Serum β-hCG Research Articles

A Rare Case Report of Molar Pregnancy with Coexisting Fetus

Abstract Aim: Here we report a molar pregnancy with a coexisting fetus progressing to a viable, healthy infant which is an extreme rarity, with the incidence of 0.005–0.01% of all the pregnancies. Background: Partial mole is defined as excessive trophoblastic proliferation with normal and hydropic villi and presence of a fetus or a fetal circulation with nucleated cells. Partial molar pregnancy with a singleton live fetes is a rare condition. it is commonly seen with twin gestation and it is rare with singleton pregnancy Case report: A 30 years old primigravida, referred from a private hospital at 38 weeks of gestation delivered a phenotypically normal and healthy infant 2200 gm in weight by caesarean section. The placenta weighed 500 gms and on sectioning revealed widespread, grape-like vesicles. Light microscopy revealed normal villi coexisting with villi showing hydropic change and cistern formation and diffuse circumferential trophoblastic hyperplasia consistent with molar change. A diagnosis of partial molar pregnancy with normal fetus was made. Conclusion: Very few twin pregnancies with a hydatidiform mole and a foetus continue to term as they often have spontaneous or induced terminations for maternal complications Management of molar changes associated with normal appearing fetus still remains challenging as not many studies have been done due to rarity of this disorder. Clinical significance: Though the general trend is to terminate pregnancy in foetus with coexistent mole in anticipation of complications, under close surveillance, optimal outcomes can be achieved. Monitoring of serum β-hCG, serial ultrasound for fetal growth, size of molar component, and theca lutein cysts can help to predict good patient outcomes.

Use of Basal Serum Testosterone Level as Predictor for Poor Ovarian Response in Women with Unexplained Infertility Undergoing <i>In Vitro</i> Fertilization Cycle: Prospective Study

Background: Delayed pregnancy in women and marked increase in the numbers of older women who fail to respond to ovarian stimulation had been a significant issue. This study aims to assess the value of basal serum testosterone level as a predictor of ovarian response for induction of ovulation in women with unexplained infertility undergoing IVF (in vitro fertilization) cycle. Patients and Methods: A prospective study was conducted in Ain Shams University Maternity hospital Infertility Center during a period of time from October 2016 to June 2017. This study recruited 89 women. On day 2 or 3 of a spontaneous menstrual cycle of the included women within 3 months before fresh IVF cycle, basal hormonal (FSH, LH, estradiol, total testosterone) concentrations, AFC (antral follicle count) were performed. Using the Long-protocol for induction of ovulation, serial monitoring of ovarian response was assessed by transvaginal ultrasound. When the expected ovarian response was reached (at least three oocytes ≥ 17 mm), we gave trigger dose of HCG. Ultrasound guided oocyte aspiration was performed 34 - 36 hours later. Two to three days after oocyte aspiration, we transferred the embryos according to the patient’s age and the condition of embryos available. Biochemical pregnancy was considered if serum B-hCG test was positive at day 14 from embryo transfer, where all the data were correlated with serum testosterone level and ovarian response as 1 ry outcome. Results: There were significant positive correlations between testosterone and LH, Prolactin, AFC, Number of oocytes & Number of Embryos (0.014, 0.032, 0.023, 0.004, 0.033, p 0.001 respectively). Poor responders versus good responders as regards testosterone level (0.81 ± 0.47 versus 1.08 ± 0.45) Fertilized & pregnant cases had significantly higher testosterone than non-fertilized & non pregnant had (1.20 ± 0.45, 0.92 ± 0.47 p value 0.035, 0.021 respectively). Yet, testosterone had significant low diagnostic performance in prediction of poor response and pregnancy (AUC 0.654, 0.676 respectively), (p value 0.015, 0.022 respectively). Conclusion: Basal T levels are helpful for predicting ovarian response, hence the dosage of gonadotropins used in induction. But it can’t be used as single marker for prediction of ovarian response.

Effect of Combination Therapy of Methotrexate with Vitamin A in Patients with Low Risk GTN (Gestational Trophoblastic Neoplasia).

