Embarazo ectópico roto con fracción beta de la hormona gonadotropina coriónica humana negativa: reporte de caso / Ruptured ectopic pregnancy with negative human chorionic gonadotropin hormone beta fraction: case report

Resumen El embarazo ectópico roto es una emergencia quirúrgica cuyo diagnóstico, gracias a la interrelación de la cuantificación de la fracción beta de la hormona gonadotropina coriónica humana (HCG-β) y los hallazgos ultrasonográficos, se ha hecho más preciso. Sin embargo, el diagnóstico se vuelve difícil cuando clínicamente se encuentran datos sugestivos de embarazo ectópico con una HCG-β negativa. Presentamos el caso de una mujer de 25 años acude a valoración por referir 12,2 semanas de retraso menstrual, asociado a sangrado transvaginal y signos de irritación peritoneal, que cuenta con HCG-β negativa (< 5 mUI/ml). Se realizó un rastreo ultrasonográfico encontrando abundante líquido libre en cavidad, sin evidencia de embarazo intrauterino. Ante la alta sospecha de embarazo ectópico se realizó laparotomía exploradora, encontrando hallazgos sugestivos de embarazo ectópico roto, y se realizó salpingectomía. Finalmente, en el estudio posoperatorio se confirmó por histopatología un embarazo ectópico roto. Existen muy pocos reportes en la literatura internacional de pacientes con características clínicas de embarazo ectópico roto, con HCG-β negativa. Es importante la difusión de este tipo de casos con la finalidad de mejorar los abordajes diagnósticos y no restar importancia ante la sospecha clínica, a pesar de presentar una HCG-β negativa.

Abstract Broken ectopic pregnancy is a surgical emergency that due to the relation between the serum quantification of the of the beta subunit of human chorionic gonadotropin (β-HCG) and the ultrasonographic findings, there have been improvements to reach a precise diagnosis. However, there are very few reported cases in the literature where a broken ectopic pregnancy is described with negative serum results in β-HCG. We present a case report of a 25-year-old patient came to the evaluation for referring 12.2 weeks of menstrual delay, associated with transvaginal bleeding and data of peritoneal irritation, she had a negative β-HCG fraction (< 5 mIU/ml). A scan was performed ultrasound finding abundant free fluid in the cavity, without evidence of intrauterine pregnancy. Given the high suspicion of ectopic pregnancy, an exploratory laparotomy was performed, finding findings suggestive of a ruptured ectopic pregnancy, a salpingectomy was performed. Finally, in the postoperative study, a ruptured ectopic pregnancy was confirmed by histopathology. There are very few reported internationally were found a patient with clinical characteristics of broken ectopic pregnancy, with a β-HCG negative. It is important the scientific diffusion of this type of cases with the purpose of improving the diagnostic approaches and not underestimating importance to the clinical suspicion, despite presenting negative β-HCG results.

Ectopic Pregnancy: A Single Tertiary Centre Experience

Background: EP is an unmitigated disaster of human reproduction, a major cause of reduced childbearing potential. EP can occur in Fallopian tubes, ovaries, cervix, abdominal cavity, cornua of uterus and c- section scar. But 95-98% of ectopic pregnancies are tubal. Aim: To study incidence, risk factors, clinical presentation immediate morbidity and mortality associated with ectopic pregnancy. Materials and methods: Patients diagnosed with ectopic pregnancy in reproductive age group (15-44 years) after clinical examination and investigations during one year period were included in the study. It was prospective study. Data was entered in MS excel spreadsheet and analyzed. Results: A total of 70 cases of ectopic pregnancy were included. Incidence of ectopic pregnancy in the present study was 7.6 per 1000 deliveries. Mean age was found to be 28 years and majority of them were multi gravida (93.3%) with low socioeconomic background (92.9%). Most common clinical presentation was a combination of amenorrhea (95.7%) and pain abdomen (100%). Bleeding per vagina was also seen in 28.6% of cases Past history of tubectomy was present in 24.3% of cases. Clinical signs such as abdominal tenderness, distension and guarding were noted in 75%, 88%, 75% of tubal rupture as compared to 25.7%, 12% and 25% of unruptured ectopic pregnancy. Cases of ruptured ectopic pregnancy presented with severe pallor (81.8%) and shock (100%). Urine pregnancy test was positive in all cases. Ultrasonography was an accurate tool for diagnosis and differentiated ruptured (74.3%) from unruptured (25.7%) ectopic pregnancies. Emergency laparotomy and salpingectomy (91.4%) on affected side was the treatment in majority of cases. Conclusion: Ectopic pregnancy is an important cause of maternal morbidity and mortality, high index of clinical suspicion, positive urine pregnancy test, ultrasonographic features point to early and accurate diagnosis of this entity. Treatment in time may save many lives and decrease associated morbidity.

