Normal Intrauterine Pregnancy Research Articles

Number of embryos transferred could possibly be associated with angular pregnancy in invitro fertilization-embryo transfer.

The probability of embryo implantation in an abnormal location is significantly higher in assisted reproductive technology (ART) than in natural pregnancies. Angular pregnancy is an eccentric intrauterine pregnancy with embryo implantation in the lateral superior angle of the uterine cavity. Cycle-level factors associated with angular pregnancy in patients conceived with ART needed to be explored. A total of 11 336 clinical pregnancies cycles were included. Angular pregnancy rate was compared among groups according to the type of embryos transferred. Among them, 53 cases of angular pregnancy and 159 cases of normal intrauterine pregnancy were screened out using propensity score matching. Risk factors of angular pregnancy were explored. The angular pregnancy rate was 0.31% (14/4572) in the day 5 blastocyst transfer group, 0.58% (39/6764) in non-day 5 embryo transfer group, with 0.55% (29/5280) in day 3 embryo transfer and 0.67% (10/1484) in the day 6 blastocyst group, respectively. A multifactor regression analysis was performed and indicated that the number of embryos transferred was significantly associated with angular pregnancy (P = 0.031, OR, 2.23, 95% CI: 1.09-4.68). Multiple embryo transfer could possibly be associated with an increased incidence of angular pregnancy in patients conceived with ART.

Role of creatine phosphokinase as a diagnostic marker in tubal ectopic pregnancy.

Ectopic pregnancy (EP) is still one of the leading preventable causes of maternal morbidity and mortality in the first trimester. Amidst the use of sensitive assays for β-HCG and high-definition ultrasonography for the identification of EP, the search for a more reliable and sensitive marker remains a challenge till date. Our aim was to determine the validity of creatine phosphokinase (CPK) and its isoenzyme (CPK-MB) in the prediction of tubal EP. A prospective and comparative diagnostic accuracy study was conducted among 105 pregnant women in the first trimester who met the eligibility criteria in the Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS). The study included 35 patients each with tubal EP (EP), abortive intrauterine pregnancy (AP), and normal intrauterine pregnancy (NP). CPK, CPK-MB, and β-HCG were measured among all the participants, and the participants were followed up longitudinally. A total of 105 pregnant women were included. The mean CPK and CPK-MB levels were significantly higher among the women with EP when compared to NP (P < 0.05) and AP (P < 0.05) women; however, there was no significant difference between the NP and AP groups (P > 0.05). Moreover, the receiver operating characteristic (ROC) curve showed that both CPK and CPK-MB were good predictors of EP, with CPK (area under the curve [AUC] = 0.764) being a better predictor than CPK-MB (AUC: 0.650) in the diagnosis of EP. Early diagnosis of EP allows appropriate and timely management, which would not only reduce mortality and morbidity associated with the condition but also enable preservation of fertility and improve future pregnancy outcome. Hence, the need of the hour is a reliable biochemical diagnostic marker for EP, such as CPK.

Identification and verification of plasma protein biomarkers that accurately identify an ectopic pregnancy

BackgroundDifferentiating between a normal intrauterine pregnancy (IUP) and abnormal conditions including early pregnancy loss (EPL) or ectopic pregnancy (EP) is a major clinical challenge in early pregnancy. Currently, serial β-human chorionic gonadotropin (β-hCG) and progesterone are the most commonly used plasma biomarkers for evaluating pregnancy prognosis when ultrasound is inconclusive. However, neither biomarker can predict an EP with sufficient and reproducible accuracy. Hence, identification of new plasma biomarkers that can accurately diagnose EP would have great clinical value.MethodsPlasma was collected from a discovery cohort of 48 consenting women having an IUP, EPL, or EP. Samples were analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) followed by a label-free proteomics analysis to identify significant changes between pregnancy outcomes. A panel of 14 candidate biomarkers were then verified in an independent cohort of 74 women using absolute quantitation by targeted parallel reaction monitoring mass spectrometry (PRM-MS) which provided the capacity to distinguish between closely related protein isoforms. Logistic regression and Lasso feature selection were used to evaluate the performance of individual biomarkers and panels of multiple biomarkers to predict EP.ResultsA total of 1391 proteins were identified in an unbiased plasma proteome discovery. A number of significant changes (FDR ≤ 5%) were identified when comparing EP vs. non-EP (IUP + EPL). Next, 14 candidate biomarkers (ADAM12, CGA, CGB, ISM2, NOTUM, PAEP, PAPPA, PSG1, PSG2, PSG3, PSG9, PSG11, PSG6/9, and PSG8/1) were verified as being significantly different between EP and non-EP in an independent cohort (FDR ≤ 5%). Using logistic regression models, a risk score for EP was calculated for each subject, and four multiple biomarker logistic models were identified that performed similarly and had higher AUCs than models with single predictors.ConclusionsOverall, four multivariable logistic models were identified that had significantly better prediction of having EP than those logistic models with single biomarkers. Model 4 (NOTUM, PAEP, PAPPA, ADAM12) had the highest AUC (0.987) and accuracy (96%). However, because the models are statistically similar, all markers in the four models and other highly correlated markers should be considered in further validation studies.

