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Background: Ectopic pregnancy is a commonest cause of maternal morbidity and mortality in the first trimester of pregnancy. Clinical presentation of ectopic pregnancy has changed from life threatening disease to a more benign condition for which nonsurgical treatment options are available with methotrexate administered systemically or locally. The study was done to evaluate the outcome of medical management of ectopic pregnancy with single regimen methotrexate.Methods: A cohort study was conducted over 18 months on 60 unruptured ectopic pregnancies who were treated with methotrexate injection.Results: Out of 60 unruptured ectopic pregnancies, 53 (88.3%) were successfully treated with methotrexate. Failure rate was 11.7% (7/60) patients who underwent laparotomy. Success of medical treatment was dependent on pretreatment β-hCG (≤4102.5 mIU/mL), period of gestation (≤5 weeks), size of gestational sac (≤3 cm) above which the failure rate increases. No correlation was seen between fall of β-hCG from day 4 to 7 and the success rate. Mean time to resolution of β-hCG seen was 4.3±1.25 weeks. Mean duration of hospital stay was 8.85±1.603 days. Single dose regimen of methotrexate was given to all patients and only 1/60 patients required second dose of methotrexate for suboptimal decrease of β-hCG.Conclusions: The result showed that pretreatment β-hCG level and period of gestation were good predictors for success of medical treatment.
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Background: The World Health Organization (WHO) factsheet revealed that 15 million babies are born too early every year and almost 1 million children die each year due to complications of preterm birth. The objective of this study was to determine whether cervicovaginal β-hCG level can be used as predictor of preterm delivery in asymptomatic high-risk pregnant women at 24-34 weeks gestation age.Methods: This was prospective observational study. Total 134 asymptomatic pregnant women were taken for study who had at least one risk factor for preterm delivery at 24-34 weeks gestation age. Cervicovaginal secretion was collected and β-hCG level was measured by chemiluminescent immunoassay.Results: Out of 134 cases, 42.5% had preterm delivery and 57.5% had term delivery. Mean cervicovaginal β-hCG level (mIU/ml) in preterm delivery group was 39.38±19.66 and term delivery group was 21.86±11.18. Cervicovaginal β-hCG level was significantly higher in preterm group compare to term group demonstrating significant association of raised β-hCG with preterm group (p value <0.001). ROC curve analysis was done to find out best cut off value of cervicovaginal β-hCG for prediction of preterm delivery and optimal cut off value was 36.45 mIU/ml. The optimal cut off value for cervicovaginal β-hCG (36.45 mIU/ml) gave sensitivity 71.9%, specificity 81.8%, positive predictive value 74.5%, negative predictive value 79.7% and diagnostic accuracy of 77.6% for prediction of preterm delivery.Conclusions: Cervicovaginal β-hCG can be used as sensitive and specific biomarker of prediction of preterm delivery in asymptomatic high-risk women.
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Background: A major challenge in obstetrics is early identification of hypertensive disorders of pregnancy (HDP). This study was performed to determine the association between elevated maternal serum β-hCG levels and HDP, the correlation between serum β-hCG level and severity of preeclampsia and to determine the value of serum β-hCG level as a diagnostic marker for early diagnosis of HDP.Methods: This was a hospital based observational study conducted in the department of obstetrics and gynecology, Rajendra Institute of Medical Sciences, Ranchi on 375 pregnant women with period of gestation more than 20 weeks, including 250 pregnant women with HDP as study group and 125 normotensive pregnant women as controls. Serum β-hCG concentration was measured and its level was compared between two groups.Results: The maternal mean serum β-hCG levels (51161.08±30038.21 IU/L) of study group of HDP were higher than the normotensive control group (17603.23±16748.21 IU/L). In non-severe preeclampsia, the mean serum levels were 36417.32±23876.74 IU/L while in severe preeclampsia, 60030.34±28771.31 IU/L. There was statistically significant difference (p<0.001) with higher levels in early onset preeclamptic mothers than late onset preeclampsia. The cut-off point of β-hCG for predicting HDP was 32077 IU/L with sensitivity of 65% and specificity of 86%.Conclusions: Serum β-hCG level is higher in HDP when compared to normotensive women. Higher levels of β-hCG are associated with increasing severity of hypertensive disorders of pregnancy. The utility of serum β-hCG as a diagnostic test is limited because of low sensitivity and difficulty in deciding the cut-off value.
