we explored the association between the number of oocyte retrievals and the maternal hCG concentration on days 14 and 21 after IVM. Data from 51 women who delivered singletons were analyzed. The mean number of oocytes retrieved was 16.78 ± 11.23, and the hCG concentration was 614.47 ± 445.50 IU/L on day 14 and 10930.20 ± 7223.17 IU/L on day 21. After adjusting for confounding factors, the concentration of maternal serum hCG on days 14 and 21 associated significantly with the number of oocyte retrievals. Crude linear regression analysis showed a positive relationship between the number of oocytes retrieved and the hCG concentration. Our results showed that the number of oocytes retrieved associated positively with the serum hCG concentration in women with early pregnancies that underwent IVM. Our results partially explain the transient changes in the early maternal serum hCG concentration after IVM.

Severe ovarian hyperstimulation syndrome in a case of nonmutated recurrent genuine empty follicle syndrome

Empty follicle syndrome (EFS) is a rare event in which no oocytes are retrieved from apparently normal growing follicles with normal steroidogenesis despite meticulous follicular aspiration in assisted reproductive technology (ART) cycles. EFS is mainly of two types, genuine EFS and false EFS. Here, we report a case of a 24-year-old woman presenting with primary infertility with normal ovarian reserve and regular menstrual cycles, husband having severe “oligo-astheno-teratozoospermia,” and planned for ART treatment. We could not retrieve any oocytes in successive cycles despite optimum human chorionic gonadotropin (hCG) levels on the day of oocyte retrieval and using different management protocols mentioned until now in the literature. The whole genomic analysis was found to be normal (46, XX). Further, the patient had experienced severe ovarian hyperstimulation syndrome (OHSS) after the second cycle of ovarian stimulation despite no luteal hCG support. We were ineffectual to find the cause of recurrent EFS in this patient and therefore counseled the patient for donor oocytes. This case highlights the difficulty in treating genuine EFS patients and the need for monitoring serum estradiol levels during ovarian stimulation to prevent another serious complication of OHSS.

Successful conservative treatment of cesarean scar ectopic pregnancy with local injections of absolute ethanol

Cesarean scar ectopic pregnancy (CSEP) is becoming more common worldwide. Here, we report a case of cesarean scar pregnancy successfully treated using transvaginal ethanol injection. A 31-year-old female (gravida 3, para 2) with two prior cesarean sections presented at 9 weeks and 3 days of pregnancy. Her serum human chorionic gonadotropin level was 91,798 mIU/mL. CSEP was confirmed by transvaginal ultrasonography, pelvic magnetic resonance imaging, and color Doppler ultrasonography. Transvaginal absolute ethanol local injection under transvaginal ultrasound guidance was performed. She was discharged 7 days after treatment with no complications and resumed normal menses 1 month after treatment. We describe a safe and successful treatment option for CSEP.

The significance of maternal blood pregnancy-associated plasma protein A (PAPP-A) and free beta-subunit of human chorionic gonadotropin (β-hCG) levels for the risk assessment of fetal trisomy 18 during the first prenatal testing between 11 and 13+6 weeks of pregnancy.

The aim of the study was to evaluate the significance of the maternal blood level of pregnancy-associated plasma protein A (PAPP-A) and free beta-subunit of human chorionic gonadotropin (β-hCG), to estimate the risk of fetal trisomy 18 and their correlation with the assessment of nuchal translucency (NT) during the first prenatal testing. Examinations of 93 pregnant women between 11 and 13+6 weeks of pregnancy were conducted, which included determination of β-hCG and PAPP-A concentrations in the maternal serum and ultrasound assessment of fetal nuchal translucency. Concentrations of biochemical parameters were expressed as multiples of median (MoM) for the appropriate gestational age. The risk assessment of trisomy 18 was analyzed using Astraia software. Pregnant women with a high (≥ 1:300) risk of trisomy 18 were offered a genetic amniocentesis with an examination of fetal karyotype. Twenty cases were healthy and 23 with trisomy 18. PAPP-A and β-hCG MoM values < 0.3 were found in 61% cases of fetal trisomy 18. In 26% of cases, PAPP-A and β-hCG MoM values < 0.2 were NT-independent risk factors for trisomy 18. There were no significant differences between groups with normal fetal karyotype (40%) and trisomy 18 (35%) in PAPP-A and β-hCG MoM 0.2-0.5 range. Maternal free β-hCG MoM was found to change parallelly to fetal NT widening in case of trisomy 18 diagnosis. Maternal β-hCG and PAPP-A MoM results presented less then 0.2 might be used independently of NT widening in fetus for trisomy 18 risk evaluation. Above 0.2 for PAPP-A and β-hCG MoMs, fetal NT measurement was an requirment.