The association between the prevalence of HIV infection and ectopic pregnancy.

Women infected with the human immunodeficient virus have a higher risk of pelvic inflammatory disease, which could lead to development of ectopic pregnancy due to fallopian tubal pathology. Due to short pregnancy period, women with ectopic pregnancy unlikely complete the antenatal screening, which includes HIV tests. Therefore, it is postulated that unscreened HIV infection prevalence in women with ectopic pregnancy diagnosis could be significantly higher than in women with normal intrauterine pregnancy (IUP). The aim of the present retrospective cross-sectional study was to determine the association between ectopic pregnancy and HIV infection in KwaZulu Natal Province hospital setting, between 2016 and 2017. 5427 pregnant women with normal pregnancies formed the intrauterine pregnancy (IUP) cohort, while 83 patients were part of the ectopic pregnancy cohort. The statistical HIV prevalence was significantly higher in the ectopic pregnancy cohort (56.63% vs 39.4%, P-value of 0.001). In addition, HIV prevalence in the ectopic pregnancy cohort was analyzed per age group, and it was found to be higher in the 25-34 years age group (88.3%) than the 16-24 (43.3%) and 35-42 (60%) years age groups. This study highlights the significance of conducting a full antenatal screening programme in patients who present with ectopic pregnancy, to improve the rate of HIV infection testing and treatment in women who present with ectopic pregnancy.

Ruptured interstitial pregnancy: a case report of a sudden maternal death in the late second trimester from a rare cause

Introduction: Interstitial pregnancy is a rare type of tubal ectopic pregnancy that occurs when implantation takes place in the interstitial segment of the fallopian tube. It remains one of the most difficult gestations to diagnose clinically and sonographically, hence a higher risk of rupture and catastrophic haemorrhage because of delayed diagnosis as the gestation progresses. We report a case of sudden maternal death from a ruptured interstitial pregnancy involving a woman at 27 weeks of pregnancy who was mistakenly thought to have a normal intrauterine pregnancy antenatally. Case description: A 40-year-old woman, normally conceived gravida 7, para 4, abortus 2 at 25 weeks of pregnancy by date, was dead on arrival at the hospital after experiencing sudden abdominal pain. A forensic autopsy revealed more than 2100 ml of hemoperitoneum. The uterine cavity was empty, and the right uterine fundus had an asymmetric cystic bulge found to be a ruptured interstitial pregnancy with a 27-week-old male fetus. Discussion and conclusion: The pathology of interstitial pregnancy and the distinction between this entity and the similar but distinct angular and cornual pregnancies will be described. This case report highlights a type of ectopic pregnancy rarely encountered in forensic pathology practice.

Ectopic Molar Pregnancy with Coexistent Normal Intrauterine Pregnancy: A Report of an Unusual Diagnosis managed in Yaound&amp;#233; Gyneco-Obstetric and Pediatric Hospital, Cameroon

Ectopic Molar Pregnancy with Coexistent Normal Intrauterine Pregnancy: A Report of an Unusual Diagnosis managed in Yaound&amp;#233; Gyneco-Obstetric and Pediatric Hospital, Cameroon

Exophytic interstitial ectopic pregnancy removal: novel use of Endoloop for uterine cavity preservation

Exophytic interstitial ectopic pregnancy removal: novel use of Endoloop for uterine cavity preservation

