Hyperreactio leuteinalis: benign tumour associated with pregnancy mimicking ovarian malignancy

Hyperreactio leuteinalis refers to pregnancy related enlargement of B/L ovaries rarely unilateral ovary, moderate to marked size due to multiple theca leutein cysts. It is a rare finding associated with pregnancy seen commonly in multiple gestation, GTDs and fetal abnormalities: viz hydrops. It is caused by elevated B-hcg level. We report a case of 28 years old female, primi with 13 spontaneously conceived weeks pregnancy who presented to ANC OPD for regular check-up and vague abdominal discomfort. USG revealed a large right sided ovarian mass, solid cystic in appearance pushing the uterus to left side and upwards. Staging laparotomy was done at 14 weeks viewing it to be a malignant mass. Unilateral right sided oophorectomy was done along with biopsy taken from left ovary. On microscopic histological examination diagnosis of hyperreactio leuteinalis unilateral ovary was made. Hyperreactio leuteinalis mimicking ovarian malignancy on USG results in unnecessary surgical intervention.

A five-year review of the clinicopathologic profile of patients with hydatidiform mole at the Philippine General Hospital / Philippine Journal of Obstetrics and Gynecology

Background@#The clinical presentation of patients with hydatidiform mole have changed in recent years due to earlier diagnosis as a result of widespread use of ultrasonography and availability of assays for human chorionic gonadotrophin.@*Objective@#To determine the clinicopathologic profile of patients diagnosed with hydatidiform mole at the Philippine General Hospital from January 2013 to August 2018.@*Methods@#This retrospective cross-sectional study included all patients with histologically confirmed diagnosis of hydatidiform mole managed at the Philippine General Hospital from January 2013 to August 2018. Medical records of patients were retrieved. All abstracted variables were analyzed retrospectively. The level of significance for all sets of analysis was set at p-value < 0.05 using two-tailed comparisons.@*Results@#From January 2013 to August 2018, a total of 435 patients diagnosed with hydatidiform mole were managed at the Philippine General Hospital with a prevalence rate of 15.7/1,000 pregnancies. Diagnosis was made in the first trimester in 52% of patients. A quarter of the patients had pre-evacuation B-hCG levels of more than 1 million mIU/mL. Vaginal bleeding was the most frequent presenting symptom but only 59% of the patients had anemia requiring blood transfusion. Majority (90.57%) had a histopathologic diagnosis of complete hydatidiform mole.@*Conclusion@#The prevalence and clinicopathologic profile of patients with hydatidiform mole in the Philippine General Hospital have remained largely unchanged.

Maternal serum βhCG level and uterine artery doppler studies as predictors of pregnancy induced hypertension and intra uterine growth restriction: a prospective study

Background: PIH, a pregnancy-specific disorder, is one of the major causes of maternal and perinatal morbidity and mortality worldwide.PIH and fetal growth restriction are important causes of perinatal and maternal morbidity and mortility.Methods: Hundred Indian pregnant women in their second trimester (13-20 weeks) and in their late second trimester (24-28 weeks) investigated for their serum β-hCG level and uterine artery Doppler studies respectively, attending OPD/IPD in Sir T. hospital, Bhavnagar from June 2014 to June 2015.Results: There is no clinical significance between parity and occurrence of PIH (p=0.2) and FGR (p=0.7). Out of 77 patients with their β hCG level ≤2 MoM, 2 patients (2.59%) developed PIH and FGR. And from 12 patients with their β hCG level ≥2 MoM 10 patients (80%) developed PIH and FGR which is highly significant (p<0.001). The study establishes the validity of beta HCG as a predictor of PIH and FGR with the sensitivity of 83.3%, specificity of 97.5%.Conclusions: This study can be concluded by there is a strong association between high maternal serum ß-hCG level, abnormal uterine Doppler studies with predicting adverse outcome of pregnancy like PIH and FGR. There is also a good association between high maternal serum ß-hCG level and rising severity of the disease.

Marcadores séricos del primer trimestre y riesgo obstétrico en una población con alta prevalencia de obesidad / First-trimester serum markers and obstetric risk in a population with a high prevalence of obesity

