A case report of 26 weeks of complete molar pregnancy with posterior uterine fibroid

Molar pregnancy is one of the classifications of GTD and sometimes can be associated with hyperthyroidism. The classic features are irregular vaginal bleeding, hyper emesis and large uterus for gestational age. Though incidence of uterine fibroid with pregnancy is 1% to 10% but encountered with molar pregnancy is rare. Here we reported a case of complete molar pregnancy with posterior uterine fibroid who initially presented with 3-month amenorrhea and had a complaint of spotting per vagina occasionally with ultrasonography report suggestive of molar pregnancy and post uterine fibroid with raised beta-hCG with low TSH suggestive of hyperthyroidism.

Association of serum beta-hCG and urine albumin-creatinine ratio with hypertensive disorders during pregnancy

Background: Preeclampsia with or without severe symptoms, chronic hypertension with or without superimposed pre-eclampsia/eclampsia, gestational hypertension, HELLP syndrome, or eclampsia all pose a significant risk of morbidity for both the mother and the unborn child. The aim of this study was to investigate if the albumin-to-creatinine ratio in urine spots and the serum beta-hCG level correlate with the hypertensive illness of pregnancy.”Method: “The current inquiry was conducted during the months of October 2020 and August 2022 at the obstetrics and gynaecology department of Subharti medical college in Meerut, Uttar Pradesh. The study was not open to women who were more than 20 weeks pregnant, had gestational diabetes mellitus, had more than one pregnancy, had chronic hypertension, chronic renal disease, chronic liver disease, cardiac disease, systemic lupus erythematosus, or haematological illnesses. We measured the levels of serum beta hCG and the urine albumin-creatinine ratio, and we compared them between the groups.”Results: After ensuring that each participant had given their informed permission, the trial comprised a total of 200 patients. In the hypertensive group of the participants in the study, 31% were between the ages of 21 and 35, and 29% were less than 20 years old. With increased beta hCG and UACR, there was a higher incidence of hypertensive retinopathy, acute renal failure, DIC, and PPH among the patients, as well as the poorest fetal outcomes. (p<0.05)Conclusions: The presence of a substantial relationship between hypertensive diseases and raised levels of beta-hCG during pregnancy, as well as a greater ratio of urine albumin to creatinine. There is a considerable increase in the incidence of fetal growth retardation, preterm, and mortality occurring within the uterus among mothers who have higher levels of beta-hCG and urine ACR.

The role of serum beta-human chorionic gonadotropin as a predictor for pregnancy induced hypertension in 12-20 weeks of pregnancy

Background: Pregnancy-induced hypertension occurs in approximately 3 to 5% of pregnancies and is still a major cause of both fetal and maternal morbidity and mortality worldwide. Pre-eclampsia is risk factor for stillbirth, intrauterine growth restriction (IUGR), low birth weight (LBW), preterm delivery, respiratory distress syndrome, and admission to neonatal intensive care unit. Overall, the incidence of preeclampsia ranges from 5 to 15% in India. This study conducted to assess the predictive value of raised beta-human chorionic gonadotropin (?-hCG) levels in development of pregnancy-induced hypertension in antenatal women and follow up the risk patients and reduce both maternal and perinatal morbidity and mortality.Methods: The present study was conducted in the department of obstetrics and gynaecology, L.L.R.M Medical College and associated SVBP Hospital, Meerut during the period of January 2021 to December 2021 on 400 antenatal women with 12 to 20 weeks of gestation. Estimation of serum beta hCG level was done by enzyme linked fluorescence immunoassay. The cases were followed up in antenatal clinics, 4 weekly till 28 weeks, fortnightly up to 34 weeks and thereafter weekly till delivery for the development of PIH.Results: From the study it was found that women with elevated beta hCG values in 12-20 weeks were at increased risk of developing PIH. The sensitivity of ?-hCG for development of PIH was found to be 90%. It was found that specificity, positive predictive value (PPV), negative predictive value (NPV) of ?-hCG for development of PIH was 82%, 41.7%, 98.3% respectively. However, p value of ?-hCG for development of PIH is 0.001 which is highly significant.Conclusions: From this study we found that that measuring second trimester serum beta-hCG levels is a good predictor of pregnancy induced hypertension and showed association with elevated levels of beta hCG with development and severity of PIH, but sensitivity and positive predictive value of beta hCG are low in this study to be useful for mass screening marker on its own.

