Are pregnancy-associated plasma protein-A (PAPP-A) and CA 125 measurements after IVF-ET possible predictors of early pregnancy wastage?

Pregnancy-associated plasma protein-A (PAPP-A), a macromolecular glycoprotein of placental origin, was reported to be depressed in established ectopic pregnancies. CA 125 is a known marker for ovarian cancer found to be elevated during the first trimester of pregnancy and in women with pelvic inflammatory disease. The present study investigated the usefulness of these parameters to predict the outcome of pregnancy in asymptomatic patients with a positive pregnancy test after in-vitro fertilization and embryo transfer (IVF-ET). Blood samples (n = 159) were obtained at different periods of time post-ET from 39 women, 21 of whom experienced a normal pregnancy, 12 had an intrauterine abortion and six had an ectopic pregnancy. PAPP-A and CA 125 were measured by radioimmunoassays. From day 30 onwards in normal pregnancies, PAPP-A was significantly increased over non-pregnant controls. In the spontaneous abortion group, the levels of PAPP-A were significantly lower than in normal pregnancy but higher than in non-pregnant controls. In ectopic pregnancy, PAPP-A remained at the level of non-pregnant controls throughout the entire observation period. CA 125 was significantly increased in all types of pregnancy. However, in two cases of hyperstimulation followed by a normal pregnancy and in four cases of ectopic pregnancy with signs of peritoneal irritation (hydrosalpinx, ruptured ectopic or salpingitis) the levels of CA 125 were 15-50 times higher than in normal pregnancies.(ABSTRACT TRUNCATED AT 250 WORDS)     

Predictive value of a single serum pregnancy associated plasma protein-A or progesterone in the diagnosis of abnormal pregnancy

The value of a single measurement of serum levels of pregnancy associated plasma protein-A (PAPP-A) or progesterone (P4) in predicting abnormal gestations was assessed in 65 patients. P4 was greater than 20 ng/ml (mean +/- SEM 61.2 +/- 6.6 ng/ml, range 22.4-100.0 ng/ml) in all patients with normal intrauterine pregnancies (n = 21), and greater than 20 ng/ml (mean +/- SEM 8.5 +/- 3.9 ng/ml, range 0.1-68.8 ng/ml) in 16 out of 17 patients destined to abort spontaneously. Patients with ectopic gestations (n = 27) exhibited P4 values less than 20 ng/ml (mean +/- SEM 6.4 +/- 1.2 ng/ml, range 0.1-17.2 ng/ml). P4 levels in normal pregnancies were significantly higher (P = 0.001) than those of abnormal gestations. PAPP-A levels ranged from undetectable to 6448 mIU/ml in normal gestations. In 42 out of 44 abnormal pregnancies levels of PAPP-A were less than 100 mIU/ml, as were 7 out of 14 normal intrauterine pregnancies of less than 7 weeks gestational age. No ectopic demonstrated a value of PAPP-A greater than 50 mIU/ml and in 23 out of 27 ectopics, levels were undetectable. However, PAPP-A was less specific than P4 in correctly discriminating normal from abnormal gestations and exhibited lower positive and negative predictive values. It can be concluded therefore that a single PAPP-A measurement is of limited value in discerning normal from abnormal pregnancy prior to 8 weeks gestation. However, a single serum P4 is highly accurate and specific in detecting abnormal pregnancy, regardless of gestational age.     