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Background: Gestational trophoblastic disease (GTD) comprises a spectrum of diseases ranging from molar pregnancy to malignant gestational trophoblastic neoplasia (GTN). GTN are highly chemo-sensitive tumours which are treated as per FIGO risk stratification. The rarity of the disease limits the evidence regarding the disease to case series and reports. The objective of this study was to study incidence, baseline characteristics of patients and clinical outcome of GTN patients treated at this centre.Methods: This is a retrospective descriptive study based on medical records of patients of GTD who were registered in department of medical oncology, from January 2015 to December 2018 (4 years). GTN was diagnosed based on serum beta HCG values. Their baseline characteristics, risk score, serum β HCG levels, and treatment regimens were investigated. The incidence of GTD and response to treatment were analysed.Results: Out of 211 GTD patients, 56 developed GTN. The incidence was 3.4 per 10000 deliveries. Low risk cases (n=38) were treated with methotrexate and actinomycin in first line while high risk cases received EMACO and EP followed by EMACO as the first line. A cure rate of 100% for low risk cases and 94.4% (n=17) for high risk cases were recorded. Resistance to MTX was 32.3% while EMACO was resistant in 46.6% as first line. Neutropenia and alopecia were the most common treatment related adverse events. Predictors of resistance to single agent in low risk GTN include higher pre-treatment βHCG values and higher risk scores.Conclusions: GTN exemplifies a rare, highly aggressive but curable malignancy. Serum βHCG is the most reliable diagnostic as well as prognostic marker in management of GTD. EMACO is the preferred regimen for high risk GTN. FIGO staging and risk stratification help in individualizing the treatment to ensure maximum response to therapy thus making GTN a curable malignancy.
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Cesarean scar pregnancy is a rare but life-threatening complication. It is the abnormal implantation of gestational sac into myometrium and fibrous scar of previous cesarean section. Its incidence is on rising trend due to increase in rate of cesarean section all over the world. A thirty years old second gravida presented at eight weeks of gestation with complaints of bleeding per vaginum and pain lower abdomen. She was diagnosed as a case of cesarean scar pregnancy (CSP) on ultrasonography and confirmation of diagnosis was done on magnetic resonance imaging. Medical management of scar pregnancy was done successfully with combination of mifepristone and methotrexate. Cesarean scar pregnancy could be catastrophic, if not managed well in time. Management includes both surgical and medical options. Treatment has to be individualized depending on patient’s hemodynamic profile, size of gestational sac, desire for future fertility, compliance for follow up and availability of interventional radiology.
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Background: Hypertensive disorders during pregnancy are one of the most common medical complication seen during pregnancy, affecting around 5-10% of all pregnancies. Spectrum of this disease ranges from mildly elevated blood pressure with minimal clinical significance to severe hypertension with multi organ dysfunction. Pre-eclampsia complicates about 2-8% of all pregnancies. Pre-eclampsia incidence in India is about 8-10%. Various studies have depicted that, there is a strict relationship between PIH and elevated serum β-hCG level.Methods: This one-year prospective case control study toteled 200 pregnant women attending antenatal care and admitted in eclampsia ward fulfiling the inclusion criteria were studied. Serum βhCG levels were estimated by chemiluminescent microparticle immunoassay. Statistical analysis of data was done by student’s t-test and p-value.Results: The mean β hCG level in PIH patients was found to 36851.59 mIU/ml with standard deviation of 22916.58 while the mean β hCG in normotensive patient was 15433.26 mIU/ml with standard deviation of 6861.56. (p <0.001). The mean β hCG level in gestational hypertensive patients was 25206.19 mIU/ml with a standard deviation of 8696.9. The mean β hCG level in pre-eclamptic patients was 61697.67 mIU/ml with standard deviation of 18498.57. The mean β hCG level were 84106.38 mIU/ml with standard deviation of 11295.05 in the eclamptic patient. The above values were statistically significant (p <0.001).Conclusions: We concluded that there was a striking relation between the PIH including pre-eclampsia and eclampsia with the elevated serum βhCG level. Concluding that early detection of altered serum βhCG shell aid in better management of pre-eclampsia and eclampsia cases which would play a pivotal role in improving the maternal and fetal outcome.