ASSOCIATION OF HUMAN CHORIONIC GONADOTROPHIN WITH PREGNANCY INDUCED HYPERTENSION

Objective: To determine the positive predictive value of beta Human Chorionic Gonadotrophin in early secondtrimester for predicting pregnancy induced hypertension.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Obstetrics and Gynaecology Combined Military Hospital, Lahore,from Jun 2017 to Nov 2017.&#x0D; Methodology: A total of 214 female pregnant patients met the criteria for inclusion in this study. Patients withbeta human chorionic gonadotrophin (βHcg) levels ≥2 MoM were followed at 22, 26, 30 and 34 weeks of gestation. Blood pressure was monitored. Pregnancy induced hypertension (PIH) was labelled after 20 weeks (as per dating scan) of gestation in patients who did not have proteinuria (≥300 mg 24 hour urine sample) and had a systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg (blood pressure readings taken at two separate points in time four hours apart).&#x0D; Results: Patients ranged between 18-35 years of age, with the mean age being 27.3 ± 4.3 years. Mean gestational age was observed to be 15.6 ± 1.8 weeks. Mean BMI was 23.8 ± 3.2 kg/m2. Out of 214 patients, 30 patients (14%) had beta human chorionic gonadotrophin level &gt;2 MoM. Out of these 30 patients, 25 patients (83.3%) developed PIH. There were 100 primigravida (46.7%) and 114 multigravidas (53.3%). Beta human chorionic gonadotrophin in predicting pregnancy induced hypertension showed sensi-tivity of 96.1%, a specificity of 97.3%, with a PPV83.3%, a NPV 99.4% and diagnostic accuracy of 97.2%.

A dynamic approach to gynaecomastia

Introduction: Gynaecomastia is characterized by enlargement of the male breast, caused by glandular proliferation and fat deposition. Although a fairly common presentation in the primary care setting and is mostly of benign etiology, it can cause patient considerable anxiety. Sometimes it could be due to serious underlying illness or a medication or inherited. Breast cancer risk is slightly higher in males with gynaecomastia. Aim: To determine the prevalence, pathophysiology, etiology and therapy of gynaecomastia. A stepwise approach that includes imaging and laboratory testing to exclude neoplasms and endocrinopathies. Materials and Methods: A one year prospective study of twenty four gynaecomastia cases was done. A detailed clinical history taken and physical examination was done. Laboratory investigations like hepatic, renal and thyroid function tests, hormonal levels like serum estradiol, testosterone, follicular stimulating & luteinizing hormone levels, prolactin, human chorionic gonadotropin and dehydroepiandrosterone levels were done. Other investigating aids like MRI and ultrasonography, mammography, cytogenetics were useful in some of them. However, histopathology proved to be gold standard. Results: We had twenty four cases of gynaecomastia of which there were one case of Klinefelter syndrome, five cases each of idiopathic gynaecomastia, two case each of true hermaphroditism, one case each of androgen insensitivity syndrome, Ehlers danlos syndrome, cirrhosis, drug induced, renal failure, hyperthyroidism, testicular torsion, androgen insensitivity syndrome, choriocarcinoma, pituitary adenoma, adrenal neoplasm and Leydig cell tumour. Six cases were those of physiological gynaecomastia. Conclusions: Gynaecomastia is a common condition that may be attributable to an oestrogen /androgen imbalance caused by several etiological factors. After confirming the diagnosis, searching for a specific cause and classifying the case according to severity grade, the therapy

Retrospective Evaluation of Patients Treated for Ectopic Pregnancy: Experience of a Tertiary Center.