Methotrexate as a single agent chemotherapy in most women with low risk gestational trophoblastic neoplasia (GTN) has been associated with high treatment rate. Combination of methotrexate with Vitamin A due to reduced number of chemotherapy regime courses is one of the treatment options for patients with low-risk GTN. Therefore, this study was performed with aim to determine the efficacy of combination therapy of Methotrexate with Vitamin A in low risk GTN treatment. This randomized clinical trial was performed on 49 patients with low risk gestational trophoblastic neoplasia. The treatment group (Group A = 19 cases) weekly received Methotrexate 50 mg/m2, and Vitamin A 200000 IU, intra-muscular, and the control group (Group B = 30 cases) only received Methotrexate 50 mg/m2 weekly. All patients were followed up for 8 weeks. Then, treatment outcomes were compared between two groups, and response to therapy was assessed in two groups by evaluation of HCG serum level. P < 0.05 was considered significant.Mean of B-HCG serum level after 4 weeks in Group A and Group B was 68.5 mIu/mL and 360 mIu/mL, respectively (P = 0.018), and after 8 weeks was 1 mIu/mL and 12 mIu/mL, respectively (P = 0.074). Combination therapy of Methotrexate and Vitamin A in low risk GTN is associated with shorter duration of chemotherapy.

Predicting success of methotrexate treatment by pretreatment HCG level and 24-hour HCG increment.

To evaluate β-human chorionic gonadotropin (β-HCG) level and its 24-hour increment as predictors of successful methotrexate treatment for ectopic pregnancy. Data were retrospectively reviewed from women with ectopic pregnancy who were treated by single-dose methotrexate (50mg/m2 ) at a university hospital in Jerusalem, Israel, between January 1, 2000, and June 30, 2015. Serum β-HCG before treatment and its percentage increment in the 24hours before treatment were compared between treatment success and failure groups. Sixty-nine women were included in the study. Single-dose methotrexate treatment was successful for 44 (63.8%) women. Both mean β-HCG level and its 24-hour increment were lower for women with successful treatment than for those with failed treatment (respectively, 1224IU\L vs 2362IU\L, P=0.018; and 13.5% vs 29.6%, P=0.009). Receiver operator characteristic curve analysis yielded cutoff values of 1600IU\L and 14% increment with a positive predictive value of 75% and 82%, respectively, for treatment success. β-HCG level and its 24-hour increment were independent predictors of treatment outcome by logistic regression (both P<0.01). A β-HCG increment of less than 14% in the 24hours before single-dose methotrexate and serum β-HCG of less than 1600IU\L were found to be good predictors of treatment success.

Twisted "appendix epiploica" as extraordinary cause of discomfort at the right lower abdomen and rare differential diagnosis of acute appendicitis - a representative case

Introduction Appendicitis can be considered the most frequent cause of discomfort at the right lower abdomen. Simultaneously, it is the most frequent indication for a surgical intervention. In addition, there is a broad spectrum of differential diagnoses, which can lead to a very challenging finding-specific management in good time as found out in the presented case. Case description A 44-year old female patient was transfered to the surgical department because of discomfort of the right lower abdomen with changing intensity which had persisted since the day before. Patient showed a reduced but stable clinical status (normosomic nutritional status; no relevant accompanying diseases). Previous oral nutrition was normal. Clinical examination revealed pain by palpation at the right lower abdomen. Laboratory parameters: White blood cell count, 8.2Gpt/L; CrP, 10.4mg/L; urine with no pathological finding; no increased serum β-HCG level. Transabdominal ultrasound as orienting initial imaging detected free fluid around the cecum and along the right iliac vessels (appendiceal diameter, approximately 6.5mm) – in summary, no sign of appendicitis with certainty. Because of a persisting symptomatology, indication for a surgical intervention was derived (intraoperatively, laparoscopic appendectomy and partial resection of the greater omentum). Postoperative course was uneventful (no general/specific complications, wound healing was properly, initiation of oral nutrition and mobilization were well tolerated). Pathohistological investigation revealed lipofibromatosis of the appendage of the cecum with attached necrotic fat tissue and hemostasis, which can be associated with the diagnosis of a twisted appendix epiploica (no hint for malignant tumor growth). Results and Conclusions The finding as presented occurs very rarely (approximately, 0.2%), which was initially misinterpreted as appendicitis with regard to symptomatology, ultrasound and laboratory findings. A definite diagnosis became only possible during the postoperative course by pathohistological investigation (suspicion already raised by intraoperative inspection aspects). Taking the final diagnosis into account, the question of a necessary indication for surgical intervention can be brought up, which can not be circumvented in case of unclear findings and medical history according to the surgical policy (“case of doubt“). However, as a consequence a more intense and extended diagnostic including a well developed clinical experience level as well as the clinical suspicion can be derived and concluded. This was an exciting and instructive case from a didactic point of view (relevant also for medical students) with rare occurrence in daily clinical practice, which includes the whole spectrum of differential diagnoses of i) unclear discomfort at the right lower abdomen in general and ii) acute appendicitis specifically.