Incidence and risk factors of post-molar gestational trophoblastic neoplasia: a prospective study

Background: Gestational trophoblastic disease (GTD) is a group of disorders arising from abnormal trophoblastic cells. Gestational trophoblastic neoplasia (GTN) is a malignant counterpart of GTD. In the earlier era, morbidity and mortality associated with GTD was very high, 90-95% presenting with metastatic GTN in 1980抯.Methods: This is a prospective study to analyze the incidence and to identify the risk factors of post-molar GTN and to evaluate the role of Beta-hCG level as a predictive factor of post-molar GTN, conducted in the department of Obstetrics and Gynecology, Institute of Maternal and Child Health (IMCH), Government Medical College, Kozhikode, on patients attending the vesicular mole(VM) clinic. Group A (remission group - was diagnosed after 6 months of follow-up with undetectable Beta-hCG values) and Group B (post-molar GTN). The two groups were compared for identifying risk factors.Results: There were 79 cases of molar pregnancy registered in VM clinic with an incidence of 4.87/1000 deliveries. Of the 79 patients with GTD, 17 were diagnosed to have GTN during follow-up with an incidence of 21.51% of GTD. Incidence of post-molar GTN were significantly more among patients with history of previous molar pregnancy. The median Beta-hCG level at 2 weeks post-evacuation and the ratio of Beta-hCG levels at 1week to 2 weeks post-evacuation was found to be highly predictive of post-molar GTN.Conclusions: Incidence of GTD was higher compared to international studies. The ratio of post-evacuation Beta-hCG at 1 week to Beta-hCG at 2 weeks is the most reliable predictor of post-molar GTN.

Epithelioid trophoblastic tumor: A case series

An epithelioid trophoblastic tumor (ETT) is an extremely rare gestational trophoblastic tumor. Cases of ETT present with abnormal vaginal bleeding in women of reproductive age group with marginally elevated beta human chorionic gonadotrophin (B-hCG) levels. Here, we describe a series of four patients (all were females) including histomorphology, immunoprofiles, and diagnostic difficulty of this rare entity. All cases were in their reproductive age group. The mean pre-treatment hCG level was 665.24 (mIU/mL). Microscopically, all cases had a tumor showing an epithelioid appearance arranged in large nests and sheets. Individual tumor cells were round to polygonal with abundant eosinophilic cytoplasm, with central vesicular nuclei and prominent nucleoli. Areas of hemorrhage, necrosis, and intercellular hyaline-like material deposition were identified in all cases (100%). Immunohistochemically, tumor cells in all cases showed diffuse positivity for AE1/AE3 and p63 (100%). GATA3 was available in one case (25%), which was positive in the tumor cells. In one case (25%), hPL was focally positive, and in one case (25%), it was negative. SALL4 was performed in two cases (50%) and was negative in tumor cells. The mean Ki67 labeling index was 19.2 (range 10–30%). All four patients underwent surgical intervention and were treated with hysterectomy. The mean follow-up in this series was 39.4 months (range 6–70), and all patients are alive to date with a mean survival of 32.8 months (range, 4–67).

Role of surgical management in invasive mole: a report of 2 cases and review of literature

Invasive mole is a rare gestational trophoblastic neoplasia with proliferative trophoblast invading into myometrium or uterine vasculature. Primary management of invasive mole is chemotherapy, but hysterectomy can be performed in selective cases. In this report, we discuss two cases of invasive mole, which required surgical intervention in the form of a hysterectomy. Both patients had a favorable outcome and are in remission.

Case report -Cesarean scar ectopic pregnancy

Cesarean scar ectopic pregnancy is one of the rarest of all ectopic pregnancy increase in number of cesarean section leads to increase in number of cesarean scar ectopic pregnancy. Early diagnosis and prompt management help in reducing mortality and morbidity occuring due to scar ectopic pregnancy. We are reporting a rare case of cesarean scar ectopic pregnancy G5P3L3D1 with period of gestation 7 weeks 3 days with previous all 4 deliveries by cesarean section. Cesarean scar ectopic pregnancy are life threatening as they pose a great risk of maternal hemorrhage as the patient vital are the stable patient managed medically with injection Methotrexate

Non-surgical diagnosis and management of chronic ectopic: A case report / The Health Sciences Journal

@#Chronic ectopic pregnancy is a rare form of ectopic gestation that contributes to the increased maternal morbidity and mortality in the frst trimester of pregnancy. Diagnosis is often challenging as it presents with subtle clinical signs and symptoms, imposing the need for surgical exploration and management. This is a case of a 27-year-old gravida 3 para 2 (2002) who presented with vaginal bleeding of three weeks duration, was hemodynamically stable with unremarkable physical examination fndings. The diagnosis of a chronic ectopic pregnancy was established with a conservative, non-surgical approach through the combination of clinical symptoms, transvaginal sonography, and b-hCG monitoring. Management was likewise conservative with multiple dose methotrexate chemotherapy, eventually yielding a decrease in b-hCG from 80.0 mIU/mL to 1.0 mIU/mL.

