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PubMed2002

Shortened fetal long bones: a possible in utero manifestation of placental function.

Shortened fetal long bones (SFLB) are usually indicative of a skeletal dysplasia. Our aim in this observational retrospective study was to describe a new association between SFLB, small for gestational age (SGA) fetuses and placental abnormalities, and to suggest an aetiologic explanation. During the last decade we have evaluated nine cases in which SFLB (more than 2SD below the mean) was associated with SGA, abnormal maternal serum placental hormones and abnormal placental sonography. Six cases had significantly increased second trimester maternal serum beta hCG and four developed toxaemia of pregnancy or had chronic hypertension. On histology, mature placentas with vascular abnormalities, including chorangiosis, large infarcts and slightly increased syncytial knots were noted. The combination of SFLB, SGA fetuses and placental abnormalities (sonographic, as well as histological) suggested a possible common pathway in the aetiology of this association.

Adult↗
PubMed2003

Early vaginal bleeding and first-trimester markers for Down syndrome.

OBJECTIVES: To assess the effect of early vaginal bleeding on first-trimester markers for Down syndrome. METHODS: A retrospective study was conducted on 2330 normal singleton fetuses who underwent first-trimester combined screening for Down syndrome based on ultrasound and maternal serum markers. Fetal nuchal translucency (NT), maternal serum pregnancy-associated plasma protein A (PAPP-A), free beta-hCG and the false-positive rate of the test were compared between pregnancies with (n = 253) and without (n = 2077) a history of early vaginal bleeding. RESULTS: The mean +/- SD log(10) MoM for NT, PAPP-A and free beta-hCG was -0.024 +/- 0.101, 0.007 +/- 0.244, 0.047 +/- 0.273 and -0.011 +/- 0.108, -0.006 +/- 0.223, 0.008 +/- 0.264 in pregnancies with and without a history of early vaginal bleeding, with a p value of 0.07, 0.40 and 0.03 respectively. The false-positive rate was 2.4% and 3.6% (p = 0.33). CONCLUSIONS: An earlier episode of vaginal bleeding is associated with an increase in maternal serum free beta-hCG levels at first-trimester combined screening for Down syndrome. However, this phenomenon is unlikely to significantly affect the false-positive rate of the test.

Adolescent↗
PubMed1993

Immunophenotyping of mitotic cells from long-term cultures of chorionic villi.

Chromosomal mosaicism in chorionic villus samples (CVS) may arise from different sources, such as clonal diversity within the chorionic tissue or contamination with maternal cells. To determine the origin of karyotyped cells, we compared the immunocytochemical features of mitotic cells in CVS long-term cultures with histological sections of their tissue of origin, i.e. chorionic villi. Immunolabelling of intermediate filaments specific for epithelial cells (cytokeratin) and mesenchymal cells (vimentin) established that mitoses yielded from CVS long-term cultures indeed stem from independently growing clones derived from both the epithelial and mesenchymal parts of the chorionic villi. Thus, mosaicism in CVS cultures may reflect true genetic heterogeneity within the biopsy. However, epithelial chorionic cells undergo in vitro metaplasia leading to co-expression of cytokeratins and vimentin. Fetal-specific immune markers (beta-HCG and SP1-glycoprotein) are not reliably expressed in CVS cell culture.

Chorionic Gonadotropin↗
PubMed1990

A controlled trial of bestatin in hydatidiform mole.

A prospective randomized controlled trial was conducted to study whether Bestatin, an immunomodifier, can reduce the incidence of persistent gestational trophoblastic disease in patients with hydatidiform mole. A group of 21 patients (Bestatin group) received 30 mg Bestatin daily after evacuation of the hydatidiform mole. A second group of 23 patients (control group) did not receive any drug. Blood was taken for white cell counts, differential counts, lymphocyte subset counts (CD2+, CD4+, CD8+ and B cells) and natural killer cell activity before evacuation of the hydatidiform moles. The tests were repeated every 4 weeks after evacuation until the serum beta subunit of human chorionic gonadotropin (beta hCG) had returned to normal or until the patient had to receive chemotherapy because of persistent gestational trophoblastic disease. There was no significant difference in the age of the patients, the pre-evacuation serum beta hCG, or the gestational age between the two groups. Chemotherapy was needed by 6 patients in the Bestatin group (28.6%) and 3 patients in the control group (13%) because of persistent gestational trophoblastic disease. There was no significant difference in any of the immunological parameters between the two groups before or after evacuation. We conclude that Bestatin at this dosage does not improve the immunological functions or clinical outcome in patients with hydatidiform mole.