A life-threatening condition—ruptured ectopic pregnancy with negative urine pregnancy test: A case report

@#Ectopic pregnancy is an extra-uterine pregnancy and is a potentially life-threatening condition that can lead to death from intra-peritoneal hemorrhage. This case reports a rare occurrence of ruptured tubal pregnancy in which the patient presented early with abdominal pain and a negative urine pregnancy test but subsequently presented again with evidence of intra-peritoneal hemorrhage. A negative urine pregnancy test is often used to rule out pregnancy, but it is not 100% sensitive. Complete assessment is critical in this important diagnosis in order to plan for the appropriate emergency management.

A retrospective analysis of ectopic pregnancies in tertiary care hospital of Western India: two year study

Background: Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality in the first trimester and major cause of reduced reproductive potential. Early detection of EP by improved ultrasonography modalities has decreased the rate of rupture and consequent maternal morbidity. Aim was to study the predisposing risk factors in modern scenario and choose the appropriate management available.Methods: A retrospective study on clinical diagnosis and management of EP of patients was carried out between January 2018 to February 2020. Investigations included CBC, UPT, serum β-hCG and TVS. Management was decided after thorough evaluation.Results: Out of 7,780 deliveries, 70 were EP (0.9%). Women with age 21-30 year had highest incidence (85.7%). Common symptoms were abdominal pain (94%), amenorrhea (87%), bleeding per vagina (48%). Most common risk factor associated with EP was PID (28.5%). Tubal EP was most common (84.2%) involving ampulla (66%), isthmus (15%), fimbria (12%), interstitial (7%). Scar ectopic was reported in 10% of cases and ovarian, rudimentary horn and abdominal pregnancy in 1.4% each. About 52.8% of ectopic was ruptured and salpingectomy was done in 74.3% and salpingo-oophorectomy in 2.8%. Five cases of scar EP required hysterotomy and 1 case was managed by methotrexate (MTX).Conclusions: EP remains a major challenge to the obstetrician worldwide. A high index of suspicion is required for early diagnosis and timely intervention in the form of medical or surgical treatment will definitely help in reducing the morbidity and mortality.

Ectopic pregnancy in a tertiary care centre of Jharkhand, India

Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions:Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions: Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.

Laser Biosensor as for Pregnancy Test by Using Photonic Crystal Fiber

The use of laser and optoelectronics concepts to develop biological detection systems is the goal of this work. A biosensor based on one of the interferometer techniques, Mach-Zhender interferometer (MZI) technique, and the using of the laser beam is developed for pregnancy detection or pregnancy hormone, Human chorionic gonadotropin (HCG), increasing. A part of photonic crystal fiber (PCF) with 3 different lengths (1.5 cm, 1.0 cm, and 0.5 cm) has been collapsed with 2 conventional single mode fibers (SMFs) to achieve MZI technique, Micro-holes collapsing and make high sensitive regions for the optical properties (refractive index and absorption) in the urine sample. This type of laser biosensor depends on light intensity measurement through a modified optical fiber. The sensing region is immersed in different urine samples of pregnant female and non-pregnant female. Biological changes in the urine sample due to the HCG increasing lead to a change in the optical properties (refractive index and absorption) of the urine sample. The results showed that the increasing of pregnancy hormones leads to an increase in the refractive index for a urine sample and a decrease in the intensity of the output laser beam. From this test, the calibration curve of laser biosensor for a pregnancy test or pregnancy detection has been found. The sensitivities of the laser biosensor with a refractive index in the range (1.33864-1.34257) at (1.5 cm, 1.0 cm, and 0.5 cm) PCF length are 61.142 ABS/ RIU, 4.5132 ABS/RIU and 2.888 ABS/RIU, respectively. Thus, the highest sensitivity was found for the (1.5 cm) photonic crystal fiber length.

Coriocarcinoma no gestacional: reporte de un caso / No gestational choriocarcinoma: case report

Resumen ANTECEDENTES: El coriocarcinoma es una neoplasia maligna del epitelio trofoblástico, agresiva pero susceptible de curación, incluso cuando hay metástasis. Puede ser de origen gestacional o no, el primero aparece después de un embarazo molar o aborto. CASO CLÍNICO: Paciente de 14 años, acudió a Urgencias debido a un cuadro de abdomen agudo, con prueba en orina positiva de embarazo; además, una tumoración en la región anexial derecha. En la laparotomía se encontró una tumoración dependiente del anexo derecho, con la cápsula rota, adherida al colon. Un día después de la intervención quirúrgica (por no contar con recursos en la unidad) se tomó la fracción beta de gonadotropina coriónica. El diagnóstico definitivo se estableció con base en el reporte del estudio histopatológico de la pieza quirúrgica. CONCLUSIÓN: El coriocarcinoma es una neoplasia maligna del epitelio trofoblástico, muy agresiva pero susceptible de curación, incluso cuando se detectan metástasis. La incidencia en México de coriocarcinoma gestacional es de 0.133 por cada 100,000 mujeres, mientras que la incidencia del cariocarcinoma no gestacional se desconoce. Se reporta como un tumor muy raro; por ello el diagnóstico preciso y oportuno es difícil en este tipo de tumores; la presentación más habitual es el abdomen agudo.