散点图对妊娠结局预测模式的评价

目的利用散点图直观分析正常早孕、自然流产与异位妊娠妇女血清绒毛膜促性腺激素（β-HCG）及孕酮（P）水平配对分布趋势,结合孕龄的差异,建立一种新的妊娠结局预测模式。方法选择正常早期单胎妊娠对照组191例,自然流产患者150例、异位妊娠患者204例。用电发光免疫法测血清β-HCG及P水平。结果正常早孕组孕龄血清β-HCG平均值为（7812.52±3599.29）IU/L,P平均值为（35.27±12.91）nmol/L;自然流产组血清β-HCG平均值为（1298.07±1808.83）IU/L,P平均值为（6.66±4.42）nmol/L;异位妊娠组β-HCG平均值为（2118.23±2905.75）IU/L,P平均值为（6.37±5.58）nmol/L;自然流产组血清β-HCG及P水平明显低于正常早孕对照组,独立样本T检验t=21.75,P=0.000（95%CI：5925.31-7103.79）及t=28.49,P=0.000（95%CI：26.52-30.46）,差异有显著性意义;异位妊娠组血清β-HCG及P水平明显低于正常早孕对照组,独立样本t检验,t=17.25,P=0.000（95%CI：5045.02-6〈343.57）及t=28.32,P=0.000（95%CI：26.79-30.79）,差异有显著性意义;自然流产组与异位妊娠组血清β-HCG差异有显著性意义,t=﹣3.27,P=0.001（P〈0.05）,两组P水平差异无统计学意义,t=0.57,P=0.57（P〉0.05）;通过绘制血清β-HCG及P水平分布散点图直观显示正常早孕组聚集在以P为纵坐标25-60nmol/L,以血清β-HCG为横坐标的5000-10000IU/L范围内（发生率59.69%）,而自然流产组与异位妊娠组聚集在P〈10nmol/L,HCG〈2000IU/L范围（发生率64.78%）。在孕龄≤49天,P〉20nmol/L均为正常早孕,孕龄〉70天,P〈10nmol/L,均为非正常早孕。结论 P较β-HCG水平具有更好的预测非正常妊娠的能力;结合孕龄利用散点图P与β-HCG联合预测更为准确、直观;随妊娠时间的延长,正常早孕β-HCG水平有迅速增加的趋势,异位妊娠有缓慢增加的趋势,而自然流产则有降低趋势;P水平不能有效区分然流产与异位妊娠。孕龄≤49天,P〉20nmol/L可作为正常早孕的诊断标准,孕龄〉70天,P〈10nmol/L可作为非正常早孕的诊断标准。     

sFlt-1、IGFBP-3、PAPP-A在稽留流产中的表达及意义

目的研究可溶性FMS样酪氨酸激酶-1(sFlt-1)、胰岛素样生长因子结合蛋白3(IGFBP-3)、妊娠相关血浆蛋白A(PAPP-A)在稽留流产中的表达及意义。方法选取2015年6月至2017年6月在重庆市两江新区第一人民医院接受治疗的稽留流产患者40例纳入稽留流产组;早期流产患者40例纳入早期流产组;另外选取进行体检的健康妊娠期产妇20例作为正常组。收集3组研究对象的绒毛组织,采用免疫组化染色处理,酶联免疫吸附测定sFlt-1、IGFBP-3、PAPP-A表达,并在显微镜下观察其阳性表达情况。结果正常组sFlt-1表达水平显著低于早期流产组和稽留流产组(P<0.05);稽留流产组sFlt-1表达水平低于早期流产组(P<0.05)。正常组IGFBP-3、PAPP-A表达水平显著高于早期流产组和稽留流产组(P<0.05);稽留流产组患者IGFBP-3、PAPP-A表达水平高于早期流产患者(P<0.05)。sFlt-1、IGFBP-3、PAPP-A三项联合检测敏感度、准确度高于sFlt-1、IGFBP-3、PAPP-A单一检测,特异度低于sFlt-1、IGFBP-3、PAPP-A单一检测(P<0.05)。结论sFlt-1、IGFBP-3、PAPP-A联合检测对稽留流产的诊断价值较高,sFlt-1、IGFBP-3、PAPP-A的异常表达参与了稽留流产的发展,为稽留流产的治疗提供一定的理论基础。     

The value of a single combined measurement of VEGF, glycodelin, progesterone, PAPP-A, HPL and LIF for differentiating between ectopic and abnormal intrauterine pregnancy

BACKGROUND: To evaluate whether serum concentrations of the non-placental markers vascular endothelial growth factor (VEGF), glycodelin (GLY) and progesterone (P) and the novel placental markers pregnancy-associated plasmaprotein A (PAPP-A), human placental lactogen (HPL) and leukaemia inhibiting factor (LIF) differ in ectopic pregnancy (EP) when compared with abnormal intrauterine pregnancy (aIUP). METHODS: A prospective clinical study was conducted at the University Hospital of Larissa, Greece. The study included 50 patients admitted with failed pregnancy and suspected ectopic pregnancy that were treated with curettage or laparoscopy and classified as histologically confirmed EPs (n = 27) or histologically confirmed aIUPs (n = 21) (mean gestational age of 7.15 and 7.3 weeks, respectively). Two suspected EPs proved to be normal IUPs and were excluded. VEGF, GLY, P, beta-HCG, PAPP-A, HPL and LIF were measured by enxyme-linked immunosorbent assay (ELISA) methods in a single pre-operative blood sample. RESULTS: The median VEGF concentration was 227.2 pg/ml in the EP group versus 107.2 pg/ml in the aIUP group (P < 0.001), with a suggested threshold value of 174 pg/ml for their differential diagnosis. LIF, P, PAPP-A, HPL and GLY serum measurements did not differ significantly between EP and aIUP. CONCLUSION: VEGF serum levels might be a useful marker in differentiating between EPs and aIUPs.     

