The administration of long in-vitro fertilization protocol in adenomyosis: case series.

Background: Adenomyosis is a gynaecological condition characterized by the infiltration of endometrial glands and stroma resulting in ectopic intramyometrial, leading to the generalized enlargement of the uterus. Various cyclical regimens are employed globally to assist infertile women with adenomyosis during in-vitro fertilization (IVF) treatment because there is no consensus regarding the best protocol for managing adenomyosis. Case: The authors reported two cases the administration of long IVF protocol in Adenomyosis with pregnancy outcome. In both cases examined were found that the levels of anti-Mullerian hormone (AMH) were below the 25th percentile. Nevertheless, in both of these cases, the number of oocytes successfully retrieved was more than 5, which may have been influenced by the use of GnRH agonists in previous cycles of long protocol. Both of them were diagnosed with intrauterine pregnancy after transfer embryo. Conclusion: Although there is currently no consensus on the most suitable protocol for adenomyosis cases, the application of a long protocol in both of the aforementioned cases has yielded positive IVF outcomes.

Comparison of salpingectomy and tubal occlusion for hydrosalpinx in in-vitro fertilization outcome.

The occurrence of hydrosalpinx can reduce the success rate of assisted reproductive technology. The laparoscopic salpingectomy and tubal occlusion have been shown to improve in-vitro fertilization (IVF) outcomes in this disease. The primary goal of this review was to assess and compare the IVF outcome following salpingectomy or tubal occlusion in the published literature. The authors included studies with at least one of the following outcomes: days of controlled ovarian hyperstimulation, retrieved oocyte number, fertilization rates, clinical pregnancy rate, miscarriage rate, or ectopic pregnancy rate. In conclusion, proximal tubal occlusion outperforms salpingectomy in terms of fertilization rate while offering no evident advantages in terms of days of controlled ovarian hyperstimulation, retrieved oocytes number, IVF results, or problems in treating hydrosalpinx patients prior to IVF. These data may help clinicians choose the best therapy for patients with hydrosalpinx prior to IVF.

Recurrent Partial Hydatidiform Mole: A Case Report of Seven Consecutive Molar Pregnancies.

Hydatidiform mole (HM) is an aberrant pregnancy characterized by atypical trophoblastic hyperplasia, hydropic chorionic villi, and deprived fetal development. There are two types of HM, ie, complete (CHM) and partial (PHM). Both CHM and PHM can recur; however, the recurrence of PHM is very scarce compared to CHM. In this report, we present a case of a 33-year-old woman with recurrent PHM for 7 times without any normal pregnancy in-between. PHM was determined by histology examination. The patient underwent suction curettage and was followed up with serial ß-hCG levels. Recurrent PHM, although rare, is associated with an increased incidence of malignancy. A series of clinical and ß-hCG evaluation should be warranted because of the possibility of gestational trophoblastic neoplasia development.

Relationship Between D-Dimer Levels and Neutrophil-to-Lymphocyte Ratio (NLR) in Preeclamptic Pregnant Women with COVID-19: A Cohort Study.