Study of demography and clinical profile of ectopic pregnancies in a tertiary level hospital in Uttarakhand: a five year review

Background: Ectopic pregnancy is a condition when a fertilized ovum is implanted outside the uterine cavity. Life threatening risk of rupture of ectopic pregnancy remains one of the important causes of maternal mortality in India. The aim of study is to analyse the clinical profile, associated risk factors, complications, treatment outcomes to improve maternal mortality and morbidity associated with ectopic pregnancy.Methods: It is a retrospective study conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences from January 2015 to January 2020. A total of 182 patients diagnosed of Ectopic Pregnancy were analysed for clinical profile, risk factors, serology, ultrasound findings, complications, treatment offered and outcome.Results: During the study period of 5 years there were total 182 patients who were diagnosed of ectopic pregnancy showing the incidence of ectopic pregnancy in our hospital 1.4% of total number of deliveries. Majority of patients were in the age group of 25 to 30 years (43.95%). Mostly multiparous women (80.1%) had ectopic pregnancy. Majority of patients (56.1%) had no associated risk factors for ectopic pregnancy. Main presenting complain was abdominal pain in 58.8% of patients. Majority of patients (63.2%) had surgery as primary care which indicates delay in diagnosis and arrival at hospital especially in hilly region of Uttarakhand.Conclusions: Ectopic pregnancies need to be diagnosed timely to decrease maternal morbidities and mortalities.  Clinical signs and symptoms with serology (Serum beta hCG) and radiological findings helps to optimize treatment for potentially life-threatening condition.

The role of pregnancy-associated plasma protein-a level in the first trimester of pregnancy and clinical outcome in an urban referral centre

Background: Estimation of serum PAPP-A levels studied predictability for adverse perinatal outcome. This case control study tries to establish the association between low PAPP-A levels among the pregnant woman and adverse maternal foetal outcome.Methods: This is an case-control study during 2017-2018 in the women delivered at Department of OBG at Mehta Hospitals. Women delivered in the labour room  had a first trimester screening of PAPP-A level were explained, taken informed consent, questionnaire which include detailed antenatal history, mode of delivery and baby data.  Depending upon outcome, the subjects are classified as case group or control group, out of the study sample of 264 subjects, 88 patients who had complications were taken as cases and 176 patients with no complications taken as control were undertaken.Results: Low PAPP-A level (<0.5 MoM) showed high incidence of PIH and preeclampsia, followed by IUGR and Preterm. PAPP-A level >0.5 MoM, normal outcome is more than the adverse outcome. The difference in the PAPP-A levels is statistically significant. In women with low PAPP A level, low birth weight found statistically significant when compared with <0.5 PAPP A level. The sensitivity of PAPP A levels in identifying the complicated outcomes was 17.04%.The specificity was 98.85%. The positive predictive value of predicting the complications was 88.23% and negative predictive value of 70.44%.Conclusions: The low PAPP-A levels confirmed during first trimester of pregnancy is associated with adverse maternal and foetal outcome such as PIH, preeclampsia, preterm, IUGR and LBW.

A molar pregnancy detected by following irregular vaginal bleeding after a first trimester evacuation: rare case report

In this case report summarizes the sequence of events that led to detection of a molar pregnancy missed by ultrasound and initial pathology examination. A 29 years old Asian nulliparous patient came to our clinic with missed period. On beta HCG she was 6 weeks pregnant. After 20 days she was diagnosed with 7 weeks missed abortion on ultrasound. surgical evacuation done for same. After 3 weeks she came with irregular vaginal bleeding. After physical and vaginal examination Beta HCG done, which was very high. On transvaginal ultrasound partial molar pregnancy was detected, so she was immediately admitted and repeat surgical evacuation was done. Histopathology report confirmed partial molar pregnancy which was not detected in previous report. She was regularly followed up with Beta HCG value up to 1 year which declined dramatically. Though molar pregnancy is rare, but it has the potential to develop into invasive mole, so any abnormal bleeding post evacuation should be followed up properly. Beta HCG values and histopathological evaluation is important for correct diagnosis and follow up.