阴道彩超联合血清孕酮、β-HCG及CA125对异位妊娠的诊断价值

目的 探究阴道彩超检测子宫内膜厚度联合血清孕酮、β-HCG及CA125检测诊断异位妊娠的价值。方法 选取我院2016年5月~2018年5月收治的40例异位妊娠患者设为异位妊娠组,同期选取30例正常妊娠者设为对照组,选取30例宫内妊娠流产者设为自然流产组,比较阴道彩超、血清孕酮、β-HCG及CA125等指标,比较单项检测与联合检测诊断异位妊娠的检出率。结果 异位妊娠组及自然流产组血清孕酮、β-HCG及子宫内膜厚度低于对照组,而血清CA125水平高于对照组,差异均有统计学意义（P＜0.05）,异位妊娠组与自然流产组血清孕酮、β-HCG及子宫内膜厚度比较,差异无统计学意义（P＞0.05）,CA125水平高于自然流产组,差异有统计学意义（P＜0.05）;阴道彩超、血清孕酮、β-HCG、CA125单一检测异位妊娠的诊断率分别为72.50%、55.00%、52.50%、47.50%,低于联合检测的97.50%,差异有统计学意义（P＜0.05）。结论 采用阴道彩超检测子宫内膜厚度联合血清孕酮、β-HCG及CA125检测可提高异位妊娠的检出率,对早期异位妊娠诊断和治疗具有重要临床意义。     

ROC曲线对妊娠结局预测模式的评价

目的通过监测正常早孕、自然流产与异位妊娠妇女血清绒毛膜促性腺激素(β-HCG)及孕酮(P)水平,建立正常早孕、自然流产与异位妊娠的妊娠结局预测模式,并利用ROC曲线评价其预测妊娠结局的能力。方法选择正常早期单胎妊娠对照组191例,自然流产患者150例、异位妊娠患者204例。用电发光免疫法测血清β-HCG及P水平,建立单独β-HCG、P以及β-HCG和P联合积分预测模式。结果正常早孕组孕龄血清β-HCG平均值为(7812.52±3599.29)IU/L,P平均值为(35.27±12.91)nmol/L;自然流产组血清β-HCG平均值为(1298.07±1808.83)IU/L,P平均值为(6.66±4.42)nmol/L;异位妊娠组β-HCG平均值为(2118.23±2905.75)IU/L,P平均值为(6.37±5.58)nmol/L;自然流产组血清β-HCG及P水平明显低于正常早孕对照组,独立样本t检验t=21.75,P=0.000(95%CI:5925.31-7103.79)及t=28.49,P=0.000(95%CI:26.52-30.46),差异有显著性意义;异位妊娠组血清β-HCG及P水平明显低于正常早孕对照组,独立样本t检验t=17.25,P=0.000(95%CI:5045.02-6﹤343.57)及t=28.32,P=0.000(95%CI:26.79-30.79),差异有显著性意义;自然流产组与异位妊娠组血清β-HCG差异有显著性意义,t=-3.27,P=0.001(P<0.05),两组P水平差异无统计学意义,t=0.57,P=0.57(P>0.05);通过ROC曲线分析血清β-HCG、P水平及联合积分预测妊娠结局的能力,曲线下面积分别为0.879、0.973、0.984,(P值均<0.05),95%CI分别为(0.845-0.913)、(0.959-0.986)、(0.973-0.994)。结论单独P较β-HCG水平具有更好的预测非正常妊娠的能力;联合积分预测妊娠结局的能力最强;单独P和联合积分与单独β-HCG预测妊娠结局的能力的差异有统计学意义,但二者的差异无统计学意义;随妊娠时间的延长,正常早孕β-HCG水平有迅速增加的趋势,异位妊娠有缓慢增加的趋势,而自然流产则有降低趋势;P水平不能有效区分自然流产与异位妊娠。     