BACKGROUND Preeclampsia involves an inflammatory response and vascular endothelial dysfunction. In COVID-19, there is also tissue damage and an inflammatory response that stimulates the formation of D-dimers and an increase in the neutrophil-to-lymphocyte ratio (NLR). These 2 parameters have become laboratory tests carried out both in preeclampsia and COVID-19. This study aimed to determine the relationship between D-dimer levels and NLR in patients with both COVID-19 and preeclampsia. MATERIAL AND METHODS This was an observational analytic study with a retrospective approach. The subjects were pregnant women with gestational age >20 weeks diagnosed with severe preeclampsia and had D-dimer and neutrophil-to-lymphocyte ratio (NLR) laboratory results at Hasan Sadikin Hospital Bandung during the period April 2020 to July 2021. We enrolled 31 COVID-19 patients with preeclampsia and 113 COVID-19 patients without preeclampsia. RESULTS The mean level of D-dimer in COVID-19 patients with preeclampsia was 3.66±3.15 and in those with COVID-19 without preeclampsia it was 3.03±3.15 (P<0.05). The mean NLR value in COVID-19 patients with preeclampsia was 7.22±4.30 and in COVID-19 patients without preeclampsia it was 5.47±2.20 (p<0.05). In the Spearman correlation test, the correlation coefficient was 0.159. Area under curve (AUC) D-dimer level was 64.9% (p<0.05) and NLR was 61.7% (p<0.05). CONCLUSIONS There was a significant difference (P<0.05) in D-dimer and NLR between COVID-19 patients with preeclampsia and those without preeclampsia. There was also a weak positive relationship between D-dimer and NLR levels in COVID-19 patients with preeclampsia, which means that the higher the D-dimer level, the higher the NLR value in COVID-19 patients with preeclampsia.

Ratio of Serum Calcium to Magnesium Levels on Pregnancy with and without Preeclampsia.

BACKGROUND Preeclampsia increases maternal and perinatal mortality and is affected by calcium and magnesium levels. Reduced extracellular levels of calcium and magnesium constitute the pathogenesis of eclampsia. A reduction in the calcium-magnesium ratio may aid in the detection and prevention of preeclampsia. MATERIAL AND METHODS This was an analytical observational study with a cross-sectional design, including patients with and without preeclampsia (inpatient and outpatient). A total of 246 patients were included in this research; 138 patients had preeclampsia and 108 patients did not. All examinations of magnesium and calcium levels at the Hasan Sadikin Hospital Clinical Pathology laboratory were conducted using an ion selective electrode modified with methylthymol blue complexometric titration. RESULTS Patients with preeclampsia had significantly higher average serum magnesium and calcium levels than did patients without preeclampsia (2.85 vs 2.09, P=0.0001; 4.45 vs 4.85, P=0.025, respectively). Patients with preeclampsia demonstrated significantly lower serum calcium-magnesium ratios than did patients without preeclampsia (1.98 vs 2.60, P=0.0001). Receiver operating characteristic curve analysis on the serum calcium-magnesium ratio showed an area under the curve of 68.0% (P=0.0001), with a cutoff value of 2.36 (sensitivity 64.8%, specificity 62.3%), indicating that patients with serum calcium-magnesium ratios of <2.36 were predicted to have a risk of preeclampsia. CONCLUSIONS Patients with preeclampsia had significantly lower serum calcium-magnesium ratios than did patients without preeclampsia; therefore, a low calcium-magnesium ratio could be a risk factor for preeclampsia.

A Case of Rapid Transformation from Hydatidiform Mole to Invasive Mole: The Importance of ß-hCG (Human Chorionic Gonadotropin) Serum Levels in Follow-Up Evaluation.

BACKGROUND Gestational trophoblastic disease (GTD) is a spectrum of disorders consisting of premalignant (ie, complete [CHM] and partial hydatidiform moles [PHM]) and malignant conditions (ie, invasive moles, choriocarcinoma, placental site trophoblastic tumors, and epithelioid trophoblastic tumor). If GTD persists after initial treatment and has persistent elevated beta human chorionic gonadotropin (ß-hCG), it is referred to as post-molar gestational trophoblastic neoplasia (pGTN). To date, there is no detailed information regarding how fast invasive moles can develop from CHM. However, the risk of developing any pGTN from CHM is rare within 1 month and is greatest in the first 12 months after evacuation, with most cases presenting within 6 months. CASE REPORT We present a case of a 46-year-old primigravida woman with rapid transformation of an invasive mole. In the beginning, the patient had a chief concern of a uterus size greater than the gestational dates. Laboratory evaluation showed high ß-hCG serum level (>300 000 mIU/mL), and ultrasonography evaluation revealed a hydatidiform mole. Suction evacuation and curettage procedures were then performed. Pathology evaluation afterwards revealed a complete hydatidiform mole without any sign of malignancy. Twenty-two days afterwards, the patient came to the emergency room with vaginal bleeding. ß-hCG serum level was high (53 969 mIU/mL), and ultrasonography examination showed the presence of fluid filling the uterine cavity. The patient was then diagnosed with GTN, and hysterectomy was chosen as the treatment of choice. After the surgery, her ß-hCG serum level gradually reverted back to normal. CONCLUSIONS Invasive moles can develop less than 1 month after suction evacuation and curettage procedure for CHM. Serial ß-hCG serum level evaluation according to the guideline should be performed to prevent late diagnosis, which could lead to the development of metastasis and worsen the prognosis.

