ĐẶC ĐIỂM LÂM SÀNG VÀ HÌNH ẢNH SIÊU ÂM QUA ĐƯỜNG ÂM ĐẠO CHỬA NGOÀI TỬ CUNG

Nghiên cứu 61 bệnh nhân CNTC được siêu âm đầu dò âm đạo trước mổ, được phẫu thuật tại khoa Phụ sản Bệnh viện E trong thời gian từ tháng 7 năm 2019 đến tháng 10 năm 2020. Kết quả: Tuổi hay gặp từ 30 đến 39, trung bình 34 ± 7,14. 55,7% có tiền sử nạo hút thai, 24,6% có tiền sử đã từng CNTC. Khi vào viện 11,5% bệnh nhân có choáng, đau bụng 96,7%, chậm kinh 77,0% và ra máu âm đạo 60,6%. Khám lâm sàng 63,9% bệnh nhân di động tử cung đau, cùng đồ khám đau 50,8%, phần phụ có khối nề 41,0%, phản ứng thành bụng 31,1% và tử cung to hơn bình thường chiếm 14,7%. Nồng độ β hCG trung bình 2.235 ± 4.767mIU/mL; thấp nhất: 44,9 mIU/mL; cao nhất: 35.176 mIU/mL. Hình ảnh túi thai không điển hình chiếm 78,7%; điển hình 9,8%. Kích thước khối chửa từ 20-40mm chiếm tỷ lệ cao nhất (39,3%). Hình ảnh dịch Douglas chiếm cao nhất 73,8% phù hợp với kết quả phẫu thuật thấy máu trong ổ bụng chiếm 74,2%, dịch buồng tử cung chiếm 22,9%, dịch ổ bụng chiếm 60,6%. Độ dày niêm mạc tử cung trung bình 8,93 ± 4,35mm (5-25 mm) dày trên 8mm chiếm 55,7%. Giá trị chẩn đoán đúng của dấu hiệu trực tiếp, gián tiếp đều đạt 100%. Kết luận: Siêu âm đầu dò âm đạo có giá trị cao, giúp lâm sàng phát hiện sớm và xử lý kịp thời CNTC.

Đặc điểm nồng độ CA-125, beta-hCG và progesterone huyết thanh trong thai lạc chỗ

Mục tiêu: Khảo sát giá trị CA-125, β-hCG và progesterone huyết thanh trong các trường hợp thai lạc chỗ. Đối tượng và phương pháp nghiên cứu: Nghiên cứu bệnh chứng trên 42 trường hợp thai lạc và 42 trường hợp thai trong tử cung được quản lý tại Bệnh viện Trường Đại học Y - Dược Huế từ 05/2019 đến 05/2020. Chẩn đoán xác định thai lạc chỗ dựa vào kết quả phẫu thuật và giải phẫu bệnh. Nhóm chứng là các trường hợp đơn thai phát triển bình thường trong tử cung, tương đồng tuổi thai. Nồng độ CA-125 và β-hCG, progesterone huyết thanh khảo sát theo các nhóm tuổi thai, < 6 tuần, 6 - 7 tuần, và ≥ 8 tuần. Kết quả: Nồng độ CA-125 ở nhóm thai lạc chổ là 23,8 U/ml (11,6 - 59,4), thấp hơn nhóm thai trong tử cung 70,1 U/ml (35,0 - 146,0), p < 0,001. Nồng độ β-hCG và progesterone ở nhóm thai lạc chỗ thứ tự là 2570,0 mUI/ml (42,8 - 94579,0) và 9,1 ng/ml (0,7 - 29,8), các giá trị này đều thấp hơn so với nhóm thai trong tử cung, tương ứng là 18357,5 mIU/ml (4622,0 - 157985,0) và 26,7 ng/ml (20,4 - 37,1), p < 0,001. Ở nhóm thai lạc chổ, nồng độ CA-125 không có sự khác biệt có ý nghĩa thống kê theo tuổi thai, ở nhóm < 6 tuần, 6 - 7 tuần và nhóm ≥ 8 tuần tương ứng là 23,2 U/ml (11,6 - 59,4), 23,6 U/ml (15,9 - 48,9) và 23,3 U/ml (20,5 - 32,8), p = 0,08. Trong khi đó, ở nhóm thai phát triển trong tử cung, nồng độ CA-125 tăng dần theo tuổi thai, nhóm < 6 tuần, 6 - 7 tuần và nhóm ≥ 8 tuần tương ứng 59,1 U/ml (35,0 - 83,3), 81,4 U/ml (75,7 - 90,1) và 101,1 U/ml (91,4 - 146,0), p = 0,02. Kết luận: Nồng độ CA-125 và β-hCG, progesterone thấp hơn trong thai lạc chỗ so với thai trong tử cung. Giá trị CA-125 thay đổi không đáng kể theo tuổi thai trong nhóm thai lạc chỗ.