Objetivo: La detección precoz del riesgo de complicaciones de la gestación como preeclampsia, parto pretérmino, y aborto, permitiría evitar morbimortalidad y secuelas. Hemos estudiado la relación entre niveles bajos de PAPP-A y BhCG con malos resultados obstétricos en una población con alta prevalencia de obesidad. Material y métodos: Estudio retrospectivo de casos y controles anidado en una cohorte de pacientes que acudieron para tamizaje de aneuploidías el I trimestre. Los casos fueron las pacientes con MoM PAPPA y/o BhCG por debajo del percentil 5 y el grupo control una muestra aleatorizada de pacientes con marcadores normales. Se ajustó por obesidad, edad, paridad, tabaquismo, y técnicas de reproducción. Resultados: La cohorte estuvo formada por 9111 pacientes. Se obtuvieron 382 casos con MoM PAPP-A inferior al percentil 5 y 325 con MoM BhCG por debajo del percentil 5, y 50 casos con ambos marcadores por debajo del percentil 5. Se tomaron 1417 controles. La prevalencia de obesidad fue del 20,7% y de sobrepeso el 28,4%. Los niveles bajos de PAPP-A se relacionaron con abortos, preeclampsia, crecimiento intrauterino retardado, pequeños para la edad gestacional, parto pretérmino y diabetes gestacional. Los niveles de BhCG por debajo del percentil 5 se relacionaron con la enfermedad hipertensiva gestacional. Los niveles de ambos marcadores por debajo del percentil 5 tuvieron relación significativa con aborto, preeclampsia precoz y parto pretérmino. Conclusión: Los niveles bajos de PAPP-A y BhCG se relacionan con malos resultados obstétricos en una población de alta prevalencia de obesidad.

Background: Early identification of pregnant women at risk of developing intrauterine growth restriction, preeclampsia, preterm birth, stillbirth, among other complications would allow more intensive surveillance to reduce the risk of severe disease. We aimed to study whether low levels of maternal serum markers PAPP-A and BHCG are associated with adverse pregnancy outcomes in an obese population. Methods: Cases were obtained from a cohort of 9111 patients who attended first trimester screening. We included women with PAPP-A and/or BHCG below the 5th percentile. A randomized group of women with serum markers above the 5th percentile was used as control group. Results were adjusted for age, parity, smoking status, BMI or reproductive techniques. Results: Prevalence of obesity was 20,7%. We found 382 women with PAPP-A below the 5th percentile, 325 with BHCG below the 5th percentile, 50 with both markers low, and recruited 1417 controls. The cases with low PAPP-A were significantly more likely to experience abortion, preeclampsia, low birth weight, preterm birth, or gestational diabetes. Low BHCG was significantly associated with gestational hypertension. Low BHCG and PAPP-A in the same patient correlated with abortion, early preeclampsia and preterm birth. Conclusions: Low levels of maternal serum markers correlate with adverse pregnancy outcomes in an obese population. We recommend to develop further calculators of obstetric risk to improve positive predictive value and to establish a maternal-fetal surveillance plan.

Cervical Molar Pregnancy and Its Future Fertility.

Background: Cervical complete molar pregnancy is very rare and fatal and surgical intervention makes it lethal. Case report: A 37 years G2P1L1 with previous cesarean section 4 years back, had presented with brisk vaginal bleeding after evacuation at private hospital 2 days back. She was admitted in labor room,VSS Medical College, Burla at 9 pm on 22.04.2012 as an emergency case. USG report which was done at our institute, showed cervical invasive mole with right ovarian cyst. She was managed with methotrexate and no other intervention was required, as her serum b-hCG was declining. Now, she is having a normal pregnancy. Conclusion: Surgical intervention in such situations is very fatal. We propose her to go for a fertility sparing medical management.

Epidemiología de embarazo ectópico en el Hospital Central de San Cristóbal “Dr. José María Vargas” 2000-2005 / Epidemiology of ectopic pregnancy at the Hospital Central of San Cristóbal “Dr. José María Vargas” 2000-2005

El Embarazo Ectópico es la implantación del óvulo fecundado en un sitio diferente al endometrio. Se realizó un estudio retrospectivo, descriptivo y longitudinal, para conocer el comportamiento de algunas variables clínico-epidemiológicas relacionadas con el Embarazo Ectópico durante los años 2000-2005 en el Hospital Central de San Cristóbal “Dr. José María Vargas”. El estudio estuvo compuesto por 200 pacientes ingresadas con diagnóstico de Embarazo Ectópico. El antecedente ginecológico encontrado más frecuente fue aborto incompleto (34,5 por ciento) seguido del uso de dispositivos intrauterinos (12 por ciento). La clínica más llamativa fue el dolor abdominal (46 por ciento). El método paraclínico predominante la ecografía (75 por ciento). A la mayoría de las pacientes se les diagnóstico Embarazo Ectópico en su forma accidentada (95,93 por ciento) y localización ampollar (0,29 por ciento).

