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INTRODUCTIONHypertensive disorders of pregnancy (HDP) are unique to pregnancy, affecting 5% to 8% of all pregnant women. In spite of the improvement in maternal and neonatal care, hypertensive disorders of pregnancy are major causes of maternal and perinatal morbidity and mortality in both developed and developing countries. Numerous clinical and biochemical markers have been proposed to predict preeclampsia. As preeclampsia is characterized by disturbed trophoblastic pathology, early placental dysfunction could be reflected by altered hCG concentrations. Therefore, this study is being done to find out the levels of serum β hCG in pregnant women between 12 to 20 ABSTRACT Background: This study was undertaken to study the association of serum β hCG levels between 12 to 20 weeks of gestation and development of hypertensive disorders of pregnancy and to assess the association between the levels of β hCG and severity of hypertensive disorders of pregnancy. Study design: Prospective cohort study (200 uncomplicated primigravida). Methods: All women between 12 to 20 weeks of pregnancy meeting the selection criteria, attended antenatal OPD in JIPMER were recruited for this study after informed consent. The venous blood samples were obtained from the subjects for β-hCG analysis. Serum β hCG level was measured by Enzyme Linked Immunoassay System (ELISA) and expressed as mIU/ml. Multiples of median were calculated from the median of the sample population and were considered as raised if it was >2 MOM. The cases were followed up until delivery and observed for development of hypertensive disorders of pregnancy. Results: Out of 200 cases, 185 cases were followed completely till term. Among 185 cases who were followed up, 10 women developed hypertensive disorders of pregnancy, accounting for 5.4% in the study group. Out of the total 185 women who were studied, 132 had β hCG levels ≤2 MOM and 53 had β hCG levels >2 MOM. Among 132 women (94.7%) with β hCG levels ≤2 MOM, 7 (5.3%) developed hypertensive disorders. Among 53 cases (94.3%) with β hCG levels >2 MOM, 3 women (5.7%) developed hypertensive disorders. The incidence of HDP was almost similar in both the groups, 5.3% among those whose β hCG levels were ≤2MOM and 5.7% among those who had β hCG levels >2 MOM (p value -0.923). Conclusions: From the present study, it may be concluded that high serum β hCG levels (2 MOM) estimated between 12 to 20 weeks of pregnancy were not predictive of development of hypertensive disorders later in pregnancy.

Malignancy in pregnancy is rare. Carcinomas in pregnancy are mostly kidney cell mass. Renal cell carcinoma (RCC) is the commonest malignancy in pregnancy. Because of softness and increased vascularity, rupture of renal cell carcinoma is not uncommon. Here we are presenting a rare case of renal cell carcinoma in pregnancy with spontaneous rupture resulting in massive hemoperitoneum and serious outcome because of late presentation renal cell carcinoma seldom ruptures. A 26 year old woman G2P1L1 with term pregnancy was referred to hospital 80kms away from periphery with non-progression of labour. There was antenatal record suggesting hypertensive disorder of pregnancy in second trimester. On examination, patient was in hypovolemic shock with profuse distension of abdomen. Diagnosis of abruption grade 3 or rupture uterus was made and immediate laparotomy was done. On opening the abdomen, there was hemoperitoneum but uterus was intact. Emergency LSCS done extracted a stillborn baby. There were no retro placental clots also. There was lot of necrotic tissue in the abdomen and there was a tumour arising from lower pole of left kidney which had invaded the renal vessels and had ruptured. Peripartum hysterectomy and left nephrectomy was done. Women did not respond to treatment and died. The objective of presenting this case is the dilemmas faced by the obstetrician in case of shock in 2nd stage of labour. Simple diagnostic tool like renal ultrasound will help to detect at an early stage which could improve the outcome. All cases of hypertensive disorders of pregnancy should be investigated for secondary causes of hypertension. Abdominal USG must be done for all cases of hypertensive disorders of pregnancy in 2nd trimester. Prompt diagnosis and early treatment is the key in management of such condition in pregnancy.

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