In recent years, there has been an increase in the incidence of ectopic pregnancies; therefore, it is important for tertiary centers to report their approaches and outcomes to expand and improve treatment modalities. The aim of the present study was to evaluate the general characteristics, treatment and outcomes of cases diagnosed with ectopic pregnancy. In total, 432 patients treated for ectopic pregnancy between February 2016 and June 2019 were retrospectively evaluated. Overall, 370 patients had tubal pregnancy, 32 had cesarean scar pregnancy, 18 had pregnancy of unknown location, 6 had cervical pregnancy, and 6 had interstitial pregnancy. The most important risk factors were advanced age (> 35 years; prevalence: 31.2%) and smoking (prevalence: 27.1%). Thirty patients who did not have any symptoms of rupture and whose human chorionic gonadotropin (β-hCG) levels were ≤ 200 mIU/ml were followed-up with expectant management, while 316 patients whose β-hCG levels were between 1,500 mIU/ml and 5,000 mIU/ml did not have an intrauterine gestational sac on the transvaginal or abdominal ultrasound, did not demonstrate findings of rupture, and were treated with a systemic multi-dose methotrexate treatment protocol. In total, 24 patients who did not respond to the medical treatment, 20 patients whose β-hCG levels were > 5,000 mIU/ml, 16 patients who had shown symptoms of rupture at the initial presentation, and 6 patients diagnosed with interstitial pregnancy underwent surgery. Patients with cervical and scar pregnancies underwent ultrasound-guided curettage, and no additional treatment was needed. The fertility status of the patients, the clinical and laboratory findings, and the levels of β-hCG are the factors that must be considered in planning the appropriate treatment.

Chemical Fingerprint Analysis and Ultra-Performance Liquid Chromatography Quadrupole Time-of-Flight Mass Spectrometry-Based Metabolomics Study of the Protective Effect of Buxue Yimu Granule in Medical-Induced Incomplete Abortion Rats.

Medical abortion is a common method to terminate an early pregnancy and often causes serious complications such as abnormal uterine bleeding and endometritis. Buxue Yimu granule (BYG) is a well-known traditional Chinese medicine prescription composed of five kinds of drugs and is widely used in gynecology and obstetrics. The aim of the present study was to establish the quality standard of BYG and investigate its protective effect on incomplete abortion. The chemical fingerprint of BYG was established by high performance liquid chromatography (HPLC). The major compounds of BYG were determined by ultra-performance liquid chromatography with triple quadrupole mass spectrometry. An incomplete abortion rat model was induced by intragastric administration of mifepristone (8.3 mg·kg−1) combined with misoprostol (100.0 μg·kg−1) during early pregnancy. The serum levels of human chorionic gonadotrophin (HCG), estradiol (E2), and progesterone (PG) were determined. The serum endogenous metabolites were analyzed by ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF/MS). Multivariate analysis, including partial least squares discriminant analysis (PLS-DA) and orthogonal partial least squares discriminant analysis (OPLS-DA), was employed to analyze the metabolic profiles, and MetaboAnalyst was used to investigate the metabolic pathways. Furthermore, hematoxylin-eosin staining (HE) was used to evaluate the histopathological changes in uterine tissue. The expression levels of VEGFA and NF-κB were detected by immunohistochemistry. The results indicated that HPLC fingerprint analysis can be successfully used to assess the quality of BYG. The medical-induced incomplete abortion rats were clearly separated from control rats, and the biochemical changes were gradually restored to normal after administration of BYG. Moreover, 19 potential biomarkers, including N-lactoylleucine, 2-piperidinone, isobutyryl-l-carnitine, eicosapentaenoylcholine, LysoPC(14:0), LysoPC(20:5), physagulin C, LysoPC(18:3), leukotriene D5, deoxycholic acid 3-glucuronide, glycine, pregnanediol 3-O-glucuronide, LysoPC(18:2), LysoPC(17:0/0:0), N-acetyl-leukotriene E4, LysoPC(18:0), platelet-activating factor, LysoPA(24:1), and LysoPC(18:1), which were mainly related to the amino acids metabolism, lipids metabolism, and bile acid biosynthesis, were identified. Consequently, BYG exerts a potential protective role in the intervention of incomplete abortion by anti-inflammatory, promote endometrial repair, and regulate the metabolic disorders.

