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“High‑dose hook effect” ‑ negative urine β‑HCG in molar pregnancy


R. Jain
S. Agrawal
M. Baid
A. Jain
M. Baid

Abstract

The hydatidiform mole, commonly known as molar pregnancy is characterized by the abnormal proliferation of trophoblasts. A hallmark of diagnosing hydatidiform mole is a positive β-hCG assay pregnancy test. Currently used β-hCG assays are sandwich chromatographic immunoassays and may sometimes produce false‑negative results in the presence of excessively high antigen concentrations, a phenomenon known as the “high‑dose hook effect”. We report an atypical case of molar pregnancy in a 24‑year‑old primi gravida female who presented to us in emergency department with a huge abdominopelvic mass, respiratory distress and bilateral pedal edema with a negative urine pregnancy test. Ultrasongraphy suggested it to be hydatiform mole and on further evaluation serum β-hCG was found to be raised. Repeat urine β-hCGassay showed positive result on 1:10 dilution. After resuscitation, patient was treated with suction and evacuation which demonstrated grape like vesicles with no fetal parts. Histopathology report revealed it to be complete hydatiform mole.

Key words: Hook effect; β-hCG assay; molar pregnancy.


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eISSN: 0189-5117