Theory of Bladder Urothelial carcinoma by serum tumor markers CA19-9 and bHCG

Tumor markers such as beta Human Chorionic Gonadotropin (bHCG) and Carboxyhydrate Antigen 19-9 (CA19-9) have long been associated with bladder cancer and although their expression is associated with poorer oncological outcomes, they have little role in the routine clinical management of this disease. Recent advances in engineered antibody technology have lead to renewed interest in these markers as potential targets for new therapeutics. Here we report the case of a patient with locally advanced bladder cancer and the response of serum bHCG and CA19-9 to endoscopic resection and then radical cystectomy and serves to highlight how these tumor markers might be used to measure treatment effect.

Evaluation of the Efficacy of Ultrasound-Guided Local Lauromacrogol Injection Combined with Aspiration for Cesarean Scar Pregnancy: A Novel Treatment

Objectives: To evaluate the efficacy of ultrasound-guided local lauromacrogol injection combined with aspiration for treating cesarean scar pregnancy (CSP). Methods: From July 2016 to December 2016, 18 patients diagnosed with CSP were treated with ultrasound-guided local lauromacrogol injection combined with aspiration. Clinical data and outcome were analysed. Results: All patients were treated successfully. The amount of bleeding ranged between 10 and 50 mL. The duration of hospitalization ranged between 2 and 11 days. Serum β-human chorionic gonadotropin (β-hCG) decreased to the nondetectable level within 19–41 days. Menstruation recovery occurred after 10–24 days of normalization of serum β-hCG level. Reproductive functions were preserved, and there were no untoward effects or complications. Conclusions: Ultrasound-guided local lauromacrogol injection combined with aspiration is an effective CSP therapy, as it was associated with a high success rate, short hospitalization and fast recovery. However, its wider application and popularization have to be validated on a larger patient population affected by CSP.

Erratum.

BJOG: An International Journal of Obstetrics & GynaecologyVolume 124, Issue 13 p. e314-e314 ErratumFree Access Erratum This article corrects the following: Diagnosis and Management of Ectopic Pregnancy Volume 123Issue 13BJOG: An International Journal of Obstetrics & Gynaecology pages: e15-e55 First Published online: November 3, 2016 First published: 22 November 2017 https://doi.org/10.1111/1471-0528.14983AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat In the following article,1 the serum β-hCG value was incorrect in the text under 4th paragraph on page e34. The text reads: NICE1 recommends that methotrexate should be the first-line management for women who are able to return for follow-up and who have: no significant pain an unruptured ectopic pregnancy with a mass smaller than 35 mm with no visible heartbeat a serum β-hCG between 1500 and 5000 iu/l no intrauterine pregnancy (as confirmed on ultrasound scan). The text should read: NICE1 recommends that methotrexate should be the first-line management for women who are able to return for follow-up and who have: no significant pain an unruptured ectopic pregnancy with a mass smaller than 35 mm with no visible heartbeat a serum β-hCG less than 1500 iu/l no intrauterine pregnancy (as confirmed on ultrasound scan). Reference 1Elson CJ, Salim R, Potdar N, Chetty M, Ross JA, Kirk EJ, BJOG 2016; 123: e15– 55. Volume124, Issue13December 2017Pages e314-e314 ReferencesRelatedInformation