Hydrosalpinges adversely affect implantation in donor oocyte cycles

Hydrosalpinges have been associated with poor in-vitro fertilization (IVF) outcome in some, but not all, studies, perhaps through endometrial effects. To determine whether hydrosalpinges affect IVF outcome via endometrial factors alone, we analysed the results of recipients of donor oocytes with hydrosalpinges, thereby controlling for confounding variables, while isolating the intrauterine environment. We retrospectively analysed 110 patients who underwent 121 donor oocyte cycles in a university-based assisted reproduction programme. Thirteen cycles involving recipients (n = 10) with hydrosalpinges were compared to 108 cycles involving recipients (n = 100) without hydrosalpinges. Pregnancy, implantation, miscarriage, and ectopic pregnancy rates were compared between women with and without hydrosalpinges. There were no significant differences between the hydrosalpinx and no hydrosalpinx groups with respect to donor age, recipient age, or number or grade of embryos transferred. Patients with a hydrosalpinx had significantly lower embryo implantation rates (7.1 versus 19.3%, P < 0.05) and significantly higher miscarriage (75.0 versus 14.9%, P < 0.05) and ectopic pregnancy rates (33.3 versus 0.0%, P < 0.05) than normal controls. We conclude that the presence of a hydrosalpinx adversely affects early pregnancy events by altering the intrauterine environment.     

The Risk Factors and Pregnancy Outcomes of 48 Cases of Heterotopic Pregnancy from a Single Center

The purpose of this study was to investigate risk factors that are associated with heterotopic pregnancy (HP) following in vitro fertilization (IVF)-embryo transfer (ET) and to demonstrate the outcomes of HP after the surgical treatment of ectopic pregnancies. Forty-eight patients from a single center, who were diagnosed with HP between 1998 and 2012 were included. All of the patients had received infertility treatments, such as Clomid with timed coitus (n = 1, 2.1%), superovulation with intrauterine insemination (n = 7, 14.6%), fresh non-donor IVF-ET (n = 33, 68.8%), and frozen-thawed cycles (n = 7, 14.6%). Eighty-four additional patients were randomly selected as controls from the IVF registry database. HP was diagnosed at 7.5 ± 1.2 weeks (range 5.4-10.3) gestational age. In six cases (12.5%), the diagnosis was made three weeks after the patients underwent treatment for abortion. There were significant differences in the history of ectopic pregnancy (22.5% vs. 3.6%, P = 0.002). There were no significant differences in either group between the rates of first trimester intrauterine fetal loss (15.0% vs. 13.1%) or live birth (80.0% vs. 84.1%) after the surgical treatment for ectopic pregnancy. The risk factors for HP include a history of ectopic pregnancy (OR 7.191 [1.591-32.513], P = 0.010), abortion (OR 3.948 [1.574-9.902], P = 0.003), and ovarian hyperstimulation syndrome (OHSS) (OR 10.773 [2.415-48.060], P = 0.002). In patients undergoing IVF-ET, history of ectopic pregnancy, abortion, and OHSS may be risk factors for HP as compared to the control group of other IVF patients. The surgical treatment of HP does not appear to affect the rates of first trimester fetal loss or live birth.     

A study of prevalence of Chlamydia trachomatis infection in women with first trimester pregnancy losses

The study included 125 patients in the first trimester of pregnancy, who were divided into group A (50 control subjects with normal intrauterine pregnancy), Group B (50 patients with spontaneous abortion), group C (25 patients with ectopic pregnancy). All the patients were investigated including routine blood and urine tests and special tests related to the cause of pregnancy loss. The patients were tested for IgG antibodies to Chlamydia trachomatis by ELISA technique and conjunctival smear were tested for presence of inclusion bodies to C. trachomatis. It was concluded that C. trachomatis is one of the important cause of spontaneous abortion and ectopic pregnancy. It is highly prevalent in our population, the prevalence being 10% in group A, 26% in group B, 28% in group C. Conjunctival smear showed presence of inclusion bodies in 0.8% patients. With abortions then risk of lower genital tract chlamydia infection spreading to upper genital tract increases. ELISA for C. trachomatis should be done when women are being investigated for the cause of spontaneous abortion and ectopic pregnancy.     