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Background: Diagnosis of ectopic pregnancy was frequently missed. Aim of the study was to determine the clinical presentation, and treatment associated with ectopic pregnancy.Methods: This is a prospective study which was carried out at Obstetrics and Gynaecology department, GMERS SOLA civil hospital from August 2017 to October 2018. Total 416 patients were admitted during study period out of them 50 patients diagnosed with ectopic pregnancy were enrolled in the study and information was collected and analysed.Results: 80% patients were between the age group of 21-30 years. 56% patients were nulliparous. Amenorrhea (92%) with lower abdominal pain (94%) is the most common presenting symptom. 26% of patients show typical triad of amenorrhea, abdominal pain and bleeding per vagina. UPT and USG were most commonly performed investigations. 96% cases showed UPT positive. 100% USG showed adnexal pathology. Serum beta-hCG was done in 37 patients as an aid for diagnosis and to decide the line of management. Conservative medical management with Injection MTX was done in 4 patients of which 1 patients required laparotomy later on. Surgical management was done in 90% of patients. Laparoscopic management was done in 54% of cases.Conclusions: Early diagnosis and timely intervention in the form of conservative or surgical treatment will help in reducing the morbidity and mortality associated with ectopic pregnancy.
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Background: Gestational trophoblastic disorders are among the rare human tumors that can be cured even in the presence of widespread dissemination. Authors can anticipate the development of persistent trophoblastic disease by identifying high risk factors affecting βhCG regression in vesicular mole. The study of this aim was to determine the incidence of gestational trophoblastic disorders and persistent trophoblastic disease in our institution. Factors affecting regression of βhCG and thereby leading to persistent disease are assessed.Methods: The study was conducted for a period of 2 years at a tertiary care centre in central Kerala. The factors affecting progression to persistent disease are assessed by a case control study. Those developing persistent trophoblastic disease were taken as cases and those with normal regression of βhCG were taken as controls. Variables studied were age, sociodemographic factors, obstetric history, histopathological report, βhCG value, post evacuation USG and clinical features.Results: The incidence of gestational trophoblastic diseases was 1 in 178 births and of persistent trophoblastic disease was 18.6%. Fourteen cases with persistent trophoblastic disease were studied and 61 controls were recruited. Incidence increased in older age group (>30) and low socio-economic group. Pre-evacuation βhCG> 40000 and presence of theca lutein cyst are important factors affecting βhCG regression. Strong association with uterine size >poa, post evacuation uterine subinvolution and presence of hyperthyroidism was found.Conclusions: Progression to persistent trophoblastic disease was associated with low socioeconomic status, high pre-evacuation βhCG values, uterine size>poa and presence of theca lutein cysts. Identification of these risk factors helps in proper counseling and meticulous follow up of patients.
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Background: Pre-eclampsia is an important cause of maternal and neonatal complication and death. If hypertension in pregnancy is diagnosed at an early age, we can provide an efficient care to mother for good outcome of pregnancy. The aim of this study to evaluated the role of B-HCG and AFP as predictors of HDP. Methods: This prospective Investigation study was conducted on 100 pregnant women attending the antenatal clinic in Department of Obstetrics and Gynaecology, Jaipur. Estimation of serum β-HCG and AFP was done by ELISA technique. Then there finding were correlated with the value of serum β-HCG and AFP in second trimester to see whether there is any relation between levels of serum β- HCG and AFP in second trimester and development of HDP. Results: ‘Out of 100 women, 5 i.e. 5% were <20 years of age, maximum i.e. 62 (62%) were in 21-25 years of age group, 25 (25%) were in 26-30 years of age group and 8 (8%) were in 31-35 years age of group. Significantly higher mean S. β-HCG (mIU/ml) was observed in HDP group i.e. 13450.5±3420.8 as compared to 7732±2024 in normotensive group and a test of full model was statistically significant indicating that the predictors reliably distinguish between HDP group and normotensive group (Chi square 55.328, df 4, p<.001). Conclusion: We conclude from this study the measurement of serum β-HCG and AFP should be routinely done in second trimester of pregnancy, to predict the occurrence of HDP for better fetomaternal outcome.
