1. ROLE OF β HCG IN DEFINITIVE DIAGNOSIS - A CASE STUDY
Drs. Moushumi Lodh *, Ratnadeep Ganguly** ,Madhulika Singh***, Prasant Panda****
Depts of *Biochemistry, **Pathology, ***Obstetrics & Gynecology, ****Microbiology
THE MISSION HOSPITAL, DURGAPUR, INDIA
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DIAGNOSTIC CHALLENGES:
CASE REPORT
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1 2 Clinical presentation is like septic abortion
Indian woman
Beta HCG levels were not very elevated at 8 weeks (>1 lac at 10
24 years old,married since 3 months weeks in molar preg, remain at 10,000-20,000 m IU/ml by 12-14
Nulliparous weeks of gestation)
No H/O oral pills D/D from USG:
No H/O consanguineous marriage 1) leiomyoma of uterus
2) complete mole with coexistent fetus
3) retained products of conception
Hydropic degeneration of multiple chorionic villi, regular, 4) ectopic pregnancy
PRESENTING SYMPTOMS:
circumferential & polar trophoblastic hyperplasia 5) missed abortion
Fever with chill and burning micturation-15 days
No haphazard proliferation as in mole & other GTD 6) Partial mole
Amenorrhoea 8 weeks Fetal tissue with fetal vessels present
7) hydropic degeneration of placenta
Obs history:3-4/28-30 day , regular Dx : HYDROPIC ABORTUS vs PARTIAL MOLE
favoring former Histology was not conclusive.
CLINICAL EXAMINATION:
a
Correlation with b-HCG level suggested Chromosomal analysis showed triploidy
Temp:99deg F , pulse=72/min , BP=90/70mm Hg
URINE PREG TEST POSITIVE DISCUSSION
PV :BULKY SOFT UTERUS
CRP levels:26 mg/L Beta HCG is a glycoprotein, secreted first by trophoblastic cells of
Radiological findings:8 weeks gestation with Post- evacuation follow up: conceptus and later by placenta,prevents degeneration of corpus
no cardiac pulsation, few small cisterns in luteum.
part of the placenta amount of HCG produced correlates with amount of trophoblastic
Patient treated conservatively with Irregular scanty bleeding PV for 3 weeks tissue.
antibiotics, antipyretic. Beta HCG levels: in normal preg, levels detectable 6-18 days after ovulation; doubles
Serum beta HCG levels:96,761 mI U /ml at every 2 days, to peak at 10th week(about 1 lac m IU /ml; declines to
admission (8 weeks);89,382 m IU/ ml after After 1 weeks: 1942 m IU/ ml
constant level about 10,000 at 17 weeks, until delivery.
48 hours. After 2 weeks:132 m IU /ml
Slow rate of rise (<2day doubling of titre/increase<66 %)suggests
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Repeat USG: same findings After 5 weeks: 11.2 m IU /ml
ectopic/spont. Abortion
Plan: D & E under GA, on 4 day, followed
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After 7 weeks: 5 mIU /ml
by histological analysis and serum beta HCG This, with corroborative histological features - excludes molar preg
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estimation. After 5 months: <2 m IU/ml and points more to abortion
Treatment: D & E done. Curetted material Advice:
REFERENCES:
sent for histopathology. Use combined OCP for next 6 months
1) Conran RM, Hitchcock CL, Popek EJ,Norris HJ(1993).Diagnostic consideration in molar
gestations.Human pathology,24;41-48
2) Cole LA (1998) hCG, its free subunits and its metabolites. Roles in pregnancy and trophoblastic disease. J
Reprod Med 43:3-10H