Corrección de medianas de la fracción beta libre de gonadotrofina coriónica humana y proteína plasmática A del embarazo del primer trimestre para una muestra de población mexicana / Medians correction of free beta subunit of human chorionic gonadotropin and pregnancy-associated plasma protein-A during the first trimester for a Mexican population sample

Resumen Objetivo: determinar si en una muestra de población mexicana la distribución de los marcadores séricos del primer trimestre difiere del modelo de riesgos de The Fetal Medicine Foundation y calcular los factores de corrección necesarios para un desempeño adecuado de la prueba. Materiales y Métodos: estudio descriptivo y transversal en el que se midieron las concentraciones de beta-hCG-libre y proteína plasmática A del embarazo en sueros maternos del primer trimestre, por ensayo de electroquimioluminiscencia aprobado por la Fetal Medicine Foundation. Se obtuvieron los múltiplos de mediana ajustados por el algoritmo de la Fetal Medicine Foundation (astraia). Para describir la distribución de cada marcador y probar su diferencia estadística con la media 0.000, se hizo su transformación a log10 ideal mediante la prueba de t para una muestra. Además, se describen las distribuciones de los múltiplos de mediana por características del embarazo y lote de reactivo. Resultados: en 1008 sueros, el log10 MoM global fue de -0.121 ± 0.2706 para beta-hCG-libre y -0.049 ± 0.2372 para proteína plasmática A del embarazo. Conclusiones: en esta muestra poblacional mexicana las distribuciones de beta-hCG-libre y proteína plasmática A del embarazo difieren de las esperadas para población similar a la hispana europea. Se recomienda aplicar los respectivos factores de corrección de 0.756 y de 0.893 para las medianas del algoritmo.

Abstract Objective: To determine whether first trimester serum markers distribution on a Mexican population sample differ from The Fetal Medicine Foundation (FMF) risks model, and to calculate the necessary correction factors for accurate test performance. Materials and Method: Transverse descriptive study, Free-beta-hCG and PAPP-A were measured on unselected first trimester maternal sera using FMF approved electrochemiluminescence assay, the adjusted MoM were obtained from FMF algorithm (astraia); they were log10 transformed to describe each marker distribution and to test their statistical difference with the 0.000 ideal mean by one sample t-test. MoM distributions for pregnancy characteristics and reagent lot are additionally described. Results: On 1008 sera, the overall adjusted log10MoM was -0.121 ± 0.2706 SD for Free-beta-hCG and -0.049 ± 0.2372 SD for PAPP-A; these distributions differed significantly from tåzhe expected by FMF risks model. Conclusions: Free-beta-hCG and PAPP-A distributions on this Mexican population sample differ from expected for population similar to Hispanic European, median correction factors of 0.756 MoM and of 0.893 MoM, respectively, are recommended for the algorithm.

The comparison of beta-hCG levels according to treatment modalities in tubal pregnancy / 대한주산의학회잡지

OBJECTIVE: The aims of this study were to evaluate the effect of the methotrexate (MTX) method by comparing the change of the serum beta-hCG level between the MTX method and salpingectomy for treating tubal pregnancy, furthermore by analyzing differences between the MTX success group and the failure group, and to provide helps in establishing criteria for choosing the MTX method. METHODS: Medical records of the 118 patients who were diagnosed with tubal pregnancy were reviewed retrospectively for the period of January 2006 to December 2007 at Kangnam St. Marys Hospital. RESULTS: Between the MTX success group and the failure group, no difference was observed in pregnancy duration, but statistically significant differences were observed in the size of hematoma and the quantity of hemoperitoneum at the site of tubal pregnancy in ultrasonography and in the serum beta-hCG level (p<0.05). Compared with salpingectomy, the MTX method showed the patterns of a low decrease rate of serum beta-hCG level after treatment and even its increase during the early period of treatment, but the serum beta-hCG level decreased rapidly from Day 7 after treatment and became equal to that of salpingectomy on Day 28 after treatment. CONCLUSION: The size of hematoma and the quantity of hemoperitoneum at the site of tubal pregnancy and the serum beta-hCG level before treatment are important factors for success in the MTX method. The MTX method may be safe and effective relatively in hemodynamically stable tubal pregnancy patients, who need preserve the salpinx particularly.