Adverse Pregnancy Outcome in Case of a False Positive Screening Test Using MS - AFP and Free beta - hCG / 대한산부인과학회잡지

OBJECTIVE: To determne whether abnormal results of doble saeening tests for Down syndrome with MSAFP and free B-hCG are associated with adverse pregnancy outcome. METHODS: Between October 1994 and September 1997, 205 among 1731 who were screened had increased risk for Down screening program of CIS biointernational, Fetuses with Chromosomal abnormality or congenital anomalies and less than 35 years of maternal age were excluded from this study. Down syndrome screening test was performed between 14-22 weeks of gestation. RESULTS: Of 1731 women, 205 (13.4%) had increased Down syndrome risk. The pregnancy outcome of women with increased Down syndrome risk were compared with those of women without such risk There were no significant difference in the incidence of preterm labor (6[2.9%] vs 112[7.3%)), premature rupture of the membranes (2[0.9%] vs 56[3.6%]), pregnancy induced hypertension (2[0.9%] vs 36[2.3%]), abruptio placentae (0[0%] vs 2[0.1%]), low birth weight (2[0.9%] vs 21[1.3%]), oligohydramnios (4[1.9%] vs 10[0.6%]), intrauterine fetal death (0[0%] vs 2[0.1%]). CONCLUSION: False positive results of Down syndrome screening test in the 2nd trimester do not appear to be associated with adverse pregnancy outcome. But there are statistically significant increases of adverse pregnancy outcome in wemen with elevation of MSAFP or elevation of free B-hCG.

The Efficacy of Vaginal Fluid B-hGC Levels for Detecting Premature Rupture of Membranes / 대한주산의학회잡지

Premature rupture of membranes(PROM) means the rupture of amniotic membranes at any time prior to labor during the gestational period. The dilemma of correctly diagnosing rupture of the fetal membranes is well known as the consequences of management based on an incorrect diagnosis. This study was undertaken to determine if the measurement of B-hCG levels in the vaginal fluid is useful for the diagnosis of premature rupture of membranes. HCG is synthesized and secreted by the placental syncytiotrophoblast and it is normally found in amniotic fluid, maternal urine and blood. We used B-hCG for diagnosis of PROM to exclude the cross reaction with other hormones. After irrigating the posterior vaginal fornix with 3 ml of sterile saline and obtaining vaginal washings, we measured B-hCG levels. The groups were classified normal group(group I), confirmed PROM group(group II ), and suspicious PROM group(groupIII) during the third trimester. The median and 95% confidence intervals(CIS) of vaginal fluid B-hCG in each group(normal, confirmed PROM, suspicious PROM group) were 30.99mIU/ml(range: 0.32-209.89mIU/ml), 188.61mIU/ml(range: 9.65-2095.00mIU/ml), 69.63mIU/ml(range 4.76-349.56mIU/ml). There was significant difference between normal and confirmed PROM group(p<0.05), sensitivity was 95.00%, specificity 80.00%, positive predictive value 82.60%, negative predictive value 94.12%, and accuracy 87.50%, using threshold value of 60mIU/ml. There was significant difference between normal and suspicious PROM group(p<0.05) but the result of the B-hCG was not used in the obstetric decision. In terms of these results, the B-hCG level in vaginal fluid is a useful marker of PROM during the third trimester. A new technic is proposed to confirm the diagnosis of rupture of the membranes based on the introduction of B-hCG in vaginal fluid.

The Predictive Value of Serum beta Human Chorionic Gonadotropin and Progesterone Measurements for Pregnancy Outcome after In Vitro Fertilizationand Embryo Transfer / 대한산부인과학회잡지

OBJECTIVE: To estimate the predictive value of initial serum B-hCG and progesterone measurement for pregnancy outcome in IVF-ET. METHODS: Serum B-hCG at 11-12th day after embryo transfer and progesterone at 7th day after oocyte aspiration were measured in 48 successful pregnant IVF-ET cases from July 1993 to June 1997. RESULTS: Of 48 cases, 26 cases (54.2%) successfully carried to sustaining gestation and 22 cases (45.8%) failed to sustain gestation. The estimated initial serum B-hCG levels in the normal sustaining pregnancy group (132.28+ 22.42 mlU/ml) were statistical significantly higher than 29.43+8.08 mIU/ml in the failed sustaining pregnancy group (p<0.001), while the estimated initial serum progesterone levels showed no significant differences (p=0.159). In order to determine the predictive values using the Receiver Operator Curve (ROC), an appropriate cutoff value of 38 mIU/ml for initial serum B-hCG was obtained. In IVF-ET pregnancies, the estimated serum B-hCG levels in cases of chemical abortion in failed sustaining pregnancy were significantly lower compared to the normal sustaining pregnancy group (p<0.001). CONCLUSION: The initial serum B-hCG levels at 11 days after embryo transfer could be used to predict the pregnancy outcome in an IVF program. An initial progesterone level acquired on the 7th day after oocyte retrieval is not a useful indicator to predict pregnancy outcome.

Primary Intracranial Choriocarcinoma: Case Report

Primary intracranial choriocarcinoma is a extremely rare neoplasm since the case was reported by Askanasy, in 1906, there have been 35 reported, even if germinal neoplasms containing chorocarcinoma-like tissue are added. But pure choriocarcinoma was rarely reported. The purpose of this paper is to report a case of 18-year-old boy with tumor in subependymal region around left frontal horn, which was present with high level of serum beta chain of chorionic gonadotropin(B-HCG) and was verified as germine choriocarcinoma by biopay.