Adjuvants, Immunologic↗
PubMed1989

The effects of maternal exercise on early pregnancy outcome.

This study was designed to test the hypothesis that vigorous aerobic exercise during both the periconceptional period and early pregnancy increases the incidence of abnormal early pregnancy outcome. Exercise performance was prospectively monitored before and during pregnancy in 47 recreational runners, 40 aerobic dancers, and 28 physically active, fit controls. Pregnancy was diagnosed by an early test for beta-subunit human chorionic gonadotropin and viability was confirmed by ultrasonography at 40 days' conceptional age. Spontaneous abortion occurred in 19% of the pregnancies. The incidence was 17% in the runners, 18% in the aerobic dancers, and 25% in the controls. At term, one congenital abnormality was detected in each of the three groups. Late pregnancy events, potentially related to abnormalities of placentation, were limited to two cases of mild pregnancy-induced hypertension. We conclude that, in physically fit women, continuation of these types of aerobic activity at intensities between 50% and 85% of maximum during the periconceptional period and early pregnancy does not appreciably alter early pregnancy outcome.

Abortion, Incomplete↗
PubMed1986

Diagnosis of anterior chamber metastasis by serologic marker found during anterior chamber paracentesis.

A 29-year-old man developed anterior uveitis unresponsive to intensive topical and systemic therapy. He had recently completed a course of chemotherapy with apparent response and resolution of metastasis from a mixed germ cell tumor (embryonal carcinoma and seminoma). Anterior chamber paracentesis was nondiagnostic on two occasions for metastatic cells. At the time of his second paracentesis a tumor marker, human chorionic gonadotropin-beta subunit, was used to confirm the diagnosis of anterior chamber metastasis to the eye.

Adult↗
PubMed1985

The structures of the serine-linked sugar chains on human chorionic gonadotropin.

The human chorionic gonadotropin beta-subunit tryptic COOH-terminal peptide (residues 123-145) which contains 3 serine-linked sugar chains was isolated. The sugar chains were cleaved by beta-elimination and then separated by gel filtration. The peaks were pooled and their compositions determined. The products of serial glycosidase digestion and periodate oxidation of the intact glycopeptide were also characterized. Of the serine-linked sugar chains, 13% were the hexasaccharide NeuAc alpha 2,3 Gal beta 1,3 (NeuAc alpha 2,3 Gal beta 1,4 GlcNAc beta 1,6) GalNAc, 34% the tetrasaccharide NeuAc alpha 2,3 Gal beta 1,3 (NeuAc alpha 2,6) GalNAc, 43% the trisaccharide NeuAc alpha 2,3 Gal beta 1,3 GalNAc and 10% the disaccharide NeuAc alpha 2,6 GalNAc.

Carbohydrate Conformation↗
PubMed1994

Management of early ectopic pregnancy.

OBJECTIVE: Management of early ectopic pregnancy was investigated in a multicenter, prospective study. METHODS: Serum beta-hCG levels were monitored after therapy and correlated to the type of management, gestational age, and initial serum beta-hCG levels in 119 patients with ectopic pregnancies detected at 5-7 postmenstrual weeks. RESULTS: Salpingectomy was performed in 16 patients. No post-operative complications were reported. After conservative laparoscopic surgery of 51 ectopic pregnancies, 9 (18%) had delayed decrease or an increase of serum beta-hCG levels. Re-operations were performed in 4 (7%) patients. Similar findings were noted in 2/6 patients after conservative operations performed by laparotomy. Intrachorionic injection treatment was successful in 17/18 ectopic pregnancies, and expectant management in 7/8 patients with initial serum beta-hCG levels below 250 mIU/ml. CONCLUSIONS: Persistence of trophoblastic activity is a potential complication of conservative surgical treatment of ectopic pregnancy. A detailed diagnosis as early as 6-7 post-menstrual weeks may be the key for future non-surgical management of ectopic pregnancy.

Abortifacient Agents↗
PubMed1983

Anaplastic seminoma.