The usefulness of angiopoietin-1 as biomarker in missed abortion

Objective: To detect serum angiopoietin -1 level as effective biomarker for missed abortion in early pregnancy.&#x0D; Methods: The study included 100 pregnant women; 50 pregnant women with missed abortion (group A) and 50 pregnant women with viable intrauterine pregnancy in first trimester (group B). Both groups were test for serum level of angiopoietin -1 using Enzyme linked immunosorbent assay technique.&#x0D; Results: The mean serum angiopoietin -1 level is significantly decrease in missed abortion compare with control group women (771.12 ± 165 VS 1381.12 ± 340.36) respectively at P value (0.001). There was correlation between missed abortion and (body mass index, reproductive history) in groups of study.&#x0D; Conclusion: The current study showed that serum levels of angiopoitin-1 are significantly decrease in pregnant women with missed abortion compared with its level in normal viable intrauterine pregnancy of matched gestation.

Comparison of Transvaginal Sonographic Doppler Indices Between Normal Intrauterine and Extrauterine Pregnancies Confirmed by Maternal Serum Beta-HCG in the First Trimester of Pregnancy

Background: Transvaginal Sonography provides high-resolution images with high reliability and is typically used for the diagnosis of intrauterine pregnancy and ectopic conception. The extra-uterine pregnancy responsible for morbidity and mortality in First Trimester and is 80 percent accounts for maternal death. Doppler ultrasound is a safe and non-invasive technique in the evaluation of uterine artery flow patterns. It can calculate the indices like Resistivity index and Pulsatility index in numerical value. It is also observed that there are changes noted between the uterine artery indices in normal intrauterine and extrauterine pregnancies. However, it is important to compare them in normal intrauterine and extrauterine pregnancies. Objective: To compare the trans-vaginal sonographic Doppler indices of the uterine artery between normal and ectopic pregnancies confirmed by maternal serum Beta-hCG. Methodology: This case-control study was conducted at Shireen Ultrasound Clinic Peshawar, KPK Pakistan. This study enrolled a purposive sample of 80 (40 ectopic &amp; 40 intrauterine) pregnant female patients with age 18 to 45 years. The examination was performed with Toshiba Nemio 20(Xario Prime with TVS Probe frequency range 7-14MHz). The Resistive index, Pulsatility index, mean and standard deviation were calculated for the continuous variables. Results: In normal early pregnancy, the mean RI of the right uterine artery was 0.53±0.10 and the mean RI of the left uterine artery was 0.52±0.07. In the cases of (ectopic pregnancy), the mean RI of the right uterine artery was 0.73±0.08 and the mean RI of the left uterine artery was 0.78±0.10. The p-value of the right and left uterine arteries in normal intrauterine and extrauterine ectopic pregnancies were significant at 0.05 level. Conclusion: The resistivity index of uterine arteries is significantly high in ectopic conceptions than in normal intrauterine pregnancies. But there was no significant change in PI of normal intrauterine and ectopic pregnancies. Keywords: adnexal mass, ectopic pregnancy, Transvaginal ultrasound, tubal pregnancy.

Predicting the Outcome of a Pregnancy of Unknown Location: What Can the Endometrial Stripe Thickness Reveal?

Objective: To investigate the role of the uterine endometrial thickness and sonographic pattern as potential predictors for a pregnancy with an unknown location (PUL) and its possible outcomes. Materials and Methods: A convenient sample of 330 symptomatic extra preposition female patients were enrolled in this study with a diagnosis of PUL. The clinical variables of endometrial stripe thickness and endometrial sonographic pattern were determined with transvaginal sonography. These sonographic examinations (it seems that examination in this context is a countable noun) were conducted during the first 24 hours of referral, and their predictive values for PUL outcomes (normal intrauterine pregnancy (IUP), ectopic pregnancy (EP), and pregnancy loss) were assessed after clinical follow-up sessions provided a definite outcome. The statistical significance was set a priori at a P value &lt; .05. Results: The mean initial endometrial stripe thickness among participants, with a normal IUP, was more than those patients with an abnormal pregnancy outcome ( P &lt; .05). The optimum cut-off value for predicting a an EP, compared to a normal IUP was 11 mm and had a sensitivity of 73.3% and specificity of 39% ( P &lt; .001). These results also demonstrated no statistically significant relationship between the PUL outcome and the categories of endometrial sonographic pattern ( P = .15). Conclusion: In this large cohort of patients, the endometrial stripe thickness of more than 11 mm, among those who were symptomatic and deemed as PUL, had the potential to predict ectopic pregnancy as an unlikely diagnosis.