Management and prognostic analysis of patients with gestational trophoblastic neoplasia (GTN) in FIGO stage IV and its special type

GTN is a group malignant diseases from placental trophoblastic cells. There are very few cases of GTN with FIGO (International Federation of Gynecology and Obstetrics) stage IV all over the world, and the special types (patients with metastatic lesions and with no evidence of GTN neither in genitalia nor in lungs) have rarely been reported. It is necessary to conduct large retrospective studies aimed at exploring the diagnosis, treatment and outcomes of this disease. In this retrospective study, 716 patients with GTN were treated at Zhejiang University School of Medicine Women’s Hospital between January 1999 and September 2019; 26 patients were diagnosed as stage IV GTN; Among the 26 stage IV GTN patients, 5 were defined as the special types. The 5-year OS rate of the total 26 FIGO stage IV GTN patients was 69.0%. There was no significant difference of survival rate between stage IV GTN and its special type. And no significant differences in blood type, antecedent pregnancy type, the interval from last known pregnancy, pretreatment serum HCG (human chorionic gonadotropin) level, maximum diameter of tumors, FIGO score, underwent surgery or not and pathological pattern by the outcomes. Age, number of tumor lesions, primary chemotherapy regimen was EMA-CO or EP-EMA protocol and chemoresponse affected the prognosis significantly. Only number of tumor lesions > 8 was independent prognostic factors associated with poorer OS.

Abstract 16738: Association Between First and Second Trimester Maternal Screening Biochemistry, Ultrasound, and Fetal Brain Growth in Presence of Fetal or Maternal Congenital Heart Disease

Introduction: Newer research has highlighted significant neurological impairments in children and adults with congenital heart disease (CHD). The more severe the heart defect, the higher the neurologic impairment. Pregnancies complicated by fetal or maternal CHD carry a higher risk of placental abnormalities. We studied the association between pregnancy hormonal levels and fetal head and body growth. Hypothesis: Placental dysfunction in pregnancies with fetal or maternal CHD alters pregnancy hormonal levels affecting fetal brain and somatic growth. Methods: We performed a retrospective case-control study on pregnant women (year 2010-2019) at the University of Iowa. Only women with first and/or second trimester prenatal screening (ultrasound and blood test) were included. Pregnancies with fetal chromosomal abnormalities, multiple gestation, maternal diabetes, smoking, or hypertension were excluded. Pregnancies were either healthy controls (n=36), women with CHD (MCHD; n=26), or fetus with CHD (FCHD; n=23). Pregnancy hormonal levels, ultrasound findings, and fetal/neonatal growth percentiles and/or z-scores data were analyzed. Results: Women with CHD were younger (p=0.004) with increased fetal nuchal translucency (p=0.003) compared to controls. Women in MCHD (p=0.02) and FCHD (p=0.02) group delivered earlier than controls. FCHD had significantly lower pregnancy associated plasma protein-A (PAPP-A) levels than controls (p=0.04). The groups had no difference in the second trimester fetal head circumference (HC) and femur length. FCHD group had significantly smaller HC percentile (p=0.03) and z-scores (p=0.03) at birth than controls. Both FCHD and MCHD had smaller birth weight and length compared to controls. However, only FCHD group demonstrated significantly lower HC to birth weight ratio (p=0.01). The controls had a positive correlation between human chorionic gonadotropin level and head circumference z-score at birth (r=0.34;p=0.053). Conclusions: Pregnant women with CHD have increased fetal nuchal translucency and deliver at earlier gestational age. Women with fetal CHD have smaller neonatal head and body size at birth with associated low PAPP-A level early in their pregnancy probably related to placental dysfunction.