Pregnancy: Corpus luteum failure in ectopic pregnancy

The endocrinology of ectopic pregnancy was studied in orderto investigate the origin of the discordance in the circulatingamounts of human chorionic gonadotrophin (HCG) and those ofoestradiol and progesterone. Serial maternal blood samples wereobtained at 4–9 weeks gestation from 93 patients who becamepregnant following in-vitro fertilization and embryo transferincluding 10 ectopic, 21 anembryonic and 62 normal singletonpregnancies. The samples were analysed for HCG, Schwangerschaftprotein-1 (SP-1), pregnancy-associated plasma protein-A (PAPP-A),progesterone and oestradiol. In ectopic pregnancies, concentrationsof all substances analysed were significantly reduced comparedto singleton pregnancies from 5 weeks gestation (P < 0.05–0.001)but they were not significantly different from those of anembryonicpregnancies. In ectopic pregnancies, associations were foundbetween the concentration of both HCG and SP-1 and those ofprogesterone and oestradiol. No associations were found betweenPAPP-A and any other substances analysed. This may be due toinsensitivity of the PAPP-A assay; alternatively PAPP-A concentrationsmay be differentially reduced in ectopic pregnancy. These findingssuggest that progesterone and oestradiol are derived from thecorpus luteum in early ectopic pregnancy but that the corpusluteum fails rapidly and the dominant source of both hormonesbecomes the trophoblast as early as 5 weeks.     

腹腔镜下输卵管切开取胚联合输卵管通液术对远期妊娠的影响

目的 探讨异位妊娠患者腹腔镜下行输卵管切开取胚术联合输卵管通液术对远期妊娠结局的影响。方法 选择2015年1月~2016年7月在我院妇科治疗的输卵管妊娠患者138例,依据手术方式不同分为实验组70例和对照组68例,实验组行腹腔镜下患侧输卵管切开取胚术及子宫输卵管通液术,对照组单纯行患侧输卵管切开取胚术,比较两组手术时间、术中出血量、术后排气时间、住院天数,及术后2年内妊娠情况。结果 两组患者术中出血量,手术时间、术后排气时间、住院天数比较,差异无统计学意义（P＞0.05）。实验组术后2年内再次异位妊娠率为4.23%,3例再次异位妊娠再次行腹腔镜手术,46例宫内妊娠,8例继发性不孕,6例失访。对照组的再次异位妊娠率为16.18%,11例再次异位妊娠再次行腹腔镜手术,30例宫内妊娠,13例继发性不孕,7例失访。实验组的再次异位妊娠率低于对照组,再次宫内妊娠率高于对照组,差异有统计学意义（P＜0.05）。结论 腹腔镜下切开取胚术联合输卵管通液术可同时在术中判断对健侧输卵管通畅度,还可指导通而不畅甚至堵塞输卵管术中同时治疗,可能有助于降低再次异位妊娠的概率。     

Double-blind randomized trial of mifepristone in combination with vaginal gemeprost or misoprostol for induction of abortion up to 63 days gestation

BACKGROUND: Gemeprost and misoprostol are two of the most widely used prostaglandins in combination with mifepristone for medical abortion in early pregnancy. However, the efficacy and side-effects of those two drugs given vaginally have not been assessed in a randomized trial. METHODS: Randomized double-blind controlled trial involving 999 women undergoing an abortion at gestational age < or =63 days who received either 0.5 mg gemeprost (group I, n = 499) or 800 microg misoprostol (group II, n = 500) vaginally approximately 48 h after taking 200 mg mifepristone by mouth. The rate of complete abortion and the side-effects were compared between the groups. RESULTS: A total of 89 cases was excluded from full analysis of outcome because either they aborted after mifepristone alone (n = 2), had an ectopic pregnancy (n = 1), or because the outcome was uncertain as they failed to attend their follow-up appointment (n = 86). The rate of complete abortion was very high (>95%) in both groups but significantly higher after treatment with misoprostol than with gemeprost [436/453 (98.7%) versus 451/457 (96.2%), P = 0.019, difference 2.5%, confidence interval 0.4-4.7%] and there were fewer ongoing pregnancies (n = 1 versus n = 8, P < 0.018). Surgical intervention rose significantly with gestation in women who received gemeprost (P < 0.03) but not with misoprostol. The incidence of side-effects such as diarrhoea (13.7 versus 16.4%) and vomiting (27.8 versus 29.7%) was similar in women who received misoprostol or gemeprost respectively, as was the duration and amount of bleeding. CONCLUSIONS: (i) Both regimens using a reduced dose of mifepristone are highly effective methods of inducing abortion in early pregnancy; (ii) vaginal misoprostol is the preferred prostaglandin because it is it is associated with fewer failures than low-dose gemeprost, particularly at gestation > or =49 days.     

