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Background: The purpose of this study was to determine the reference range of maternal urine free beta-human chorionic gonadotropin (beta -hCG) concentrations between 14 and 21 weeks of gestation., Methods: We measured the concentrations of urine free beta -hCG from 268 healthy singleton Taiwanese pregnancies between 14 and 21 weeks of gestation. Results were corrected for creatinine (Cr) concentration and converted to the multiple of the median (MOM) level for the appropriate gestation. Gestational ages of all cases were determined using ultrasound dating., Results: The median levels of urine free beta -hCG and free beta-hCG/Cr had a downward trend in association with the increasing gestation age. The median, 5th, 10th, 90th and 95th centiles of free beta- hCG/Cr MOM values were 1.02, 0.20, 0.25, 2.32 and 3.38 MOM, respectively. Urine free beta- hCG/Cr MOM values showed a log Gaussian distribution with the mean and standard deviation (SD) distribution of -0.0657 and 0.3792, respectively., Conclusion: To allow for differences in free beta -hCG/Cr median values at various ages of gestation, establishment of the reference range is essential for further development of maternal urine screening for Down syndrome.

Background: The purpose of this study was to assess the relation of maternal age and weight on the maternal serum alpha-fetoprotein (AFP), total human chorionic gonadotropin (hCG) and free beta-hCG levels during the second trimester., Methods: We collected 419 serum samples from normal singleton pregnancies to assay serum marker levels of AFP, total hCG and free beta-hCG between 14 and 21 weeks of gestation. Maternal age at the day of delivery and maternal weight at the time of sampling were recorded in all cases. The relationship between maternal weight and multiple of the median (MoM) levels of serum markers was analysed by regression models., Results: There was an inverse trend in median MoM levels of serum markers in relation to maternal weight. No significant association between maternal age and serum marker levels was found., Conclusion: Because of its impact on serum marker levels, weight correction may be mandatory for further refinement in the maternal serum screening for Down's syndrome.

Circulating levels of insulin-like growth factor-I (IGF-I) and insulin-like growth factor-binding protein-1 (IGFBP-1) in Taiwanese women during normal pregnancy were investigated. Three hundred and eighty-five pregnant women at various gestational ages and 30 nonpregnant females were recruited into the study. Serum concentrations of IGF-I and IGFBP-1 were determined by immunoradiometric assay (IRMA) and radioimmunoassay (RIA). Maternal serum levels of IGF-I increased as pregnancy progressed. Circulating IGF-I levels in women during the first trimester of pregnancy were higher than those in nonpregnant females. Serum levels of IGFBP-1 rose rapidly before 12 weeks of gestation and remained high until term. Serum IGFBP-1 levels in pregnant women during the first trimester were significantly higher than those in nonpregnant females. However, there was no difference in maternal serum IGFBP-1 levels between the second and the third trimester of pregnancy. It is concluded that serum IGF-I levels during pregnancy may be regulated by various classes of IGF-binding proteins other than IGFBP-1.

In order to establish normative median values of maternal serum total human chorionic gonadotropin (hCG) at our own laboratory, 2711 normal sera were collected from uncomplicated, singleton Chinese pregnant women, including 1705 samples measured by radioimmunoassay (RIA) between 13 and 24 weeks' gestation and 1006 samples measured by enzyme immunoassay (EIA) between 14 and 20 weeks' gestation. The hCG secretion pattern throughout midtrimester measured by RIA is similar to that of measured by both RIA and EIA have a steep drop initially and then steadily decline from 17 weeks of gestation. The total (hCG levels measured by RIA and EIA showed different normative median values and distribution. If it was measured by RIA between 14 and 20 week's gestation, there were 3.7% and 17.8% of pregnancies with serum total hCG levels less than 0.25 multiple of the median (MoM) and 0.5 MoM, retrospectively, and 11.6% and 5.5% among them with serum levels above 2.0 MoM and 2.5 MoM, respectively. When it was measured by EIA, there were 0.7% and 9.2% of pregnancies with serum total hCG levels less than 0.25 MoM and 0.5 MoM, respectively, and 8.9% and 3.7% among them with serum levels above 2.0 MoM and 2.5 MoM, respectively. Accurate and satisfactory interpretation of maternal serum screening for Down syndrome depends on establishment of a well-developed normative median value for each week of gestation. Any laboratory intends to provide hCG for maternal serum screening should have its own reference data by its own immunoassay method.