β-hCG levels in second trimester as a predictor of gestational hypertension and preeclampsia

Background: Hypertensive disorders of pregnancy complicate up to 10% of pregnancies worldwide, and remain amongst the most significant and intriguing unsolved problems in obstetrics. The goal of this study is to test the hypothesis that women with high serum β-hCG levels in early pregnancy are at higher risk of developing gestational hypertension and preeclampsia.Methods: This is a prospective study done in 200 women between 13 and 20 weeks of gestation, selected randomly for this study. Serum β-hCG estimation was done by Sandwich chemiluminescence immunoassay method and calculated in multiple of median (MOM). They were followed till delivery for development of gestational hypertension and preeclampsia. Results were analysed statistically.Results: Out of 200 cases, 43 (21.5%) cases developed PIH. β-hCG levels were considered raised if the levels were >2 MOM. Out of 39 cases with beta HCG levels >2 MOM, 32 (82.1%) developed PIH whereas 7 (17.9%) remain normotensives against. Also, higher levels of beta HCG are associated with increased severity of PIH (p<0.000). The sensitivity was 82%, specificity was 93.2% and positive predictive value was 74.3%.Conclusions: The study conclude that elevated serum β-hCG levels in women with second trimester pregnancy indicates increased risk of gestational hypertension and preeclampsia and raised β-hCG levels are associated with severity of disease

A Homeopathic Treatment İn a Female Patient with İnfertility

There is a physiological balance between our systems in our body. When this physiological balance is disturbed, diseases ocur. Infertility; It is defined as not having a pregnancy despite the couples having regular sexual intercourse. Homeopathy, a natural remedy that has been used widely all over the world for 200 years system. It has been recognized by the World Health Organization (WHO) as the second largest treatment method used worldwide. Although it is the most popular form of treatment in India and South America, it is also used by over 30 million people in Europe and millions of other people around the world. A female patient 33 years old who applied to Getat Polk for infertility had also divorsed from her first marriage for 8 years due to infertility. She continued her infertility treatment during her marriage. Tsh 1.93Uıu/ml, t3 3,05 pg/ml,t4 0.76ng/dl. Glukose 82mg/ml, d vitamine 8ng/ml, b12 270pg/ml, total cholesterol 176mg/ml, creatinine 0.63mg/dl tg 77 mg/dl fe 38ug/dl AST 19 U/L E stradiole 46ug/l LH 12,42IU/L Ferritine 8.51 ug/l hemoglobine 11.8g/dl .After a detailed anamnesis, the patient was started on Hyos c30 2*1, Ignatia c30 2*1, and folliculunum c200 2*1 (1st and 14th days of menstruation) in December 2020. The patient was 7 weeks pregnant in september 2021.β-Hcg 15000Mıu/ml Fe 171 ug/dl. Hormonal balance in women is very sensitive and easily effected, either by endogen or exogen disturbances. Pressure and suppression induced by dominant forces on an individual such as dominant parents, husband, harassment at work or religions dominance can be a cause to create a so called Folliculinum state, as well as results from immune system suffering after long lasting and profound infection, which is suppressed by medication.