Clinical value of serum β-HCG detection in the diagnosis of abnormal pregnancy

Objective To explore the value of serum human chorionic gonadotropin (β-HCG) and progesterone (P) levels in the early diagnosis for abnormal pregnancy. Methods 53 cases with abnormal pregnancy and 30 normal pregnancy women were enrolled from Sep.2009 to Dec.2014 in our hospital.The automated chemiluminescent microparticle was used to detect the levels of β-HCG and P in serum, then analyzed the results. Results The expression of P was not associated with gestational weeks both in the normal and abnormal pregnancy patients on the day of admission (t=10.42, P 0.05). Despite of gestational factors, the levels of E2/β-HCG and P in abnormal pregnancy group were lower than those in normal pregnancy group, the differences were statistically significant (all P 0.05), while the levels of P and E2 were much higher in success group than those in failure group with significant difference (t=9.431, 6.792, all P<0.05). It showed that 12 ng/mL was the best one with perfect diagnosis value, and it could be used as an important index to evaluate the suitability of conservative treatment for abnormal pregnancy patients. Conclusion The levels of E2/β-HCG and P in serum can be used as important predictors in clinical diagnosis of abnormal pregnancy patients. Key words: Human chorionic gonadotrop; Progesterone; Estradiol 2

Placenta Accreta at 15 Weeks of Gestational Age and Uterus Preservation with Hysterectomy Abortion

: Placenta accrete refers to an abnormality of placental implantation in which the anchoring placental villi attached to myometrium rather than decidua resulting in a morbidity adherent placenta. Placenta increta (chorionic villi penetrate into the myometrium) and placenta percreta (chorionic villi penetrate through the myometrium to the uterine serosa or adjacent organs) are related, but more severe, abnormalities of placental implantation. The pathogenesis is primarily attributed to defective decasualization of the implantation site. Placenta accreta has been recognized mostly in the third trimester however may also present in second trimester. It has very heavy, life-threatening hemorrhage to both the mother and fetus. The authors’ report a patient with two previous cesarean deliveries, who had been referred for pregnancy termination from Iranian legal medicine organization with 15 weeks of gestational age and placenta acctera. In this patient, uterus preservation and hysterectomy abortion was performed. The case totally lost 1500 cc blood and she was discharged from hospital two days later, with feeling of well- being. We have examined this patient after 1.5 months, she wasn’t vaginal bleeding and the uterus was in the pelvic and serum BHCG (with titer) was negative.

Emergency Medicine Myths: Ectopic Pregnancy Evaluation, Risk Factors, and Presentation

BackgroundEctopic pregnancy (EP) is an important cause of morbidity and mortality in females of reproductive age. Proper diagnosis and treatment are critical, as complications such as rupture, hemorrhagic shock, and even death can occur. ObjectiveEP is a condition emergency physicians are trained to detect, yet there are multiple myths concerning its evaluation and diagnosis. This article reviews several of these myths in order to improve emergency department (ED) evaluation and diagnosis. DiscussionEP is a difficult diagnosis and may be missed on initial ED visit. While the diagnosis is often delayed simply due to very early presentations, it can also be missed because patients may not have all the same risk factors or demonstrate the same symptoms. They may also not demonstrate the same serum B-human chorionic gonadotropin levels and trends or have the same ultrasound findings at equivalent gestational ages. Some patients with early EP may have positive ultrasound findings with serum β-hCG levels under a defined discriminatory zone (DZ). On the other hand, some patients with an early viable intrauterine pregnancy may have no visible findings on initial ultrasound, but have serum β-hCG (quantitative) levels well above the DZ. Although rare, EP has even been demonstrated in women with negative urine β-hCG tests or low serum β-hCG levels. ConclusionsWhile EP may be a challenging diagnosis, understanding the myths surrounding EP may help emergency physicians consider it, even when patient risk factors, symptoms, or ED laboratory or imaging studies do not initially or easily define the diagnosis.

Conservative endovascular management of retained placenta accreta with marked vascularity after abortion or delivery.

