Tubal Ectopic Pregnancy with Undetectable Initial Serum ß-Human Chorionic Gonadotropin Level.

We present a case of a tubal ectopic pregnancy (EP) in a patient with an initially undetectable serum ß-human chorionic gonadotropin (ß-hCG) level. A 33-year-old woman in a same-sex relationship underwent timed donor intrauterine insemination. Her serum ß-hCG level was <5 mIU/mL 14 days after the intrauterine insemination. She reported menstrual bleeding 3 days after her negative pregnancy test and returned to the office 10 days later to begin a new treatment cycle. Her serum levels of estradiol, progesterone, and ß-hCG were 119 pg/mL, 6.1 ng/mL and 1157 mIU/mL, respectively. Transvaginal ultrasonography did not show an intrauterine pregnancy. Her ß-hCG level increased to 1420 mIU/mL the next day. She was diagnosed with a pregnancy of unknown location and treated with methotrexate. Her ß-hCG levels continued to increase despite 3 methotrexate doses, necessitating laparoscopy. The diagnostic laparoscopy demonstrated approximately 100 mL of hemoperitoneum in the posterior cul-de-sac with an intact right fallopian tube that was dilated at its distal end by the EP. A total right salpingectomy was performed. Her ß-hCG level was <5 mIU/mL 3 weeks later. The current case supports that although rare, an undetectable serum ß-hCG level does not completely rule out the diagnosis of an EP.

The Primodos components Norethisterone acetate and Ethinyl estradiol induce developmental abnormalities in zebrafish embryos.

Primodos was a hormone pregnancy test used between 1958-1978 that has been implicated with causing a range of birth defects ever since. Though Primodos is no longer used, it's components, Norethisterone acetate and Ethinyl estradiol, are used in other medications today including treatments for endometriosis and contraceptives. However, whether Primodos caused birth defects or not remains controversial, and has been little investigated. Here we used the developing zebrafish embryo, a human cell-line and mouse retinal explants to investigate the actions of the components of Primodos upon embryonic and tissue development. We show that Norethisterone acetate and Ethinyl estradiol cause embryonic damage in a dose and time responsive manner. The damage occurs rapidly after drug exposure, affecting multiple organ systems. Moreover, we found that the Norethisterone acetate and Ethinyl estradiol mixture can affect nerve outgrowth and blood vessel patterning directly and accumulates in the forming embryo for at least 24 hrs. These data demonstrate that Norethisterone acetate and Ethinyl estradiol are potentially teratogenic, depending on dose and embryonic stage of development in the zebrafish. Further work in mammalian model species are now required to build on these findings and determine if placental embryos also are affected by synthetic sex hormones and their mechanisms of action.

Effects of early pregnancy diagnosis by per rectal palpation of the amniotic sac on pregnancy loss in dairy cattle.

OBJECTIVE: To determine effects of per rectal amniotic sac palpation (ASP) for pregnancy diagnosis during early gestation on pregnancy loss in lactating cows. DESIGN: Controlled, randomized block design. ANIMALS: 368 pregnant dairy cows. PROCEDURES: Pregnancy was detected via transrectal ultrasonography (TRUS) at day 29 (day of estrus = day 0), and cows were allocated into a control group (n = 167 cows) and ASP group (180). Control cows were not subjected to pregnancy diagnosis via palpation per rectum. Per rectal ASP was performed between days 34 and 43 by only 1 experienced veterinarian. All cows were reevaluated with TRUS on days 45, 60, and 90. RESULTS: 21 cows were removed because of illness. Pregnancy loss between days 29 and 90 occurred in 44 of 347 (12.7%) cows. Pregnancy loss for the control and ASP groups from days 29 to 90 occurred in 22 of 167 (13.2%) and 22 of 180 (12.2%) cows, respectively. Late embryonic pregnancy loss (days 29 to 45) for the control and ASP groups occurred in 18 (10.8%) and 15 (8.3%) cows, respectively. Early fetal pregnancy loss (days 46 to 60) for the control and ASP groups occurred in 2 of 149 (1.3%) and 6 of 165 (3.6%) cows, respectively, and late fetal pregnancy loss (days 61 to 90) for the same groups occurred in 2 of 147 (1.4%) and 1 of 159 (0.6%) cows, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Pregnancy diagnosis via per rectal ASP during early gestation did not increase pregnancy loss in dairy cattle.