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To measure maternal serum beta human chorionic gonadotropin during 13-24 weeks of pregnancy and compare the same between those who develop pregnancy induced hypertension with those who do not. In a prospective study βhCG levels were estimated in 75 antenatal women in the second trimester (12-24 weeks) by ELISA technique. Results were noted in terms of development of preeclampsia, mean serum levels of the marker, mode of delivery and complications. During the course of study, a total of 8 (10.7%) patients developed hypertension. Thus incidence of pregnancy induced hypertension was 10.7%. A significant rise of mean serum βhCG level (32022MIU/ml, mean)was present in those who developed preeclampsia.The marker can prove an important role in early recognition of a pregnancy related complication and provides the obstetrician ample opportunity to guide the management during pregnancy.
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[Objective]To compare early serum beta-human chorionic gonadotropin (β-hCG) levels after cleavage or blastocyst embryo transfers (ET) in predicting pregnancy outcome.[Methods]A total of 2421 IVF-ET cycles in our center performed from June 2010 to May 2015 and resulted in clinical intrauterine pregnancies were analyzed retrospectively. The predictive value was compared betweenβ-hCG on day 14 after cleavage ET andβ-hCG on day 12 after blastocyst ET.[Results]Serumβ-hCG levels of patients re?sulted in clinical intrauterine pregnancies were significantly higher with blastocyst ET compared with cleavage ET. This significant dif?ference was also existed in patients resulted in miscarriage, ongoing pregnancy (OP) or live birth (LB). However, this significant differ?ence was only existed in frozen embryo transfers. For a frozen cleavage ET, the cut-off value was 475 U/L (sensitivity 79%, specificity 61.3%) in predicting LB. For a frozen blastocyst ET, the cut-off value was 575 U/L (sensitivity 74.9%, specificity 59.2%) in predicting LB.[Conclusion]In frozen embryo transfers, early serumβ-hCG level after blastocyst ET is higher than cleavage ET. The cut-off val?ue in predicting pregnancy outcome is different according to the stage embryo transferred. Early serum β-hCG can effectively predict live birth after blastocyst or cleavage ET.
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To investigate the clinical effect of Gushen Antai pills and progesterone in the treatment of threatened abortion, in order to provide references for early clinical intervention with threatened abortion. The 112 cases of patients with threatened abortion were randomly divided into the control group and the observation group. 56 cases in each group. Patients in the control group was injected with progesterone, the observation group was treated with Gushen Antai pills in addition to the therapy of the control group. Both groups were treated by drugs for two weeks. Their venous bloods (5 mL) were collected before treatment and in 1, 2 weeks after treatment to determine serum levels of β-HCG, P, E2 and CA125. The differences between the two groups after treatment were compared. The total effective rate of the control group and the observation group were 79% and 91.9% respectively, with a statistically significant difference between the two groups (P＜0.05). Two weeks after the treatment, the serum levels of P and E2 in the observation group were significantly higher than before treatment, but the serum CA125 levels decreased significantly after treatment (P<0.05). These indicators showed statistically significant difference compared with that of the control group (P<0.05). After treatment, the serum β-HCG levels of the two groups were significantly higher than before treatment (P<0.05), but there was no statistically significant difference between the two groups. Gushen Antai pills and progesterone had a better clinical curative effect in treatment threatened abortion, which could significantly raise serum β-HCG, P and E2, reduce serum CA125 and increase the tocolysis efficiency, and so it was worth promoted in clinic.