A 10-year retrospective single-center study of alpha-fetoprotein and beta-human chorionic gonadotropin in Romanian children with (para)gonadal tumors and cysts

Objectives Malignant tumor is a top-ranking cause of pediatric (>1-year) mortality in America and Europe. Among pediatric tumors, germ cell tumors (GCT) and gonadal tumors rank fourth (6%) by the Surveillance, Epidemiology, and End Results (SEER) program (seer.cancer.gov). Continuous research on tumor markers harnesses their full potential in tumor detection and management. We evaluated the effectiveness of beta-human chorionic gonadotropin (β-hCG) and Alpha-fetoprotein (AFP) in Romanian children with (para)gonadal tumors and cysts, determining their accuracy in detecting malignancy, tumor-type, stage, complications, prognosis, and treatment response. Methods A 10-year retrospective study of AFP and β-hCG in 134 children with cysts and (para)gonadal tumors aged one month to 17 years was performed. Results AFP/β-hCG was unelevated in patients with cysts and nonmalignant tumors. Forty-eight/86 patients (43 GCT and 5 non-GCT) with malignant tumors had elevated AFP/β-hCG, 3/48 patients had recurrences, and 25/48 had mixed-GCT (68% had elevated AFP + β-hCG). All 30 patients with Yolk sac tumors (YST) or their components had elevated AFP. Area under the curve, sensitivity and specificity for GCT were: AFP + β-hCG- 0.828, 67.2%, 100%; AFP- 0.813, 64.1%, 100%; and β-hCG- 0.664, 32.8%, 100%. Two patients whose AFP/β-hCG levels remained elevated died. Common mixed-GCT components were YST-80% and embryonal carcinoma-72%. Thirty of 34 metastasis cases were GCT, with 26/34 patients having elevated AFP/β-hCG. Conclusions AFP/β-hCG detects malignant GCT and can determine tumor-type. GCT patients with markedly elevated AFP + β-hCG had poor prognosis, especially if recurrence or metastasis was present. Recurrence is unrelated to elevated AFP/β-hCG. The tumor components and quantity present determine AFP/β-hCG values in mixed-GCT.

Study of various treatment modalities of caesarean scar pregnancy

Background: Caesarean scar pregnancy (CSP) can be defined as the implantation of the gestational sac within the scar of a previous caesarean surgery. Incidence of CSP is 1 in 1800 pregnancies.Methods: It is a retrospective study based on clinical diagnosis and management of CSP of women who presented to the obstetrics and gynaecology department SVP hospital from January 2008 to August 2021. Total number of cases of CSP were 28. Incidence, gestational age, ultrasound findings, serum β-human chorionic gonadotropin (β-hCG) levels, flow profiles of color Doppler, and different methods of treatment were recorded. Diagnosis was confirmed by ultrasound.Results: In this study, all 28 cases of CSP considered were offered definitive management. In present study 5 cases (17.88%) showed torrential haemorrhage during dilatation and evacuation (D and E) which was treated by various methods like 1 (3.57%) Foley’s tamponade, 1 (3.57%) uterine artery embolization (UAE) and 3 (10.71%) hysterectomy. Hysterotomy was performed in 13 cases (46.42%) and (7.69%) of heterotrophic CSP (HCSP). One case (3.84%) of CSP presented at 26 weeks of gestation with haemorrhagic shock, underwent obstetric hysterectomy.Conclusions: There is a rise in the incidence of CSP because of increase in the global rate of caesarean sections and early transvaginal USG in pregnancy. Transvaginal sonography is the best diagnostic tool. Medical management can be offered when diagnosis is made at gestational age of <7 weeks. Whereas, surgical modalities have shown better results at >7 weeks of gestational age. Surgical management has an advantage of shorter follow up.

NGHIÊN CỨU HIỆU QUẢ CHUYỂN PHÔI NANG TRỮ ĐÔNG VÀ SỐ MỘT YẾU TỐ LIÊN QUAN TẠI BỆNH VIỆN HỖ TRỢ SINH SẢN VÀ NAM HỌC ĐỨC PHÚC

Mục tiêu: Xác định được tỷ lệ sống sau rã đông của phôi nang và xác định tỷ lệ có thai của chuyển phôi nang trữ đông. Đối tượng và phương pháp nghiên cứu: Nghiên cứu hồi cứu, đánh giá tỷ lệ sống của phôi nang sau rã đông và tỷ lệ có thai của 365 trường hợp chuyển phôi nang tại Bệnh viện Hỗ trợ sinh sản (HTSS) và Nam học Đức Phúc, trong thời gian từ tháng 1 đến hết tháng 8 năm 2021. Kết quả: Từ tháng 1/2021 đến tháng 8/2021 có 365 trường hợp phù hợp tiêu chuẩn nghiên cứu. Tỷ lệ sống sau rã đông 99,85%. Tỷ lệ β-hCG dương tính và tỷ lệ mang thai lâm sàng của nhóm này lần lượt là 74,79% và 67,12%. Tỷ lệ làm tổ của phôi là 40,35 %. Kết luận: Kết quả có thai là khá cao khi chuyển phôi nang trữ đông và trường hợp tiên lượng tốt chỉ nên chuyển 1 phôi có chất lượng tốt hoặc phôi trung bình nên chuyển kèm thêm 1 phôi tốt, khá, trung bình.