Fourteen patients with anaplastic seminoma were analyzed retrospectively. At the time of presentation anaplastic seminoma has similar prognosis stage for stage as the classic seminoma. However, the distinctive histologic findings and the high rates of local invasion and of elevations of serum beta-subunit human chorionic gonadotropin serve to distinguish anaplastic seminoma from the classic seminoma. These features, suggesting a possibly greater metastatic potential for anaplastic seminoma, warrant its continued identification as a distinct pathologic subtype.

Adult↗
PubMed1990

Urinary gonadotropin fragment, a new tumor marker. I. Assay development and cancer specificity.

Urinary gonadotropin fragment (synonyms: UGF and human chorionic gonadotropin beta-subunit core fragment) is a small peptide which is present in the urines of pregnant women, of those with trophoblast disease and of those with certain nontrophoblastic malignancies. We developed a new UGF assay with improved specificity and then investigated levels in urines of 493 women: 155 healthy and postmenopause, 79 healthy and premenopause, 89 with benign gynecologic disease, and 170 with active gynecological cancer. A UGF cutoff level of greater than 3 fmole/ml was chosen to monitor the progress of patients during and after cancer therapy. Using this cutoff value, UGF specificity and sensitivity for active cancer were 90 and 66%, respectively. Levels exceeded this cutoff in 74% of women with recurrent disease. For screening purposes and for differentiating benign and malignant disease a cut-off of 8 fmol/ml, was indicated. At this higher cutoff specificity and sensitivity for active cancer were 99 and 46%, respectively.

Biomarkers, Tumor↗
PubMed2003

Relationship among maternal serum endocrinology, placental karyotype, and intervillous circulation in early pregnancy failure.

OBJECTIVE: To evaluate the relationship among maternal serum endocrinology, placental karyotype, and intervillous blood flow in missed miscarriage. DESIGN: Cross-sectional study of maternal serum, transvaginal ultrasound/Doppler, and placental cytogenetic and immunohistochemical investigations. SETTING: Tertiary care academic hospital. PATIENT(S): One hundred fifty-two women with missed miscarriage between 7 and 13 weeks of gestation. INTERVENTION(S): Ultrasound features, placental intervillous circulation findings on color Doppler imaging, and maternal serum level of alpha-fetoprotein (AFP), beta-hCG, E(2), P, and inhibin A were compared retrospectively with placenta karyotype and hCG immunochemistry. MAIN OUTCOME MEASURES: Data were analyzed according to karyotype results, presence or absence of an intervillous circulation, and delay between fetal demise and evacuation. RESULT(S): The presence of intervillous blood flow and serum concentrations of the different hormones were independent of placental karyotype. Serum beta-hCG and P were significantly higher in cases with intervillous blood flow. No difference in immunostaining for beta-hCG was found between placental tissues from normal pregnancies and missed miscarriages, but significantly higher villous beta-hCG content was found on Western blotting in miscarriage with a recent fetal demise. CONCLUSION(S): The excessive entry of maternal blood inside the placenta in the early stage of most miscarriages is unrelated to conceptus karyotype, and hCG features may reflect a temporary attempt of the trophoblast to stabilize after the initial oxidative insult.

Abortion, Spontaneous↗
PubMed1981

Genital abnormalities and abnormal semen analyses in male patients exposed to diethylstilbestrol in utero.

Urologic examination of 48 male patients exposed in utero to diethylstilbestrol showed genital abnormalities in 29. Only 33 per cent of the patients studied had normal semen analyses by Eliasson scoring. Genital abnormalities demonstrated included varicoceles, epididymal cysts, hypoplastic testes and undescended testes among others. None of the patients had elevations of alpha-fetoprotein or beta-subunit human chorionic gonadotropin. The high incidence of the aforementioned abnormalities suggests that all male patients exposed to diethylstilbestrol should undergo urologic examination and semen analysis. Additionally, a history of diethylstilbestrol exposure should be sought in all patients with apparent idiopathic infertility.

Abnormalities, Drug-Induced↗
PubMed1998

Extratubal secondary trophoblastic implants: clinicopathologic correlation and review of the literature.

Extratubal secondary trophoblastic implants (ESTI) are a rare complication of conservative laparoscopic procedures for tubal ectopic pregnancies. These implants present with persistent beta-hCG titers postoperatively and are probably the result of disruption of the ectopic pregnancy at salpingostomy or morcellation of the fallopian tube at salpingectomy. We describe the case of a 32-year-old woman who underwent a laparoscopic salpingectomy for a tubal ectopic pregnancy that was complicated postoperatively by peritoneal ESTI including extensive omental implants. Intraoperatively the lesions appeared as 0.3 cm red-black nodules and, microscopically, consisted of degenerating chorionic villi associated with implantation changes in the surrounding tissue. To the pathologist unaware of the clinical entity of ESTI, these lesions may present a diagnostic challenge.