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.

Proteome-defined changes in cellular pathways for decidua and trophoblast tissues associated with location and viability of early-stage pregnancy

BackgroundIn early pregnancy, differentiating between a normal intrauterine pregnancy (IUP) and abnormal gestations including early pregnancy loss (EPL) or ectopic pregnancy (EP) is a major clinical challenge when ultrasound is not yet diagnostic. Clinical treatments for these outcomes are drastically different making early, accurate diagnosis imperative. Hence, a greater understanding of the biological mechanisms involved in these early pregnancy complications could lead to new molecular diagnostics.MethodsTrophoblast and endometrial tissue was collected from consenting women having an IUP (n = 4), EPL (n = 4), or EP (n = 2). Samples were analyzed by LC–MS/MS followed by a label-free proteomics analysis in an exploratory study. For each tissue type, pairwise comparisons of different pregnancy outcomes (EPL vs. IUP and EP vs. IUP) were performed, and protein changes having a fold change ≥ 3 and a Student’s t-test p-value ≤ 0.05 were defined as significant. Pathway and network classification tools were used to group significantly changing proteins based on their functional similarities.ResultsA total of 4792 and 4757 proteins were identified in decidua and trophoblast proteomes. For decidua, 125 protein levels (2.6% of the proteome) were significantly different between EP and IUP, whereas EPL and IUP decidua were more similar with only 68 (1.4%) differences. For trophoblasts, there were 66 (1.4%) differences between EPL and IUP. However, the largest group of 344 differences (7.2%) was observed between EP and IUP trophoblasts. In both tissues, proteins associated with ECM remodeling, cell adhesion and metabolic pathways showed decreases in EP specimens compared with IUP and EPL. In trophoblasts, EP showed elevation of inflammatory and immune response pathways.ConclusionsOverall, differences between an EP and IUP are greater than the changes observed when comparing ongoing IUP and nonviable intrauterine pregnancies (EPL) in both decidua and trophoblast proteomes. Furthermore, differences between EP and IUP were much higher in the trophoblast than in the decidua. This observation is true for the total number of protein changes as well as the extent of changes in upstream regulators and related pathways. This suggests that biomarkers and mechanisms of trophoblast function may be the best predictors of early pregnancy location and viability.

Maternal Serum Creatine Kinase and Single Serum Progesterone Measurement as Predictors of Ectopic Pregnancy

Objective: To evaluate the role of serum creatine kinase (CK) and progesterone (p) in the prediction of ectopic pregnancy (E.P). Patients and methods: A prospective study was carried out on 60 pregnant women of comparable gestational age and they were divided into 3 groups: Group A: 20 patients with confirmed E.P. Group B: 20 patients with missed or spontaneous miscarriage. Group C: 20 women with normal intrauterine pregnancy (IUP). The following laboratory measurements were performed for the studied groups: 1- Test for serum CK level for all groups. 2- Test for serum progesterone for all groups. 3- Histopathological study to determine the depth of invasion of the trophoblast to the muscular layer of fallopian tube for group A. Results: 1- The serum CK level was significantly higher in group A than in group B and C and was significantly higher in ruptured than in unruptured and in isthmic compared to ampullary EP. 2- The serum progesterone level was significantly lower in group A and B than in group C, but there was no significant difference between group A and B. 3- The serum progesterone level was significantly higher in ruptured than in unruptured EP. 4- There was significant positive correlation between serum CK and progesterone level in group A. Conclusion: 1- An increase in serum CK levels probably antedates tubal rupture and could help in discriminating ruptured from unruptured EP. 2- Serum progesterone discriminates EP from normal IUP but it does not differentiate it from miscarriage. 3- The combination of both serum CK and progesterone in suspected EP has a higher differential accuracy than either analysis alone

Association between serum chlamydial antibody levels and tubal infertility in tertiary health facility in South-East Nigeria: a case-control study.

