Atraumatic antepartum subdural hematoma causing fetal death.

A case of atraumatic antenatal fetal subdural hematoma, severe enough to cause death, is reported. Although it is often associated with traumatic delivery, its occurrence before labor suggests that assumptions of causation require some medical investigation or corroboration before trauma is accepted as the etiologic factor.

Does cyclic human chorionic gonadotropin secretion indicate embryo loss in in vitro fertilization?

The human chorionic gonadotropin (hCG) beta subunit curve of normal singleton in vitro fertilization (IVF) pregnancies shows cyclic peaks during the first 56 days after embryo transfer (ET). This phenomenon is not demonstrable in normal spontaneous conceptions. The hCG curves of 151 singleton IVF pregnancies achieved by transfer of two, three, and four embryos therefore were compared statistically with the hCG curves of singleton IVF pregnancies achieved by transfer of only one embryo. The hCG levels of singleton IVF pregnancies achieved by transfer of more than one embryo had statistically higher hCG levels at 7 and 8, 19 and 20, and 37 and 38 days after ET. In a separate evaluation it was observed that declines in hCG levels of normal singleton IVF pregnancies preceded four of five first-trimester abortion incidence peaks of singleton IVF pregnancies. The observed cyclic hCG secretion may be indicative of early embryo deaths. This observation supports the contention that multiple ET results in significantly more multiple implantations than previously appreciated. Thus embryo survival in utero may represent another major contributory factor to success or failure of IVF.

The predictive value of hCG beta subunit levels in pregnancies achieved by in vitro fertilization and embryo transfer: an international collaborative study.

Serial human chorionic gonadotropin (hCG) beta subunit measurements of 300 pregnancies achieved by in vitro fertilization (IVF) were obtained by 15 IVF centers worldwide. Hormonal curves were established for 164 normal singleton pregnancies, 25 normal multiple gestations, 60 chemical pregnancies, 41 first-trimester spontaneous abortions, and 10 ectopic pregnancies. In comparison to the normal singleton pregnancy curve, chemical pregnancies and spontaneous abortions showed statistically lower hCG levels. hCG levels of ectopic pregnancies, compared with normal singleton gestations, were lower from days 7 to 14. It is concluded that beta-hCG determinations of in vitro fertilized pregnancies allow pregnancy diagnosis as early as 7 to 9 days after embryo transfer (ET) and will permit early discrimination between normal and abnormal IVF pregnancies. A single beta-hCG determination on day 9 after ET may discriminate chemical, ectopic pregnancy or impending miscarriage from a normal gestation. An hCG determination on day 17 will predict early normal development of an IVF pregnancy.