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Objective To explore comparison between methotrexate and uterine arterial embolization in β-HCG, bleeding volume and success rate of women with cesarean scar pregnancy after cesarean section.Methods 42 patients who were diagnosed with cesarean scar pregnancy after cesarean section were collected.All patients were randomly divided into uterine arterial embolization group and methotrexate group,21 cases in each group corresponding treatment were given respectively, after the treatment, the serum levels of β-HCG, bleeding volume and success rate were detected in all patients.Results After treatment, compared with methotrexate group, the serum level ofβ-HCG was lower in the uterine arterial embolization group,and the difference was statistically significant(P<0.05); the bleeding volume was lower in the uterine arterial embolization group(P<0.05); the success rate was higher in the uterine arterial embolization group(P <0.05).Conclusion Compared with methotrexate,the uterine arterial embolization can significantly reduce the serum level ofβ-HCG in patients with cesarean scar pregnancy after cesarean section,reduce the amount of bleeding, improve the success rate of treatment.
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Objective To explore the clinical value of combined detection of serum beta human chorionic gonadotropin (β-hCG),estradiol (E2),progesterone (P) and antiphospholipid antibodies (ACA) in predicting the outcomes of early threatened abortion.Methods 80 pregnant women were chosen from six to eight weeks singleton pregnancies,50 cases of threatened abortion and 30 cases of normal pregnancy.The serum levels of β-HCG,estradiol,progesterone and ACA-IgG,ACA-IgM and ACA-IgA were detected.The threatened abortion patients were given intramuscular progesterone 20 mg/day/time for 1 week,then,the pregnancy outcomes were analyzed and the serum levels of β-HCG,estradiol and progesterone were explored.Results The serum β-HCG,estradiol and progesterone of the threatened abortion group [(5 140.77 ± 2 365.47) IU/L,(680.28 ± 306.06) pg/mL,(15.59 ± 3.65) pg/L]were lower than those of the normal pregnant women [(14 520.4 ± 11 016.24) IU/L,(1 142.81 ± 670.57) pg/mL,(27.6 ± 4.78) pg/L] (t =3.224,P =0.003 ; t =2.43,P =0.022 ; t =7.72,P =0.001).According to pregnancy outcome,patients with threatened miscarriages were divided into the two groups,including 45 patients with continuing pregnancies and 5 patients with inevitable miscarriages.The serum levels of β-HCG,estradiol and progesterone in ongoing pregnancies group [(10 829.42 ± 6 926.28) IU/L,(832.9 ± 397.91) pg/mL,(25.62 ± 4.51) pg/L] were higher than those in inevitable miscarriages [(6 310.14 ± 2 593.19) IU/L,(487.14 ± 275.47) pg/mL,(13.6 ±4.84) pg/L] (P ＜ 0.05) ;The serum levels of ACA-IgG,ACA-IgM and ACA-IgA in 80 cases tested,only 2 cases who appeared in the threatened abortion group were detected with the positive of serum ACA-IgG,accounted for 4％ (2/50) (x2 =68.05,P =0.000),occurred spontaneous abortion in the end.Conclusion Combined detection of serum ACA,β-HCG,estradiol and progesterone may be helpful for prognosis of threatened abortion.However,the clinical predictive value of ACA needs further study in the early threatened abortion.
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Objective To compare effect of trichosanthin and methotrexate in the treatment of uterine scar pregnancy by a multi-center study. Methods 90 uterine scar pregnancy patients were selected from department of obstetrics and gynecology,in xinyang central hospital,the second affiliated hospital of zhengzhou university,zhumadian central hospital,using random number table divided into 2 groups.The control group of 45 cases were treated by methotrexate,gluteal muscle injection,50 mg one time,and took mifepristone 50 mg,two times a day,a week for a course of treatment;45 cases in the experimental group,were treated with trichosanthin,intramuscular injection of 1.2 mg/time,two times a day,and oral administration of bloven,0.6 g/d,a week for a course of treatment.The end of a course of treatment,2 groups of patients before and after treatment were compared of the serum progesterone level,β-HCG,side reactions after treatment.Results After treatment,progesterone levels were significantly reduced,and the experimental group levels were lower than the control group obviously,the difference has statistical significance(P<0.05).Serum -HCG level after the treatment significantly reduced,and the experimental group in serum -HCG levels were significantly lower,with statistical difference (P <0.05 ). Comparison of adverse reaction of the patients,the experimental group was obviously lower than control group,with statistically significant difference (P<0.05).Conclusion For the treatment of uterine scar pregnancy,trichosanthin and methotrexate have certain effect,but trichosanthin could lower serum progesterone,β-HCG levels more significantly than methotrexate,trichosanthin group side reaction rate is low.