SIGNIFICANCE OF LOW MATERNAL SERUM Β-HCG LEVELS IN THE ASSESSMENT OF THE RISK OF ATYPICAL CHROMOSOMAL ABNORMALITIES

Introduction: The introduction of prenatal cell-free DNA as a screening test has surpassed traditional combined first-trimester screening (cFTS) in the detection of common trisomies. However, its current limitation in detecting only common trisomies is affecting the diagnostic yield for other clinically significant chromosomal abnormalities. Methods: In efforts to optimize the detection of fetuses with genetic abnormalities, we have analyzed the relationship between the cFTS risk score and biomarkers with atypical chromosomal abnormalities. Furthermore, we have evaluated the impact of prenatal cell-free DNA screening on the detection of chromosomal abnormalities in our population. For these purposes, we performed a retrospective study of 877 singleton pregnancies who underwent chromosomal microarray analysis (CMA) between 2013 to 2020 and for whom first-trimester screening data were available. Results: The results demonstrated that low levels of free beta human chorionic gonadotropin (β-hCG) (≤ 0.37 MoM) and increased fetal nuchal translucency (NT) (≥ 3.5mm) were statistically associated with the presence of atypical chromosomal abnormalities. In fact, the risk of pathogenic CMA results increased from 6% to 10% when fetal NT was increased and from 6% to 20% when a low serum β-hCG level was detected in the high-risk cFTS group. Moreover, our results showed that altered serum levels of β-hCG can have a substantial impact on the early detection of clinically relevant copy number variants. Discussion/Conclusion: Traditional cFTS can potentially identify a substantial proportion of atypical chromosomal aberrations, and women with increased NT or low maternal serum β-hCG levels are at increased risk of having pathogenic CMA results. Our results may help clinicians and women decide whether invasive testing or prenatal cell-free DNA screening testing are more appropriate for each situation.

The relationship between first and second trimester biochemical parameters used to screen down syndrome and intrahepatic cholestasis of pregnancy

Objective: To assess the role of first and second-trimester screening biomarkers pregnancy-associated plasma protein-A(PAPP-A), free beta-human chorionic gonadotropin(free ß-hCG), estriol, alpha-fetoprotein and total β-hCG in the early diagnosis of intrahepatic cholestasis of pregnancy (ICP). Materials and Methods: Patients with ICP admitted to Mersin University Hospital for delivery between 2015 and 2019 and had first and second-trimester aneuploidy screening tests performed in the same facility were retrospectively assessed. Randomly 60 pregnant women without comorbid conditions during the same period were included as controls. Data regarding demographic characteristics, laboratory values including free ß-hCG and PAPP-A in first-trimester screening and total ß-hCG, estriol and alpha- fetoprotein in second-trimester screening were compared. Results: There were 46 eligible patients with ICP. In first trimester screening, it was found that PAPP-A MoM was significantly lower (0.89±0.55 vs. 1.94±0.73; p=0.035) while free ß-hCG MoM was significantly higher in ICP group when compared to controls (1.84±0.59 vs. 0.99±0.47; p=0.018). In second trimester screening, no significant difference was detected in aneuploidy markers between groups. For prediction of ICP development, first trimester free β-hCG >1.44 MoM was found to have a sensitivity of 50%, a specificity of 80% and positive and negative predictive values of 33% and 88.9% respectively. Similarly first trimester PAPP-A values <1.075 MoM was found to have 80% and 75% sensitivity and specificity with positive and negative predictive values of 75% and 44% respectively. Conclusion: Low PAPP-A MoM value and elevated free ß-hCG in first trimester seem to be associated with ICP development.