To report our experience on the value of transcatheter arterial embolization (TAE) or transcatheter arterial chemoembolization (TACE) for the uterus-preserving management of retained placenta accreta with marked vascularity after abortion or delivery. Thirty-eight consecutive women with retained placenta accreta were retrospectively analyzed over a 5-year period. When elevated levels of serum β-hCG (>25 mIU/mL) were detected, TACE with dactinomycin was chosen for devascularization along with cytotoxic effects on active trophoblasts; in contrast, if the serum β-hCG level was low (≤25 mIU/mL), TAE was chosen. After confirming devascularization, the additional need for hysteroscopic resection and systemic methotrexate administration was individually determined. The most frequent sign and symptom in the abortion group was significant hemorrhaging, while a hypervascular mass detected at a regular check-up was the most frequent in the delivery group. The median time elapsed between abortion and endovascular management was 36days, and the median time elapsed after delivery was 31.5days. TACE was performed more frequently than TAE in the abortion group, while TAE was the more frequent procedure in the delivery group. In 10 and 11 cases, after abortion and delivery, respectively, hysteroscopic resection was performed. Systemic methotrexate administration was additionally done in three and one cases after abortion and delivery, respectively. Uterine preservation was achieved in all cases. This case series emphasizes that endovascular embolization is an effective key intervention with or without additional therapies for uterus-preserving management of retained placenta accreta with marked vascularity after abortion or delivery.

Down’s syndrome screening with hydrogel photonic barcodes

Abstract For giving birth to a healthy baby without Down’s syndrome, screening the level of alpha fetoprotein (AFP) and free-beta human chorionic gonadotropin (β-hCG) in maternal serum has been a routine examination for all gravidas. However, many assays only detect one target once time, which requires large samples and is low-throughput and costly. Herein, we describe a sensitive and inexpensive multiplex detection assay based on inverse opal structure hydrogel barcodes with poly(ethylene glycol) diacrylate (PEG-DA), poly(ethylene glycol) (PEG) and acrylic acid (AA) hybrid components. The polymerized PEG-DA hydrogel could guarantee the stabilities of the inverse opal structure, while the AA could offer active carboxyl groups for the probe immobilization. In addition, the interconnected pores of the inverse opal structure caused by PEG could also provide channels for biomolecules diffusing and reaction into the voids of the barcodes. The immunoassay results of our detection on AFP and β-hCG showed acceptable accuracy and detection reproducibility, and the results were in acceptable agreement with those from common clinic method for the detection of practical clinical samples. Thus, the new platform is apparently suitable for multiplex detection of Down’s syndrome.

Bladder and Urothelial Carcinoma by Response of Serum Tumor Markers

Tumor markers such as beta Human Chorionic Gonadotropin (bHCG) and Carboxyhydrate Antigen 19-9 (CA19-9) have long been associated with bladder cancer and although their expression is associated with poorer oncological outcomes, they have little role in the routine clinical management of this disease. Recent advances in engineered antibody technology have lead to renewed interest in these markers as potential targets for new therapeutics. Here we report the case of a patient with locally advanced bladder cancer and the response of serum bHCG and CA19-9 to endoscopic resection and then radical cystectomy and serves to highlight how these tumor markers might be used to measure treatment effect.

EP18.10: First trimester screening maternal and biochemical factors affecting preterm delivery

We aimed to identify maternal factors and biochemical markers that can be used to identify pregnancies at high risk of preterm delivery from the First Trimester Screening so that appropriate management, counselling and follow up can be planned to provide the best care for these patients. Single centre, retrospective observational study. A sample size of 12599 singleton pregnancies recruited over 3 years at KK Women's and Children's Hospital were analysed to identify First Trimester Screening maternal and biochemical factors which were significantly related to preterm delivery before 37 weeks of gestation. SPSS linear regression and chi square tests were used for analysis. We found that a high maternal BMI above 22.9kg/m2, advanced maternal age >35 years old and first trimester PAPP-A MoM (multiples of median) below 0.5 were significantly related to preterm deliveries before 37 weeks of gestation. Maternal ethnicity, parity, smoking status, ovulation induction and serum bhcg were not significantly related to preterm delivery. Our study shows that maternal demographics and biochemical markers obtained in the First Trimester Screening may be useful for clinicians in identification of high risk mothers who are more likely to deliver preterm and small for gestational age babies. More resources should be allocated to these high risk mothers so that they can be followed up and managed appropriately.