A case of suprasellar germinoma misdiagnosed as lymphocytic hypophysitis / 대한내과학회지

We report here on a case of a 22-year-old girl with a suprasellar mass that was originally diagnosed as lymphocytic hypophysitis, but it eventually turned out to be a germinoma. She initially underwent partial tumor removal and the tissue diagnosis was suggestive of lymphocytic hypophysitis. 46 months later, she presented with a lateral visual field defect and decreased visual acuity of her right eye. The serum and cerebrospinal beta-hCG and alpha-fetoprotein levels were measured. The beta-hCG level was elevated in both, whereas the alpha-fetoprotein level was detectable in neither. The serum anti-pituitary antibody-1 level was negative. She was reoperated and the permanent section biopsies were compatible with pure germinoma. There was no evidence of meningeal metastasis on her whole spine MRI. She was treated with chemotherapy.

Malignant gestational trophobalstic tumor with markedly elevated serum hCG levels and negative urine hCG level / 대한산부인과학회지

Gestational trophoblastic disease comprises a spectrum of interrelated conditions originating from the placenta. Malignant gestational trophoblastic disease refers to lesions that have the potential for local invasion and metastasis. This compromises many histological entities including hydatidiform moles, invasive moles, gestational choriocarcinomas, and placental site trophoblastic tumors. Before the advent of sensitive assays for human chorionic gonadotropin (hCG) and efficacious chemotherapy, the morbidity and mortality from gestational trophoblastic disease were substantial. Currently, with sensitive quantitative assays for beta-hCG and current approaches to chemotherapy, most women with malignant trophoblastic disease can be cured. We present a case of malignant gestational trophobalstic tumor with serum beta-hCG concentration over 1million IU/L that metastaze to the lungs and have a hyperthyroidism, but negative urine hCG testing. We report a case with a brief review of literatures.

Midtrimester triple test in IVF/ICSI twin pregnancies / 대한산부인과학회지

OBJECTIVE: To compare the midtrimester triple marker levels for down syndrome screening between natural and IVF twin pregnancies and to evaluate the difference triple marker in IVF twin pregnancies according to the fertilization method and number of transferred embryos. METHODS: The study population consisted of conventional IVF twin (n=106), ICSI twin (n=142), and natural (n=436) twin pregnancies as controls between 2001 and 2004. All pregnancies in this study were known to have normal outcome. Maternal serum samples were collected between 14-18 gestational weeks. Levels of AFP, total hCG, and uE3 were measured and were expressed as multiples of the median (MoM) based on reference medians established at Cheil Hospital. RESULTS: The mean maternal age (31.6+/-2.8 vs. 31.6+/-3.0 vs. 32.1+/-2.1: conventional IVF group vs. ICSI group vs. control, respectively) and gestational weeks (16.0+/-0.5 vs. 16.0+/-0.7 vs. 16.1+/-0.2) for triple test were similar. There was no difference in levels of all serum markers between conventional IVF and ICSI group. The median AFP MoM for conventional IVF and ICSI group were significantly higher than that of the control group (2.40 vs. 2.22 vs. 1.98; p0.05). Also, the median hCG MoM was not different from that of the control group (2.04 vs. 2.06 vs. 2.02; p>0.05). There was no correlation in triple marker levels according to the number of transferred embryos in conventional IVF and ICSI groups. CONCLUSION: Midtrimester triple marker levels of IVF twin pregnancy for down syndrome screening are similar with those of natural twin pregnancy regardless of fertilization method and number of transferred embryos.

Human chorionic gonadotropin and invasion of trophoblast into the tubal wall in tubal pregnancy / 대한산부인과학회지

OBJECTIVE: To evaluate the relationship between gestational age, tubal ultrasonographic diameter, and serum beta-hCG levels and different stages of trophoblastic infiltration of the tubal wall in tubal pregnancy. METHODS: The 45 cases of fallopian tube containing tubal pregnancy were reviewed. Gestational age, diameter of the tubal mass, and beta-hCG level on the day of surgery were calculated by transvaginal sonography and immunoassay respectively. The tubal pregnancy was classified according to the depth of trophoblastic infiltration: trophoblast limited to the tubal mucosa (stage I), extension to the tubal muscularis (stage II), or complete tubal wall infiltration up to the serosa discontinued by trophoblastic cells (stage III). RESULTS: 14 patients (31.1%) had stage I tubal infiltration, 10 patients (22.2%) had stage II infiltration, 21 patients (46.7%) had stage III infiltration. There was no relationship between gestational age, tubal diameter and stage, but there was a predictable correlation between beta-hCG and the depth of trophoblastic invasion. The median beta-hCG level was 1,332.1 mIU/mL (range, 215-2,995 mIU/mL) for patients with stage I infiltration, 9,548.0 mIU/mL (range, 569-43,989 mIU/mL) for stage II infiltration, and 23,087.9 mIU/mL (range, 1,373-98,000 mIU/mL) for stage III infiltration. Cut off level of beta-hCG for each stage were 1,996.5 mIU/mL (stage I vs II, III) and 5,665 mIU/mL (stage I, II vs III) respectively. CONCLUSION: These findings may explain why beta-hCG is a important predicting factor for invasion of trophoblast in tubal pregnancy.