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Objective To explore the diagnostic value of β‐human chorionic gonadotropin (β‐HCG) and its free β‐subunit (fβ‐HCG) of adverse pregnancy .Methods Chemiluminescence technique was used for the detection of serum levels ofβ‐HCG ,fβ‐HCG and progesterone in women with early adverse pregnancy (threatened abortion group ,missed abortion group and ectopic pregnancy group) and normal pregnant women (control group) ,respectively .The 48 h doubling rate ofβ‐HCG of each group was calculated . And the results were analyzed .Results Comparing with threatened abortion group ,there were significant differences in the levels of β‐HCG ,fβ‐HCG ,progesterone and doubling rate both of missed abortion group and ectopic pregnancy group (P 0 .05 ) . Conclusion T he changes of β‐HCG and fβ‐HCG can reflect adverse pregnancy .
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Objective To explore the relationship of depth of trophoblastic invasion with trophoblast cell activity and serum β-hCG according to the expression of proliferation antigen Ki-67 which viewed as an indicator of cell proliferation activity.Methods Fallopian tube specimens collected from 108 patients who underwent operation treatment for fallopian tubal pregnancy in our hospital were investigated by light microscopic examination.They were divided into three groups according to the depth of trophoblastic infiltration: Ⅰ group (stage): trophoblastic invasion of tubal mucosa,Ⅱ group(stage): trophoblastic invasion of the muscularis,Ⅲ group(stage): trophoblast invasion of serosa layer(muscularis penetration).The expression of Ki-67 was detected by SP method and blood β-hCG was detected within 2 hours of preoperative.The level of β-hCG,the expression of Ki-67 and the depth of trophoblast invasion were analyzed.Results Mean level of serumβ-hCG in Group Ⅰ,Ⅱ and Ⅲ were(1416.64 ± 859.94)U/L,(3380.33 ± 2392.36)U/L and(6999.33 ± 4949.90)U/L respectively.Positive expression rate of cell proliferation antigen Ki-67 in Group Ⅰ,Ⅱ and Ⅲ were 21.95％,53.66％ and 6.40％ respectively.There were significant difference on the expression of Ki-67 between group Ⅰ and group Ⅱ,group Ⅱ and Ⅲ group,group Ⅰ and group Ⅲ(x2 =3.94,4.07,4.35,respectively,P ＜ 0.05).The serumβ-hCG level also displayed statistics difference in the three groups(F =9.914,P ＜ 0.01).The positive expression of Ki-67 and serum β-hCG level were positively correlated with each other(r =0.678,P ＜ 0.05)Conclusion The high level of the serum β-hCG indicates high expression of Ki-67 and deeper trophoblast invasion of tubal wall.
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Numerous factors, such as VEGF and intra-placental oxygenation, can influence placental angiogenic activity. Early in the normal gestation period, β-hCG enhance VEGF activity to induce angiogenesis. The aims of this study were to identify the correlation between β-hCG concentration in placental culture and placental angiogenic activity in pre-eclampsia. Ten placenta samples from women with pre-eclampsia and l0 from controls (normal pregnancy) were collected. All subjects agreed to participate in this study and signed an informed consent form. β-hCG concentration in supernatant of placental culture was measured by Microparticle Enzyme Immunoassay (MEIA) and placental angiogenic activity was measured by endothelial cell migration toward placental explant (score 0-4). The results showed that the median score of placental angiogenic activity in pre-eclampsia was significantly higher than in normal pregnancy (p<0.05). Concentration of β-ahCG in pre-eclampsia was significantly higher than in normal pregnancy (p<0.001). hCG concentration in placental culture was positively correlated to placental angiogenic activity both in pre-eclampsia (r=+0.50) and in normal pregnancy (r=+0.57). Althouglt the correlations were weak, β-hCG is considered one of the factors that influence placental angiogenic activity.