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Early Pregnancy Loss
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Lisa K. Perriera, Beatrice A. Chen, Aileen M. Gariepy
In a clinically stable patient with a highly desired pregnancy, a single beta-human chorionic gonadotropin (BHCG) level ≤3000 mIU/mL cannot differentiate between an ectopic pregnancy or EPL if a gestational sac is not visualized in the uterus [5]. If the pregnancy is desired, ectopic precautions should be given and intervention should be avoided until additional testing is performed.
Embryology, Anatomy, and Physiology of the Male Reproductive System
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Foetal testosterone production is initially independent of gonadotropin stimulation.At ~14th week, the maternal human chorionic gonadotropin (hCG) stimulates a peak.It becomes responsive to foetal luteinising hormone (LH) thereafter.
Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
Because of its presentation early in the first trimester, a hormonal etiology has been suggested. Serum and urinary human chorionic gonadotropin (hCG) levels have been compared in emetic, hyperemetic, and non-emetic pregnancies; the results of these studies are inconsistent. Some groups have found no correlation between hCG levels and nausea and vomiting (44,45), whereas others report higher levels in emetic vs. non-emetic patients (46). However, increased free beta subunit of hCG has been found in the sera of hyperemetic patients compared with normal pregnant controls (47).
Myasthenic crisis as an initial presentation of myasthenia gravis in an 81-year-old following endoscopic myotomy for Zenker’s diverticulum
Published in Baylor University Medical Center Proceedings, 2023
Daniel Tran, Lucas Fair, Bryana Baginski, Bola Aladegbami, Steven Leeds, Marc Ward
In patients presenting in myasthenic crisis, airway support is paramount for optimal outcomes. Patients with appropriate mentation and secretion management may be candidates for noninvasive positive pressure ventilation or bilevel positive airway pressure. Intubation can be performed if necessary, and decisions regarding this are similar to those for other critically ill patients. Once a patient with myasthenic crisis is stabilized, further evaluation can be performed to evaluate for triggers. Infectious evaluation may include a chest radiograph, complete blood count, urinalysis, and blood cultures. As metabolic abnormalities can result in crisis, electrolyte levels and thyroid function tests should be checked. Pregnancy can precipitate crisis, and beta-human chorionic gonadotropin levels should be obtained in females of childbearing age. Creatinine kinase levels can be measured to evaluate for other myopathies. Electrocardiography is useful in evaluating a cardiac dysrhythmia or a toxicologic etiology. Arterial or venous blood gases may not be useful for diagnosing crisis, but can help with ventilator management. Plasma exchange and intravenous immunoglobulin are the primary treatments for myasthenic crisis.12 If the trigger is identified, the underlying cause should be treated concurrently.
Activated protein C resistance impact on Syrian candidates for in vitro fertilisation and the benefit of anticoagulation therapy: a retrospective cohort study
Published in Journal of Obstetrics and Gynaecology, 2022
Rami Sabouni, Maarouf Gorra Al Nafouri, Ibrahem Hanafi, Ismael Al Droubi, Marwan Alhalabi
Patients diagnosed with APCR were treated with aspirin and low-molecular-weight heparin (LMWH) following the hospital protocol. A daily dose of 80 mg of aspirin was prescribed from the day of embryo transfer till the end of the eighth month, and 0.45 mg of LMWH was administered daily from the day of embryo transfer till the end of the pregnancy. However, APCR assay is not routinely done as the Canadian Fertility and Andrology Society guideline did not recommend the testing for thrombophilia in patients with recurrent pregnancy loss (Shaulov et al. 2020). Thus, the assay was only performed when there was a high thrombophilia suspicion or when the IVF attempt failed in infertile women. That is why in some patients, APCR was not managed in advance as shown in Figure 1. The hospital management protocol was in accordance with the Canadian guideline, which recommended restricting the use of anticoagulants in research setting in patients with recurrent implantation failure (Shaulov et al. 2020). So, the treatment was only given after patients’ informed consent was obtained. Patients who were under treatment were excluded from the analysis to study the pure effect of APCR on IVF outcomes. All patients underwent controlled ovarian stimulation with a long or antagonist protocol. Pregnancy was confirmed in the lab by measuring Beta-human chorionic gonadotropin and clinically by seeing the gestational sac.
Heterotopic pregnancy after bilateral salpingectomy, IVF and multiple embryos transfer. A case report and systematic review of the literature
Published in Journal of Obstetrics and Gynaecology, 2022
Grigorios Karampas, Andreas Zouridis, Evangelia Deligeoroglou, Dimitra Metallinou, Theodoros Panoskaltsis, Konstantinos Panoulis, Martin Rudnicki, Nikolaos Vlahos
As far as laboratory tests are concerned, referring mainly to beta – human chorionic gonadotropin (beta-hCG), in the majority of the cases it was not part of the diagnostic algorithm (Table 1) as it ‘can be unhelpful inasmuch as they might indicate normal ranges in combined pregnancies’ (Rizk et al. 1991; Ben-Ami et al. 2006). Nevertheless, according to other studies the possibility of a HP should be included in the differential diagnosis when more than one embryo has been transferred and an inappropriately high concentration (>300 IU/l on day 15 after oocyte fertilisation) is associated with a singleton intrauterine pregnancy (Shavit et al. 2013; Wang et al. 2020). In authors’ opinion, serum β-hCG levels should be closely monitored after multiple embryo transfer and it should be part of the standard follow-up protocol with assessment on day-15 following oocyte fertilisation as elevated levels combined with a singleton intrauterine pregnancy at the early stages of pregnancy could indicate a HP.