Analysis of implantation and clinical pregnancy in repeated implantation failure undergoing frozen transfer using transfer media with granulocyte macrophage colony stimulating factor or hyaluronan

To compare the efficacy of addition of granulocyte macrophage colony stimulating factor (GMCSF) or hyaluronan in transfer media over conventional cleavage transfer media on implantation and clinical pregnancy rate in day3 frozen cycles in in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles. A prospective observational study done between January 2014 to May 2016. A total of 233 patients with ≥ 2embryo transfer (ET) failure (fresh and frozen) undergoing day3 frozen ET were included in the study. Endometrium was prepared using oral estradiol from day 2 of cycle. Endometrial thickness was measured using transvaginal ultrasound from day 12 onwards. Progesterone was administered when endometrial thickness reached ≥7 mm. Patients were divided into three groups: Group A (n=73) had ET with media enriched with 2 ng/ml of GMCSF, Group B (n=78) with 0.5 mg/ml hyaluronan containing transfer media and Group C (n=87) had transfer with conventional cleavage media. Embryos were preincubated with GMCSF or hyaluronan containing media in Group A & B for 30 min before ET. Luteal support was given and serum βhCG estimated on day 14 of ET. Clinical pregnancy was confirmed by transvaginal ultrasound after 4 weeks of ET. Implantation rate, clinical pregnancy and live birth rates were main outcome measures. Statistical analyses were applied using chi-square and t-test, as applicable. Baseline clinical parameters and grade1 embryo transferred were found to be comparable in all three groups. A significant increase in implantation rate was observed in group A (23.97%) and group B (17.31%) as compared with group C (9.2%) (p<0.01). Clinical pregnancy rate was also found to be significantly higher in group A (38.36%) and B (30.77%) compared to group C (17.24%) (p<0.05). Live birth rate in group A (24.66%) and B (23.08%) was significantly higher than Group C (11.49%). We observed that transfer media with GMCSF or hyaluronan for frozen day3 ET may improve implantation and clinical pregnancy rates. Further, GMCSF treatment showed better implantation and clinical pregnancy rates than hyaluronan treated transfer media. This positive result may be due to effect of GMCSF on embryo development and improved endometrial receptivity.

Density of tubal ring vascularization: A new marker for prediction of success of medical treatment in tubal ectopic pregnancy

ObjectivesThe diagnosis of ectopic pregnancy has been facilitated especially by the use of Doppler ultrasonography. In previous studies the presence of peri-trophoblastic blood flow by Doppler ultrasound and the detection of a low-resistance, high-velocity flow pattern were defined as specific signs for trophoblastic tissue. The aim of this study was to evaluate the efficacy of Doppler ultrasonography in the prediction of treatment success in tubal pregnancies being treated with single dose conservative methotrexate. Study designA total of 104 patients with non-ruptured ectopic pregnancy who were hemodynamically stable and eligible for methotrexate treatment were included in the study. The spectral wave form of the mass was classified according to the vascularization density by Power Doppler. It was defined as Grade 1, 2 and 3, respectively. All patients received a single 50mg/m2 dose of systemic methotrexate. Serum β-hCG levels were measured on the 4th and 7th days of treatment. The treatment was considered unsuccessful in patients without a decrease of 15% or more in the serum β-hCG levels between days 0 and 7. ResultsTwenty-four patients with grade I vascularity, 11 patients with grade II vascularity and 13 patients with grade III vascularity were referred as Group I, II and III, respectively, according to the degree of adnexal vascularity assessed by Doppler ultrasonography. Overall success rate of MTX treatment was found to be 72.9%. The response rates to systemic MTX treatment in cases with Grade I, II and III ectopic pregnancy mass vascularization were found to be 58.3%, 81.8% and 92.3%, respectively. Comparison of the groups’ treatment responses revealed a linear-by-linear correlation with the Chi-square test. Increased vascularization grade of ectopic pregnancy was associated with a higher likelihood of responding to MTX treatment. ConclusionsDetection of the vascularization grade with Doppler ultrasound could be considered a remarkable parameter in predicting treatment success considering its ease of utilization and low cost.