The aim of this study was to investigate circulating levels of insulin-like growth factor-binding protein-3 (IGFBP-3) in women with normal pregnancy. A total of 468 pregnant women at various gestational ages and 30 non-pregnant females were recruited in this study. Serum concentration of IGFBP-3 was determined by radioimmunoassay. Maternal serum levels of IGFBP-3 increased as pregnancy progressed. The concentration of IGFBP-3 in pregnancy serum was positively associated with the gestational age. The mean values of circulating IGFBP-3 in the second and third trimesters of pregnancy were higher than those in the first trimester of pregnancy and in non-pregnant females. In addition, there was a highly significant correlation between IGFBP-3 and IGF-I in pregnancy serum. We conclude that, during pregnancy, IGFBP-3 appears to be the principal binding protein for circulating IGF-I and may be involved in the regulation of fetal growth.

Maternal serum alpha-fetoprotein (MSAFP) screening has been widely used and proven valuable in the prediction of a variety of fetal disorders. Any laboratory intending to provide MSAFP screening needs to establish its own reference data. In order to establish a normal MSAFP median value at our own laboratory, 5256 samples of MSAFP were collected from uncomplicated, singleton pregnant women between 13 and 24 weeks' gestation. The MSAFP median levels steadily rise with advancing gestation about 16% per gestational week in average. There were 0.17% and 4.4% of the pregnancies with serum AFP levels less than 0.25 multiple of the median (MoM) and 0.5 MoM respectively, and 4.22% and 1.66% with serum levels above 2.0 MoM and 2.5 MoM. Accurate and satisfactory interpretation of MSAFP screening should be emphasized in the establishment of a well-developed normal median value.

An association between low maternal serum alpha-fetoprotein (MSAFP) and fetal trisomy has now been thoroughly documented. The mechanisms resulting in low MSAFP are still unclear. In order to determine whether the low values of MSAFP in autosomal trisomies are associated with smaller fetal weights, we compared 11 fetuses with Down syndrome (trisomy 21), 4 with trisomy 18, with 45 normal fetuses. All of them are aborted in the second trimester of pregnancy. No significant difference in the weight distribution between fetuses with Down syndrome and control fetuses was found. In contrast, as compared with the control fetuses, fetuses with trisomy 18 had a significant lower weight distribution. The mean value of MSAFP was 0.72 +/- 0.26 MoM for those with Down syndrome and 0.51 +/- 0.33 MoM for fetuses with trisomy 18; both results being significantly lower than that of normal control (1.01 +/- 0.28). The mean value of amniotic fluid AFP was 0.63 +/- 0.23 MoM for fetuses with Down syndrome. This value was significantly lower than those of the fetuses with trisomy 18 and normal controls (1.02 +/- 0.09 and 1.02 +/- 0.30). A linear relationship between MSAFP and fetal weight was found in normal fetuses at a given gestational age but was not found in trisomy pregnancy. Fetal weight cannot be used to explain the reason for low MSAFP in Down syndrome pregnancy but may partially account for the lower levels noted in fetuses with trisomy 18.

Infertility and amenorrhea are reported in most cases of Wilson's disease. In this report, we describe a case of Wilson's disease with pancytopenia and liver cirrhosis for over 4 years, without any specific treatment. After 2 years of D-penicillamine therapy, the patient became pregnant and delivered a liver mature female baby with a body weight of 2,800 g. Both before the pregnancy and after delivery, brainstem auditory evoked potential studies showed similar bilaterally abnormal prolongation in the III-V and I-V intervals. In visual evoked potentials, the P 100 latency was delayed bilaterally. Although serial evoked potential studies failed to show any improvement, a successful pregnancy was proven to be possible in a patient with Wilson's disease who had received regular D-penicillamine treatment.

