Live Delivery Despite Abnormal Serial Rise in Serum Beta Human Chorionic Gonadotropin Levels and Sac Size Crown-Rump Length Discrepancy

There are several parameters that when inadequate, e.g., low serum progesterone (P), low serum estradiol (E2), or a sac size crown-rump length discrepancy with a sac size lagging behind by more than one week, are poor prognostic parameters for the delivery of a healthy baby. Perhaps the most important abnormal prognostic parameter is an inappropriate rise in serial beta human chorionic gonadotropin (hCG) levels. A case is described who had abnormalities in all these parameters including, in addition, issues with both increased and decreased fetal heart rates. She did however deliver a healthy baby just three weeks before her due date. Her treatment consisted of aggressive P supplementation, plus estrogen, antibiotics, and dextroamphetamine sulfate. One cannot say for certainty whether any or all of these treatments were responsible for her good outcome. This case may be, based on the lack of rise of beta hCG levels, to be the case with the worst prognosis to deliver a live baby published to date, based on failure to have an appropriate type of rise of serial beta hCG levels.