First trimester maternal serum ischaemia-modified albumin: a marker of hypoxia-ischaemia-driven early trophoblast development

BACKGROUND: A hypoxic intrauterine environment is believed to play a pivotal role in physiological trophoblast development. Ischaemia-modified albumin (IMA) is used in the measurement of cardiac ischaemia. We aimed to test the hypothesis that maternal serum IMA may be elevated in early pregnancy as a measurable manifestation of intrauterine ischaemia. METHODS: Prospective observational study in healthy women with singleton pregnancies (n=66) and non-pregnant controls (n=26). Maternal serum IMA levels were measured at 11-13 weeks of gestation and in non-pregnant women. RESULTS: The median IMA level in the pregnant group [115.14 kU/l; interquartile range (IQR) 102.33-124.71 kU/l] was significantly higher (P<0.001) than in non-pregnant controls (73.71 kU/l; IQR 60.38-82.78 kU/l). During pregnancy, absolute values of IMA were higher than the concentration used for the diagnosis of myocardial ischaemia (>95 kU/l) in 86% of women. CONCLUSIONS: In early pregnancy, IMA levels were above the concentration used for the diagnosis of myocardial ischaemia in most women, and should therefore not be used as a marker for cardiac ischaemia in pregnancy. Maternal serum IMA is elevated to supra-physiological levels in early normal pregnancy supporting the hypothesis that normal trophoblast development is associated with a hypoxic intrauterine environment, although other mechanisms leading to an IMA increase cannot be excluded.     

Analysis of ectopic pregnancies resulting from in-vitro fertilization and embryo transfer

The purpose of this study was to analyse the risk factors, stimulation characteristics, site and outcome of pregnancy and future fecundity of patients who develop ectopic pregnancies after in-vitro fertilization (IVF). Of 3145 transfer cycles between January 1981 and July 1989, 27 (3.3%) of the resulting 825 pregnancies were ectopic. There was a significantly greater incidence of a prior ectopic pregnancy in the study group compared to the controls. Compared to matched controls with intrauterine pregnancies, the study group had significantly higher peak oestradiol levels. Twenty-one ectopic pregnancies were ampullary, two were interstitial, one was abdominal, one was cervical and two were heterotopic. Sixteen of the patients subsequently underwent 40 IVF attempts with a pregnancy rate of 28% per transfer. We conclude that patients with a prior ectopic pregnancy are at risk for an IVF ectopic pregnancy. The subsequent IVF outcome of those who develop ectopic pregnancies after IVF is encouraging.     

Endovaginal sonography for the early diagnosis of intrauterine and ectopic pregnancies.

Endovaginal sonography, together with beta-HCG titre, was used to diagnose ectopic pregnancy in 58 patients. Transabdominal ultrasound failed to conclude this diagnosis. The data from endovaginal sonography revealed the presence of a gestational sac in all 15 patients with normal pregnancies at a beta-HCG level of 1042 mIU/ml. Of the 23 patients with pathological pregnancies only 61% had an intrauterine gestational sac. Only 15% of the 20 patients with ectopic pregnancies showed an increase in beta-HCG greater than 66% in 48 h, while in normal pregnancy, this increase was found in 71% of the patients. The endovaginal findings of the ectopic gestation revealed a complex adnexal mass in 55%, a cystic mass in 30% and fluid in the cul-de-sac in 20%. The diagnostic indices of adnexal and cul-de-sac sonographic findings in the ectopic group further improved specificity and positive predictive accuracy. The detection of ectopic versus intrauterine gestation showed a high sensitivity of 95%, a specificity of 100%, a positive predictability of 100% and a negative predictability of 97%. The data confirm the value and reliability of endovaginal and cul-de-sac sonography, combined with measurement of the beta-HCG level in the early diagnosis of ectopic pregnancy. This combined approach not only makes the differentiation between normal and extrauterine gestation more accurate but also helps to avoid unnecessary diagnostic laparoscopy and hospitalization.     