Abstract BACKGROUND: Choriocarcinoma is a malignant neoplasm of the trophoblastic epithelium, very aggressive but highly curable, even when there is metastasis. It can be of gestational and non-gestational origin, the first one can develop after a pregnancy, abortion or molar pregnancy; in Mexico it is calculated with an incidence of 0.133 per 100,000 women. While the incidence of non-gestational choriocarcinoma is unknown as it is reported as a very rare tumor. The objective is present the first case reported in our hospital, there are few cases reported in Mexico, it is important to know them in order to identify, diagnose and refer them on time. CLINICAL CASE: A 14-year-old patient who presented to the emergency department with a picture of acute abdomen with pregnancy test in positive urine and tumor in the right adnexal region, laparotomy was performed, finding a tumor dependent on the right annex with a broken capsule attached to the colon, one day after the surgical event (due to lack of resources in the unit) beta fraction of chorionic gonadotropin, the definitive diagnosis was made by the histopathological study of the surgical piece. CONCLUSION: Choriocarcinoma is a malignant neoplasm of the trophoblastic epithelium, very aggressive but highly curable, even when metastases are detected. In Mexico, the incidence of gestational choriocarcinoma is 0.133 per 100,000 women, while the incidence of non-gestational cariocarcinoma is unknown, it is reported as a very rare tumor, which is why accurate and early diagnosis is difficult in this type of tumors. , since the most common presentation is an acute abdomen.

Dilution model of early pregnancy test strip for quantitative detection of serum β-hCG level by Abbot AxSYM detection system / 国际检验医学杂志

Objective To study the dilution model of the early pregnancy test strip for the quantitative detection of serumβ-hu-man chorionic gonadotropin(β-hCG)level by the Abbot AxSYM detection system and its application.Methods The detection re-sults of serumβ-hCG level in 5 612 outpatients and inpatients of the internal medicine department and the gynecology and obstetrics department during 5 years were retrospectively analyzed.In addtion,234 serum samples from the patients were collected for prelimi-narily determining the serumβ-hCG level by the early regnancy test strip and then the quantitative detection of serumβ-hCG level was detected by the Abbot AxSYM detection system.Results The retrospective analysis showed that 241 cases(4.6%)were low-age pregnant women.The qualitative screening was necessary.The screening model was successfully established.But one thing to note was that the part of serum sample needed to be taken out and put into another tube for determination.Conclusion Establishing the rational and effective dilution interpretation model of early pregnancy test strip for screening serumβ-hCG can bring the econom-ic and time benifits for the routine detection work of the Abbot AxSYM detection system.

Evaluation of Clinical Usefulness of PREG-Q(TM) as a Screening Test for Pregnancy / 임상검사와정도관리

BACKGROUND: Among the many methods estimating the quantity of beta-hCG for pregnancy testing in urine, immunochromatography is one of most widely used semi-quantitative detection method for its convenience to use and also for its rapid result reporting system. PREG-Q(TM) is a newly introduced semi-quantitative immunochromatography method for detecting b-hCG. Clinical usefulness of PREG-Q(TM) was evaluated as a screening test for early pregnancy detection. METHODS: Accuracy, detection limit, cross-reactivity with various glycoprotein hormones, interference study, and comparison study using total 100 urine samples from pregnant (50 samples) and non-pregnant women (50 samples) was evaluated. RESULTS: All the 50 urine samples of pregnant women showed positive results, and another 50 urine samples of non-pregnant women showed negative results with PREG-Q(TM). The lower detection limit of PREG-Q(TM) was 25 mIU/mL and the result was not affected by addition of glycoprotein hormones tested. Interfering substance causing false negative or false positive results enrolled didn't affect the test results in this study. CONCLUSIONS: We conclude PREG-Q(TM) is an excellent test kit for pregnancy test, and is valuable especially for detecting early pregnancy.

Low cost pregnancy test and HCG stability.

A modified technique for pregnancy slide test (Roche) using hypodermic needles No.23 as droppers for urine and needles No.25 as droppers for antiserum and for human chorionic gonadotropin (HCH)-latex suspension was reported. One hundred positive-and 26 negative-urine specimens by regular Roche pregnancy slide test were used as study samples. The results showed that the modified technique was compatible with the standard method regarding sensitivity and reliability. The modified technique, is however, 6.76 times less expensive than the standard method. The authors recommend this new technique to be used in hospital laboratories and clinics as routine laboratory test. In this study if was also found that the urine specimens that kept at room temperature for up to one year the HCG hormone remained active though the number of positively was reduced if kept 1ฝ year and 2 years to 98.41 and 93.65 percent respectively. Urine specimens that preserved in refrigerator freezer remained positive for HCG hormone for up to 2 years.