Adult↗
PubMed2003

Intramural pregnancy with negative maternal serum b-HCG.

We report an extremely rare case of intramural pregnancy with negative maternal b-HCG value. The patient underwent a "myomectomy" but the pathology examination revealed chorionic villi consistent with ectopic pregnancy. Diagnosis is very difficult in cases with menorrhagia and especially when pregnancy is not suspected.

Chorionic Gonadotropin, beta Subunit, Human↗
PubMed1996

Late complications after systemic methotrexate treatment of unruptured ectopic pregnancies: a report of three cases.

BACKGROUND: The use of methotrexate (MTX) by systemic administration in the treatment of unruptured ectopic pregnancy has been reported as a safe and effective method. CASES: We report three cases (one hematosalpinx and two pelvic hematocoeles) of complications after the use of MTX in the treatment of unruptured ectopic pregnancies. All three cases came to our observation for pelvic pain, abnormal bleeding and a pelvic mass after an interval of 3-5 months, subsequent to the disappearance of symptoms and normalization of serum human chorionic gonadotropin beta-subunit (beta-hCG) levels. CONCLUSIONS: These findings suggest that: (a) such complications should be considered before selecting the mode of treatment for ectopic pregnancy; and (b) that an early ultrasonographic control should be performed after MTX treatment even when the decline in beta-hCG levels suggests a successful resolution. This would permit an early diagnosis of these late complications.

Adult↗
PubMed1996

Ectopic Pregnancy Treated by Combined Laparoscopic Surgery and Methotrexate

Conservative laparoscopic surgery using only an operative laparoscope, followed by injection of methotrexate 50 mg into the proximal segment of the involved tube, was performed successfully in seven women with ectopic pregnancy. Significant decreases in beta-subunit human chorionic gonadotropin occurred at 7, 14, and 30 days. No intraoperative or postoperative surgical complications, or side effects of methotrexate occurred. Five women became pregnant, with no miscarriages or recurrent ectopic pregnancies. This combined approach is a practical alternative to current management protocols.

Journal Article↗
PubMed2001

Clinical and pregnancy outcome following ectopic pregnancy; a prospective study comparing expectancy, surgery and systemic methotrexate treatment.

BACKGROUND: The improved possibility of an early diagnosis of ectopic pregnancy by use of serial quantitative beta-subunit human chorionic gonadotropin hormone levels together with transvaginal ultrasound has opened up options for conservative treatment. Systemic methotrexate treatment of unruptured ectopic pregnancy has emerged as a safe and effective alternative to surgical procedures. The aim of the present study was to investigate the effectiveness of methotrexate treatment in routine clinical practice, but also to assess pregnancy outcome during a 2.5-year follow-up period. METHODS: All patients presenting to the Department of Obstetrics and Gynecology, Umeå University Hospital, with signs and symptoms of ectopic pregnancy between January 1, 1995 and December 31, 1997 were included in this prospective study. Patients with ectopic pregnancy were either managed expectantly, treated with methotrexate or by laparoscopic or open surgery (salpingostomy/salpingectomy). Systemic methotrexate (Pharmacia & Upjohn, Stockholm, Sweden) was administered as an intramuscular injection of 50 mg/m(2). RESULTS: One hundred and seven patients presented with signs and symptoms of a possible ectopic pregnancy, of these 89 patients eventually were diagnosed as having an ectopic pregnancy. Twenty-six (29%) patients were treated with methotrexate, 46 (52%) patients with laparoscopy or laparotomy, and 17 (19%) patients by expectant management. Success rate in the methotrexate group, after one or more injections, was 77% (20 patients out of 26). The mean time to resolution was 24+/-9 days. There was no difference in pregnancy rate following methotrexate treatment compared to surgical treatment. CONCLUSIONS: Systemic single-dose methotrexate treatment is a safe treatment option with a reasonably high success rate, with similar probability of a later intrauterine pregnancy as conventional surgical treatment.

Abortifacient Agents, Nonsteroidal↗