Is ultrasound-guided suction curettage a reliable option for treatment of cesarean scar pregnancy? A cross-sectional retrospective study

Purpose: The purpose of our study is to present clinical courses and outcomes of 50 first-trimester cesarean scar pregnancy (CSP) cases, which are managed either with transabdominal ultrasound (TAUS)-guided suction curettage alone or abdominal hysterotomy. Methods: We retrospectively analyzed our records from 2011 to 2016 at a single-center. TAUS-guided suction curettage alone was preferred in hemodynamically stable patients when the myometrial thickness was ≥3 mm and there was no vascular invasion. If the myometrial thickness was <3 mm and/or vascular invasion was present, then hysterotomy was preferred. Results: Statistical analysis of age, gravidity, parity, history of previous CS (≥3 or <3), presence of embryonic cardiac activity, complaints (vaginal bleeding, pelvic pain, or both), preoperative and postoperative hemoglobin levels (g/dl), blood transfusion, initial serum β-hCG levels, and duration to resolution of β-hCG demonstrated no significant difference between TAUS-guided suction curettage and abdominal hysterotomy groups. There was a significant difference between two groups in terms of postoperative length of stay in the hospital and gestational age. Conclusion: TAUS-guided suction curettage in selected cases may be considered as a reliable first-line treatment option due to its low cost, ease of application, lower side-effect profile, and potentially minimal influence on future fertility in CSP patients that are hemodynamically stable.

First trimester β-hCG and estradiol levels in singleton and twin pregnancies after assisted reproduction.

Objective To compare levels of β-hCG and estradiol collected during the first trimester in singleton and twin pregnancies following assisted reproduction technologies (ART). Methods We prospectively evaluated 50 singleton and 47 dichorionic twin pregnancies that eventually ended in live births. Patients were recruited from a single ART center with standard treatment protocols followed by fresh embryo transfers. Hormone measurements were performed within a narrow gestational age range and analyzed in a single laboratory thus minimizing inter- and intra-assay variability. We measured serum β-hCG at 13 days after embryo transfer as well as samples of β-hCG and estradiol at 8-9 weeks+6 days. Results No significant differences existed between singletons and twins in respect to demographic and cycle characteristics. β-hCG and estradiol were all significantly higher in twins (P<0.05). Conclusion The data confirms the higher levels of β-hCG and estradiol in twins, pointing to the potential role of these placental hormones in early support of a twin pregnancy.

Blighted ovum in subfertile patients undergoing assisted reproductive technology

To explore the incidence and risk factors of blighted ovum in subfertile patients undergoing assisted reproductive technology (ART). This retrospective analysis was conducted among 2378 patients who were pregnant following embryo transfer at our center from January, 2012 to December, 2015, including cases of early pregnancy losses and simultaneous live births. The cases with early pregnancy losses were divided into embryonic pregnancy and blighted ovum groups based on the presence or absence of an embryonic pole before dilation and curettage. The clinical data of the 3 groups were analyzed for comparisons of the maternal age, paternal age, BMI, AFC, basal FSH, bFSH/bLH, duration of infertility, Gn dosage, Gn days, serum estradiol on the day of HCG administration, endometrium thickness, number of oocyte retrieved, proportion of high-quality embryos transferred, serum β-HCG value on the 10th to 14th days of embryo transfer, infertility type and miscarriage times. The incidences of blighted ovum were compared between cases with different cycles, embryo stages, infertile factors and methods of fertilization. Maternal age and paternal age, BMI, duration of infertility, infertility type and miscarriage times differed significantly between cases with blighted ovum and those with live births. Serum β-HCG level was the lowest in blighted ovum group followed by embryonic pregnancy group and then by live birth group. Blastocyst transfer was associated with a significantly higher incidence of blighted ovum as compared with cleavage embryo transfer (11.6% vs 5.6%, P=0.000). No significant difference was found in the other parameters among the 3 groups (P>0.05). Adjusted logistic regression analysis showed that maternal age, β-HCG level and blastocyst transfer were risk factors of blighted ovum. Advanced maternal age, low β-HCG level and blastocyst transfer may increase the risk of blighted ovum possibly in association with gene imprinting errors during the early stage of embryo development.