Manejo práctico de adalimumab / Practical management of adalimumab

Adalimumab, aprobado en Estados Unidos y Europa para el tratamiento de las artritis reumatoide activa y psoriásica y de la espondilitis esclerosante, pudo utilizarse previamente en el tratamiento de la psoriasis en placas como ¿medicamento de uso compasivo?. Debe recordarse que u empleo será en adultos con psoriasis moderada-grave que, por algún motivo, no toleran o no responden a las otras terapéuticas sistémicas existentes o a la fototerapia. Previamente a su empleo se debe realizar una detallada historia clínica con el estudio de antecedentes de tuberculosis y realizar las pruebas de embarazo y Mantoux. La dosis actualmente recomendada para la inducción es de 80 mg en la semana 0, seguida de 40 mg la primera semana y de dosis de mantenimiento de 40 mg cada dos semanas. Las revisiones serán cada 4 semanas en los primeros tres meses de tratamiento y más adelante, según la evolución, pueden espaciarse. Debe retirarse si el paciente va a ser intervenido quirúrgicamente y no se recomiendan las vacunas de agentes vivos mientras esté con este tratamiento (AU)

Adalimumab, approved in the United States and Europe for the treatment of active rheumatoid and psoriatic arthritis and ankylosing spondylitis, might be used previously in the treatment of plaque psoriasis as "compassionate use drug." It should be remembered that its use should be in adults with moderate-severe psoriasis who, for some reason, do not tolerate or respond to the other existing systemic therapies or to phototherapy. Prior to its use, a detailed clinical history should be obtained with the study of the background of tuberculosis, and pregnancy and Mantoux tests should be performed. The current recommended dose for induction is 80 mg in week 0, followed by 40 mg the first week and maintenance dose of 40 mg every two weeks. Revisions should be performed every 4 weeks in the first three months of treatment and can be spaced after that, according to the evolution. It should be withdrawn if the patient is going to undergo surgery and vaccines with live agents are not recommended while the patient is on this treatment (AU)

Epidemiological investigations of an outbreak of intestinal atresia in two Israeli dairy herds.

An epidemiological investigation of an outbreak of intestinal atresia in Israeli Holstein-Friesian newborn calves showed a linkage with rectal palpation for early pregnancy diagnosis, performed less than 42 days after insemination. The odds of an exposed calf, i.e., one born to a dam that was diagnosed by early palpation as having intestinal atresia were 119.7 times higher than one born in normal control herds (95% CI; 7.4-1946.3). A total of 682 calves-at-risk was recorded from mid-1998 to mid-2000 and a total of 47 calves (6.9%) were born with intestinal atresia during this period. Two forms of intestinal atresia were recognized at post-mortem: atresia coli and atresia ilei.

Pregnancy attrition associated with pregnancy testing by rectal palpation.

The objective of this study was to estimate the effect on calving risk of interval from AI date until scheduled date of pregnancy examination. First AI (n = 7105) from 65 dairy herds in the United States and Canada were followed for 294 d to determine whether cows calved. Calving was modeled as a function of the number of days in the interval, herd, season, and breeding at PGF2 alpha-induced estrus by multivariate logistic regression. The main effects of herd and AI following PGF2 alpha-induced estrus were significantly associated with calving rate from first AI. The main effects of interval and season were not significantly associated with calving.

Correlation between pregnancy diagnosis by membrane slip and embryonic mortality.

In a study involving 7,477 pregnant cows (5,426 Holstein-Friesians and 2,051 Guernseys), each pregnancy was diagnosed by rectal palpation, using the membrane slip technique. Each cow was examined twice, first by a veterinary student, then by a clinician. Of the cows diagnosed pregnant, 7,058 (94.4%) calved. The embryonic death rate in cows examined during the first 50 days of gestation was significantly (P less than 0.001) greater than that associated with examinations after 50 days of gestation. A significant difference was found between herds in different years (P less than 0.05). There was no conclusive indication that embryonic loss at the time of or shortly after early examination was iatrogenic abortion resulting from the membrane slip technique.

The oral-hormone pregnancy test: possible association with anencephaly

A case is described of an anencephalic monster delivered of a mother who had received a synthetic oestrogen-progestogen preparation as a diagnostic test during the first trimester of pregnancy. The possible association between the use of synthetic sex hormones in the diagnosis of pregnancy and an increased risk of congenital malformations is discussed (AU)