In this study the levels of lead, arsenic, cadmium and mercury were measured by the method of graphite-furnace atomic absorption spectrophotometry in paired maternal and fetal cord blood (n = 168) collected from three cities in Taiwan, (Kaohsiung, Taipei and Keelung). The mean values of those heavy metals were within normal limits. There was no difference in levels by maternal parity or fetal sex. The mean value for the level of lead in maternal blood was 64.8 micrograms/L, and 40.9 micrograms/L for the umbilical-cord blood; comparing the three locations by ANOVA analysis, there was no difference in maternal or fetal blood levels. Mean maternal As concentrations (6.8 +/- 0.58 micrograms/L) and umbilical cord blood levels (7.9 +/- 0.67 micrograms/L) were within reference levels. The mean Cd concentrations in maternal blood were (1.30 micrograms/L) significantly higher than that of the umbilical-cord blood concentrations (0.78 micrograms/L). The maternal Cd concentrations (1.62 micrograms/L) of Kaohsiung were significantly higher than that (1.24 micrograms/L) of Taipei. The fetal Cd concentrations of Kaohsiung (1.04 micrograms/L) were also significantly higher than those (0.7 micrograms/L, 0.6 micrograms/L) of Taipei and Keelung. The mean umbilical-cord blood Hg concentration (28.8 micrograms/L) was higher than that (19.4 micrograms/L) of maternal blood. The maternal Hg concentrations of Taipei were significantly higher than those of Keelung. The fetal Hg concentrations (28.8 micrograms/L) of Taipei were also marginally higher than that of Keelung and Kaohsiung.

Factors affecting pregnancy rates in gamete intrafallopian transfer (GIFT) and in vitro fertilization (IVF) were evaluated. Higher pregnancy rates were found when more mature oocytes were recovered (6.2 +/- 2.5 vs 3.8 +/- 3.0) and more oocytes (4.6 +/- 1.0 vs 3.3 +/- 1.2) or zygotes (4.7 +/- 1.4 vs 3.0 +/- 1.7) were transferred. Ultrasound-guided follicular aspiration was successful for in vitro fertilization and had a pregnancy rate (14.3%) comparable to the laparoscopic approach (13.3%). Laparotomy for correction of pelvic pathology concomitant with oocyte retrieval should be used cautiously despite the high preliminary pregnancy rate (42.9%). Failed fertilization of the surplus oocytes left after gamete intrafallopian transfer did not mean a poor chance of pregnancy (27.6%). The combined treatment of gamete intrafallopian transfer and in vitro fertilization may have a higher chance of pregnancy (43.5% vs 21.4% in GIFT and 13.3% in IVF), and more multiple pregnancies (40.0% vs 22.2% in GIFT and 16.7% in IVF). Cycles with spontaneous LH (luteinizing hormone) surges, detected by daily morning urine samplings, need not be aborted and the timing of ovum recovery should be individually evaluated.

Objective: A ruptured cornual pregnancy is a rare and challenging problem. We present two cases of cornual pregnancies after in vitro fertilization and embryo transfer (IVF-ET) treated by cornual resection, with an excellent perinatal outcome for the intrauterine pregnancy in both cases. A literature review of cornual pregnancy after IVF-ET is also included.Case Reports: Two women had undergone IVF-ET because of tubal problems. Emergent laparotomy was performed because of internal bleeding at 12 weeks of gestation in one case and 17 weeks in the other, and in both cases, ruptured cornual pregnancies were found. Cornual resection and primary repair were performed. The women were discharged on the 6th and 7th postoperative day, respectively, and they underwent an elective cesarean delivery at 37 weeks of pregnancy. They were delivered of healthy babies, one weighing 2700 g and the other 2310 g.Conclusion: These cases illustrate that good perinatal outcomes can be achieved by surgical intervention in heterotopic pregnancies, even in the event of a ruptured cornu. [ABSTRACT FROM AUTHOR]

We present the early diagnosis and successful surgical treatment of uterine perforation. This was a rare case of cystic change of a uterine perforation, which was diagnosed by sonography during the first trimester of pregnancy. Surgical closure of the uterine wall defect was successful. [ABSTRACT FROM AUTHOR]

Leuprolide acetate (Lupron) belongs to the group of gonadotrophin-releasing hormone agonists (GnRHa). It is used in conjunction with human menopausal gonadotrophin (HMG) and/or follicle stimulating hormone (FSH) for ovarian stimulation in the so-called ultra-short, short or long protocols. In our programme, the long protocol is mainly used, which starts routinely with s.c. administration of Lupron, 1 mg/day, from day 21 of the cycle preceding ovum retrieval. After pituitary desensitization is achieved, gonadotrophin administration is started. However, unexpected, spontaneous pregnancy may occur during the flare-up phase of Lupron administration. We present six pregnancies and four deliveries which have occurred under these circumstances. The mechanisms by which pregnancy may occur and escape from luteolytic, abortifacient and teratogenic effects of prolonged use of GnRHa are discussed, as well as pregnancy outcome. [ABSTRACT FROM AUTHOR]