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