Random urinary pregnanediol glucuronide measurements in pregnancy: lack of utility for evaluation of first-trimester vaginal bleeding

Progesterone and its urinary metabolite pregnanediol-3 alpha-glucuronide (PDG) are generally lower in women with abnormal pregnancies compared to those with normal intrauterine gestations. We evaluated the ability of random urinary PDG measurements determined by enzyme immunoassay (EIA) to differentiate normal from abnormal pregnancies. Patients with first-trimester vaginal bleeding (n = 104) were evaluated. Eventual outcomes indicated 39 women had viable intrauterine pregnancies (IUPs), 54 had spontaneous abortions (SABs) and 11 had ectopic pregnancies (EPs). Urinary PDG was significantly lower in SAB and EP compared to IUP patients. However, a wide range of values in IUP patients was noted (3.2-93.3 micrograms/ml), due to varying degrees of patient hydration at presentation. Hence, random measures of urinary PDG demonstrated poor specificity (32.8%) in correctly differentiating normal from abnormal gestations, thus limiting its clinical usefulness.     

Analysis of the incidence and risk factors associated with ectopic pregnancy following in-vitro fertilization and embryo transfer

Ectopic pregnancy is a well known complication of in-vitro fertilization(IVF) and embryo transfer. From March 1983 to December 1993,3000 clinical pregnancies were achieved at Bourn Hall Clinic,including 135 ectopic pregnancies (4.5%). Of these ectopics20 were heterotopic, eight ovarian, six bilateral tubal andthe remainder were singleton tubal pregnancies. The main riskfactor identified in the series was a history of pelvic inflammatorydisease (P < 0.001). The data also showed that ectopic pregnancyis at present more prevalent among patients in whom tubal damageis the reason for treatment. There was slight statistical evidence(P = 0.05) that patients having ectopic pregnancies receiveda higher volume of culture medium than those having normal deliveries.There was also an apparent trend (P = 0.07, not significant)that high progesterone/oestradiol ratio on the day of embryotransfer was associated with ectopic pregnancy. There was nostatistical evidence of association between ectopic pregnancyand a history of ectopic pregnancy, abortion, still birth, terminationof pregnancy, neonatal death, tubal surgery, ovarian stimulationprotocol, plasma concentration of oestradiol, luteinizing hormoneand progesterone, number of oocytes retrieved, number or qualityof embryos transferred, administration of general anaesthesiafor embryo transfer, and the number of patent Fallopian tubes.Awareness of the risk factors associated with ectopic pregnancyplays an important part in the early diagnosis of this potentiallyfatal condition.     

103例夫精宫腔内人工授精妊娠的结局分析

目的分析夫精宫腔内人工授精妊娠结局及子代安全性。方法分析2008年1月-2012年12月行夫精宫腔内人工授精后临床妊娠的的103个周期,随访妊娠结局至产后1年。结果异位妊娠率1．94％,自然流产率16．50％,多胎率2．91％,早产率2．38％,剖宫产率72．62％。自然流产组与正常宫内孕组比较女方年龄、自然流产史有差异（P〈O．05）。新生儿男女性别比为1．56,平均出生体重、身长均在正常范围,无出生缺陷,1岁时仅1例体重偏轻。结论夫精宫腔内人工授精多胎率、剖宫产率高,自然流产与患者年龄、自然流产史有关,出生后子代发育正常,男性明显多于女性。     

Trophoblast tissue culture of human intrauterine and ectopic pregnancies and treatment with methotrexate.

The application of drugs for conservative treatment of patients with ectopic pregnancy has been used worldwide for several years. In-vitro studies, however, are very few. We therefore examined the effects of methotrexate on trophoblast tissue cultures derived from intrauterine and ectopic pregnancies. Methotrexate was administered either 12 h or 6 days after initiation of the culture. Human chorionic gonadotrophin (HCG) levels were measured in the culture medium. All cultures showed secretion of HCG within the first 16 days. Methotrexate concentrations less than 3.8 x 10(-4) mol/l had no effect on HCG secretion. Cultures of ectopic pregnancies required a concentration about 10x higher to induce an equivalent reduction of HCG levels compared to intrauterine pregnancies. A few intrauterine and ectopic pregnancies showed no reduction of HCG values after treatment. These results suggest that data obtained from studies on intrauterine pregnancies may not be transferable to ectopic pregnancies in all instances. In some regimens approximately 8 days are required before the effect becomes measurable. In combination with our clinical data, we therefore recommend not to repeat a methotrexate dose too early in treatment of patients with ectopic pregnancies. The possibility that non-responding patients could exist should be kept in mind.