The Platelet to Lymphocyte and Neutrophil to Lymphocyte Ratios in Predicting Response to Platinum-based Chemotherapy for Epithelial Ovarian Cancer.

OBJECTIVE: The patients with advanced-stage ovarian cancer have higher factors complicating surgery; thus, the best choice for them is surgery with chemotherapy with six cycles of adjuvant chemotherapy. Generally, chemotherapy can be evaluated in various ways, phsychal examination, radiology examination, and laboratory examination. This study aims is to examine if the measurement of the platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) can be used to predict a patient's response to chemotherapy. METHODS: Analytic observational study with a case-control design conducted in the Dr. Hasan Sadikin Hospital in Bandung from 2017 to 2018. This study used the medical record of ovarian cancer patients with post-surgery complete blood counts and histopathological reports. The sample size was determined based on the categorical test's statistical calculation to obtain a total number of at minimal 90 samples. All the study subjects who had undergone complete chemotherapy were followed up for 6 months. Their response to chemotherapy was assessed with a clinical examination, ultrasonography, and a CA-125 blood test every 3 months. RESULTS: In 2017-2018, 504 patients were diagnosed with ovarian cancer at the Dr. Hasan Sadikin Hospital in Bandung, Indonesia. After reassessment, 116 patients had stage I to III ovarian cancer and underwent cytoreduction followed by platinum chemotherapy. The age, cancer stage, and types of epithelial cells in the platinum-sensitive and platinum-resistant patients were characterized. There were significant differences between the two groups in age and cancer stage characteristics (p < 0.05). The increase in platelet/lymphocyte (p = 0.003) and neutrophil/lymphocyte ratios (p = 0.026) are associated with the increase in the response to platinum chemotherapy against epithelium-based cancers. CONCLUSION: A patient's NLR and PLR are strongly associated with his response to chemotherapy.

A Rare Case of Early Transformation of Gestational Trophoblastic Neoplasia Following Molar Pregnancy.

BACKGROUND Gestational trophoblastic disease (GTD) encompasses a group of disorders that arise from abnormal growth of trophoblastic tissue. The spectrum of GTD includes 2 major groups: benign and malignant. The benign form is a hydatidiform mole, either complete or partial; the malignant forms, referred to as gestational trophoblastic neoplasia (GTN), consist of invasive moles, choriocarcinomas, placental site trophoblastic tumors, and epithelioid trophoblastic tumors. Most patients who undergo evacuation of a hydatidiform mole by curettage have a disease-free period before a new tumor develops that can be considered malignant. In rare cases, metastasis occurs rapidly and manifests coincidentally before the hydatidiform mole can be evacuated. CASE REPORT A 19-year-old woman in Bandung City, West Java, Indonesia, was diagnosed with a molar pregnancy with early evidence of a mass in her vagina that was suspicious for stage II GTN. The early emergence of a vaginal mass was a rare case of early transformation of a molar pregnancy into GTN. CONCLUSIONS Careful evaluation is warranted of patients with characteristics typical of an intrauterine molar pregnancy who have an early presentation of a vaginal mass because of the possibility that the diagnosis could be GTN.