Clinical Guidelines for Methotrexate in Conservative Treatment for Ectopic Pregnancy / 대한산부인과학회지

OBJECTIVE: To provide more useful guidelines for methotrexate (MTX) treatment in ectopic pregnancy, including patient selection, therapeutic dose, and reproductive outcome. METHODS: Retrospectively, records of 54 patients treated for ectopic pregnancy with systemic MTX were reviewed. MTX was administered 1.0 mg/kg intramuscularly, alternatively with leucovorin 0.1 mg/kg intramuscularly for up to four daily doses of each drug. Samples for beta-hCG detection were obtained on days +3, +7 after beginning of the therapy and then weekly until values were undetectable. RESULTS: 50 patients (92.6%) were treated successfully. 4 patients (7.4%) for whom MTX therapy failed, were treated surgically. The endometrial thickness significantly increased in the failed group, compared to the successful group (14.3+/-4.0 mm vs 7.0+/-2.8 mm, P=0.0001). The serum hemoglobin levels significantly changed in the failed group, compared to the successful group (2.1+/-0.9 g/dL vs 1.0+/-0.8 g/dL, P=0.044). Patients were divided into increasing group and decreasing group according to beta-hCG levels on day 0, that were higher or lower than day -2 level. The resolution time of beta-hCG between increasing group and decreasing group was significantly different (27.6+/-14.0 days vs 17.7+/-8.6 days, p=0.016). In 8 patients (15.1%), an immediate rise of beta-hCG was recorded on day 3 after MTX treatment, but on day 7, a rapid decrease was recorded. Women were treated with significantly different therapeutic dose of MTX according to initial level of serum beta-hCG (p=0.021). There were mild complications (12%). MTX treatment preserved the fallopian tube and thus preserved fertility (70%). CONCLUSION: Systemic MTX use with the dose according to initial level of serum beta-hCG is a safe and highly effective treatment in clinically stable ectopic pregnancy.

The relation of beta-hCG levels before the artificial abortion and fetal age and the number of removed tissue of hydatiform mole

Study conducted on 57 cases of complete hydatiform mole, with the average fetal age of 13.5641.04 weeks (lowest 6 weeks, highest 20.5 weeks) beta-hCG average level 1158656.16246627.71 IU/l (min 79072 IU/l, max 5474400 IU/l), volume of removed tissue – min 100 ml, max 2500 ml). Results showed that the correlation between preevacuation beta-hCG level and removed tissue volume is higher than the correlation between gestational age and the number of evacuated mole. Between preevacuated beta-hCG level and gestational age the correlation is not valuable

Efficacy and Predictors of Success of Methotrexate Treatment in Women with Unruptured Tubal Ectopic Pregnancies / 대한산부인과학회잡지

OBJECTIVE: To evaluate the efficacy and predictors of success of methotrexate (MTX) treatment in selected cases of unruptured tubal pregnancies. METHODS: This study was retrospectively performed in 36 women who had diagnosed unruptured tubal pregnancies. Patients received intramuscular MTX. Serial beta-hCG measurement was performed weekly, and success was defined as the achievement to beta-hCG concentration of 10 mIU/mL without surgical intervention. Surgical intervention was performed for presumed tubal rupture. Pretreatment serum concentration of beta-hCG, the size of tubal mass and gestational sac by transvaginal ultrasonography were measured to evaluate the predictors of MTX therapy. RESULTS: 29 patients (81%) were successfully treated by MTX systematic treatment. There were not significant differences in the patient's age, parity, gestational age and the size of tubal ectopic mass, but significant differences in the gestational sac size and serum beta-hCG concentration between success group and failure group of MTX treatment. The mean time for achieving successful treatment was 33.8 days. The success rate of systemic MTX was significantly decreased and resolution time was prolonged if the initial pretreatment serum beta-hCG was 10,000 mIU/mL or gestational sac size was >or=1 cm. CONCLUSION: Pretreatment serum beta-hCG concentration and gestational sac size are important predictors of success of MTX treatment in women with unruptured tubal pregnancy.