Advertisement

Persistence of elevated betaHCG after uterine curettage: unexpected diagnosis for a young woman

Published:August 14, 2018DOI:https://doi.org/10.1016/j.ajog.2018.08.007
      A 31-year-old woman has been referred to our department for the persistence of elevated beta human chorionic gonadotropin values 2 months after uterine dilation was performed because of a miscarriage diagnosis. The transvaginal ultrasound image showed a bicornuate uterus with a 3×4-cm hyperechogenic and hypervascularized area on the right horn (Figure 1, Figure 2). The finding was confirmed by magnetic resonance imaging (Figure 3, Figure 4). It has been diagnosed to be the results of a miscarried cornual pregnancy not previously recognized. Based on limited literature,
      • Dilbaz S.
      • Katas B.
      • Demir B.
      • Dilbaz B.
      Treating cornual pregnancy with a single methotrexate injection: a report of 3 cases.
      Medical treatment of ectopic pregnancy: a committee opinion.
      • Jourdain O.
      • Fontanges M.
      • Schiano A.
      • Rauch F.
      • Gonnet J.M.
      Management of other ectopic pregnancies (cornual, interstitial, angular, ovarian).
      • Moawad N.S.
      • Mahajan S.T.
      • Moniz M.H.
      • Taylor S.E.
      • Hurd W.W.
      Current diagnosis and treatment of interstitial pregnancy.
      • Zalel Y.
      • Caspi B.
      • Insler V.
      Expectant management of interstitial pregnancy.
      we proposed to the patient a methotrexate therapy or a close follow-up period. She chose the second option, and we observed a gradual decrease in beta human chorionic gonadotropin values until negativization within 2 months.
      Figure thumbnail gr1
      Figure 1Magnetic resonance image–1
      Coronal t2-weighted magnetic resonance image of the pelvis shows a bicornuate uterus with results of a miscarried cornual pregnancy on the right horn after uterine dilation had been performed 2 months earlier.
      Palmeri. Persistence of elevated betaHCG after uterine curettage. Am J Obstet Gynecol 2019.
      Figure thumbnail gr2
      Figure 2Magnetic resonance image–2
      Axial t2-weighted magnetic resonance image of the pelvis shows the fundus of a bicornuate uterus that is the result of a miscarried ectopic pregnancy on the right horn.
      Palmeri. Persistence of elevated betaHCG after uterine curettage. Am J Obstet Gynecol 2019.
      Figure thumbnail gr3
      Figure 3Ultrasound image–1
      Color Doppler transvaginal 2-dimensional scan in coronal plane shows a bicornuate uterus with plentiful vascularization on the right horn that represents the result of a miscarried cornual pregnancy.
      Palmeri. Persistence of elevated betaHCG after uterine curettage. Am J Obstet Gynecol 2019.
      Figure thumbnail gr4
      Figure 4Ultrasound image–2
      Power Doppler transvaginal 2-dimensional scan in sagittal plane shows a thick vascularization from uterine artery to the right uterine horn that is the result of an ectopic pregnancy.
      Palmeri. Persistence of elevated betaHCG after uterine curettage. Am J Obstet Gynecol 2019.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dilbaz S.
        • Katas B.
        • Demir B.
        • Dilbaz B.
        Treating cornual pregnancy with a single methotrexate injection: a report of 3 cases.
        J Reprod Med. 2005; 50: 141-144
      1. Medical treatment of ectopic pregnancy: a committee opinion.
        Fertil Steril. 2013; 100: 638-644
        • Jourdain O.
        • Fontanges M.
        • Schiano A.
        • Rauch F.
        • Gonnet J.M.
        Management of other ectopic pregnancies (cornual, interstitial, angular, ovarian).
        J Gynecol Obstet Biol Reprod (Paris). 2003; 32 (S93-100)
        • Moawad N.S.
        • Mahajan S.T.
        • Moniz M.H.
        • Taylor S.E.
        • Hurd W.W.
        Current diagnosis and treatment of interstitial pregnancy.
        Am J Obstet Gynecol. 2010; 202: 15-29
        • Zalel Y.
        • Caspi B.
        • Insler V.
        Expectant management of interstitial pregnancy.
        Ultrasound Obstet Gynecol. 1994; 4: 238-240