This study evaluates the association between genital Chlamydial infection and tubal factor infertility in a tertiary health facility in South-East Nigeria. This was a case-control analytical study. Gynaecology Clinic and Maternity Unit of the Department of Obstetrics and Gynaecology of the Federal Medical Centre (FMC), Owerri, Imo State, Nigeria. Ninety-six (96) women with confirmed tubal factor infertility served as the cases, and 96 women with normal intra-uterine pregnancy matched in age served as the control. A structured questionnaire was used to extract information on the sociodemographic data and the sexual history of the participants. About 2mls of blood was collected, the blood was allowed to clot, and the sera were used for the test. Pearson Chi-square, Fisher's exact test, likelihood ratio and multivariate logistic regression were used to determine risk associations and identify factors independently related to tubal factor infertility. P-value < 0.05 was considered significant. The sociodemographic characteristics of both cases and control did not differ (P = 0.975). The Chlamydial antibody seropositivity was significantly higher in the cases than the control 78(81.2%) versus 13(13.5%) respectively {(P < 0.001; OR (95% CI) = 27.7(12.7-60.2)}. Only lower abdominal pain {(P = 0.011); OR (95% CI) = 4.3(1.4-13.3)}; was independently associated with tubal factor infertility. Tubal factor infertility is strongly associated with chlamydial IgG antibodies, and a history of lower abdominal pain significantly predicted tubal factor infertility. The authors paid the cost of procuring the anti-chlamydial ELIZA test kits, plain sample bottles, syringes, gloves and other consumables and stationaries.

Diagnostic Evaluation of Uterine Artery Doppler Imaging for the Prediction of Early Abnormal Pregnancy

Objective: to assess the predictive value of Doppler imaging of the uterine artery in the identification of early intrauterine abnormal pregnancy as compared to a normal intrauterine pregnancy.&#x0D; Subjects and methods: one hundred and twenty pregnant ladies, at their 6-12 weeks of gestation, with a singleton pregnancy were included in this population-based case-control study. Thirty women with a missed miscarriage, 30 with hydatidiform mole, 30 with a blighted ovum, and 30 as a control group, without risk factors, underwent Doppler interrogation of the uterine arteries. Resistive index (RI), pulsatility index (PI), and the systolic/diastolic ratio (S/D) were measured for both sides. The t-test, or ANOVA test when appropriate, was used to analyze the relationship between the variables.&#x0D; Results: there was a significant reduction of RI mean, PI mean, and S/D ratio among women with different types of abnormal pregnancy compared with the control group. RI and PI mean levels were significantly lower in women with hydatidiform mole and significantly higher in women with missed miscarriage. Lower left S/D mean level was significantly associated with hydatidiform mole and upper left S/D level was associated significantly with control women. For prediction of missed miscarriage; right and left uterine artery RI shows a sensitivity of 80%, 73.3%, a specificity of 68%, 71.1%, and the highest AUC was 0.78 for both.For prediction of molar pregnancy, right and left uterine artery RI showed a sensitivity of 63% for both, a specificity of 54.4%, 60%, and the highest AUC was 0.58, 0.61 respectively.&#x0D; Conclusions: Uterine artery Doppler ultrasonography at 6-12 weeks of gestation is predictive for early pregnancy complications such as missed abortion, hydatidiform mole, and blighted ovum.

The review on the smallholder farmers’ food security and conflict in Ethiopia

Ultrasonography is a safe and effective method of diagnosing early pregnancy and determining the position of the gravid uterus. In our study, 2080 pregnant women with amenorrhea for three months and a positive pregnancy test were chosen. The study was conducted in the Radiology &amp; Imaging department of Failaria &amp; General Hospital from Jan 2016 to Dec 2019. The objective of our study is to investigate the Sonographic findings of first trimester pregnancies detecting the retroverted gravid uterus, normal, abnormal and complicated pregnancies. In the present study out of 2080 pregnancies, we found uterus retroverted in about 7% of women and only one case of acute retention of urine due to retroverted gravid uterus. Here, the majority of pregnant women were 20-24 years of age, which is 980 (47.12%) and 150 (7.21%) women pregnant at the age of over 35 years. In our study, 190 (9.13%) of the 2080 pregnancies with sonographic diagnosis were fetal losses. The diagnosis of early normal intrauterine pregnancy (IUP) was 1890 (90.87%), Incomplete abortion 95 (4.57%), Missed abortion 35 (1.68%), Blighted ovum 39 (1.88%), ectopic pregnancy 14 (0.67%) and Hydatiform mole 7 (0.34%) cases.

Ltrasonographic assessment of retroverted gravid uterus and first trimester pregnancy loss of women in a semi urban area of Dhaka, Bangladesh

Ultrasonography is a safe and effective method of diagnosing early pregnancy and determining the position of the gravid uterus. 2080 pregnant women with amenorrhea for three months and a positive pregnancy test were chosen. The study was conducted in the Radiology &amp; Imaging department of Failaria &amp; General Hospital from Jan 2016 to Dec 2019. Results were presented in tables and charts and expressed as percentages and average. The objective of our study is to investigate the Sonographic findings of first trimester pregnancies detecting the retroverted gravid uterus, normal, abnormal and complicated pregnancies. In the present study out of 2080 pregnancies. In our study, 190 (9.13%) of the 2080 pregnancies with sonographic diagnosis were fetal losses. The diagnosis of early normal intrauterine pregnancy (IUP) was 1890 (90.87%), Incomplete abortion 95 (4.57%), Missed abortion 35 (1.68%), Blighted ovum 39 (1.88%), ectopic pregnancy 14 (0.67%) and Hydatiform mole 7 (0.34%) cases.

Ektopik gebelik ve düşük tehdidi tanısında hemogram parametrelerinin değerlendirilmesi

Purpose: The aim of this study is to compare hemogram parameters of patients with the threat of ectopic pregnancy and abortion with those of patients with normal intrauterine pregnancy, and to investigate the utility of these parameters in the diagnosis of ectopic pregnancy and distinction of threatened abortion. Materials and Methods: This study was planned as a retrospective study including patients diagnosed with ectopic pregrancy who were treated medically or surgically (n: 50), patients diagnosed with normal intrauterine pregnancy (n: 50), and patients hospitalized with the diagnosis of threatened abortion (n:50). Preoperative and during hospitalization hemogram blood parameters of all patients were obtained from their files. Sociodemographic data, complete blood count data were recorded and neutrophyl lymphocyte ratio (NLR) platelet lymphocyte ratio (PLR) and lymphocyte monocyte ratio (LMR) were calculated. Results: In threatened abortion and ectopic pregnancies, lymphocyte count was found much higher than that of control group. PDW was significantly lower in ectopic pregnancies compared to control group. Monocyte values were significantly higher in threatened abortion group compared to control group. PLR was significantly lower in threatened abortion group compared to control group. Conclusion: Low PDW values are accused of disrupting pregnancy implantation by changing microenvironment in ectopic pregnancy. Since PDW values were found low in ectopic pregnancy group in our study, it may be useful to use this parameter in early diagnosis.

Abnormal rate of human chorionic gonadotropin rise: a case series of patients with viable intrauterine pregnancies after embryo transfer

ObjectiveTo report three cases of viable intrauterine pregnancies after embryo transfer with lower quantitative human chorionic gonadotropin (hCG) rates of rise than that expected in 99% of normal intrauterine pregnancies, based on current guidelines.DesignCase series.SettingTertiary care center.Patient(s)Three patients underwent in vitro fertilization for ovulatory dysfunction or male factor infertility and had successful live births after an unusually low rate of hCG rise following embryo transfer.Intervention(s)In vitro fertilization was utilized for all three patients.Main Outcome Measure(s)Serial hCG levels.Result(s)Three cases of abnormally rising hCG levels were described. All cases presented achieved pregnancy through assisted reproductive technologies. The lowest documented rate of rise for each case, over 48 hours, was 22.1%, 23.3%, and 26.9%. All three cases resulted in live births. Literature on this topic was reviewed.Conclusion(s)Based on the cases presented, we recommend conservative management for patients found to have abnormally low rise hCG levels after embryo transfer; a high clinical suspicion for ectopic pregnancy should be maintained.

About large cell growths on the peritoneum and ovaries during pregnancy

Some authors described nodular small thickenings and enlargements of the pelvic peritoneum during ectopic pregnancy, which were considered especially characteristic of peritoneal pregnancy. Schmorl, who thoroughly studied the peritoneum of the pelvic floor in a number of cases of normal intrauterine pregnancy, soon came to the conviction that these growths are all too often found in the latter and therefore do not constitute anything characteristic of an ectopic pregnancy.