Beta-human Chorionic Gonadotrophin Concentrations Research Articles

Unexplained elevated maternal serum free beta-human chorionic gonadotrophin concentrations and adverse pregnancy outcome

The objective of this study was to investigate the association between unexplained very highly elevated maternal serum beta-human chorionic gonadotrophin (hCG) in the second trimester of pregnancy and adverse outcome of pregnancy. In a case–controlled study of 3463 women who opted for second trimester serum screening for Down's syndrome, 124 were found to have an unexplained elevated serum beta-hCG of greater than 3.5 multiples of the median (MoM), 40 of whom had a serum beta-hCG of greater than 5.0 MoM. For a large number of adverse outcomes, these women were compared to a control group of women with serum beta-hCG of around the median. In the elevated beta-hCG group statistically significantly more babies required admission to the special care baby unit (P = 0.02) or were small for gestational age (SGA) (P = 0.03). The mean birth weight was also statistically significantly lower in the elevated beta-hCG group. Women with a serum beta-hCG of ≥5, ≥6, ≥7 or ≥ 8 MoM were associated with SGA in 40%, 44%, 64% and 86%, respectively. All six babies born to women with beta-hCG of 8.75–24.1 MoM were small for gestational age.

Prognostic factors for an unsatisfactory primary methotrexate treatment of cervical pregnancy: a quantitative review.

To determine the risks when the primary methotrexate (MTX) treatment of cervical pregnancy has an unsatisfactory outcome, we conducted a Medline search on relevant literature published from January 1983 to June 1997. The search yielded 28 publications of 48 cases of cervical pregnancy. These and four new cases from our institutions were used in our study. A cervical pregnancy that presented with a serum beta-human chorionic gonadotrophin concentration of > or = 10,000 mIU/ml [odds ratio (OR) 10.82, 95% confidence interval (CI) 2.59, 45.14], gestational age at > or = 9 weeks (OR 6.44, 95% CI 1.46, 28.52), embryonic cardiac activity (OR 14.29, 95% CI 2.95, 76.92), and crown-rump length of >10 mm (OR 13.33, 95% CI 1.46, 120.48) was considered to be associated with a higher unsatisfactory rate of primary MTX treatment. A concomitant feticide was found to enhance the therapeutic effect of MTX treatment if embryonic cardiac activity was evident (OR 0.13, 95% CI 0.02, 0.68). Administration of a high dose of MTX did not seem to be more effective than a lower one. Our findings supported some previous observations and, more importantly, provided useful clinical information in selecting appropriate candidates for MTX treatment in cases of cervical pregnancy.

Coelomic fluid chorionic gonadotrophin and protein concentrations in normal and complicated first trimester human pregnancies.

Coelomic fluid and maternal serum samples were collected from 43 normal pregnancies and 18 missed abortions between 7 and 12 weeks of gestation. The samples were analysed for the concentrations of intact human chorionic gonadotrophin (HCG), free alpha HCG, free beta HCG and total protein. The relationships between the biological findings and the ultrasound and pathological features were assessed by regression analysis. In normal pregnancies, intact HCG, free alpha HCG and free beta HCG concentrations were respectively 1.3, 185 and 33 times higher in coelomic fluid than in maternal serum. The coelomic concentrations of intact HCG and free alpha HCG decreased significantly with advancing gestation. No relationship was found between coelomic fluid and maternal serum concentrations of the different variables. These findings suggest that in normal pregnancies, the concentration of HCG in the coelomic fluid, as in maternal serum, is mainly influenced by cytotrophoblastic differentiation and that the metabolic clearance of HCG molecules is slower in the coelomic cavity than in maternal serum. In missed abortions, the serum concentrations of intact HCG, alpha HCG and free beta HCG and the coelomic concentration of total protein were significantly lower than in normal pregnancies. In three out of nine anembryonic pregnancies diagnosed by ultrasound, embryonic remnants were present at histological examination. The coelomic concentration of total protein was extremely low in all missed abortions with advanced trophoblastic necrosis whereas the HCG concentration was low when embryonic remnants were absent. These findings support the concept that embryonic and placental development are closely related in the first trimester of human pregnancy, placental biological functions persisting only for a limited period of time after embryonic demise.

Prenatal screening for trisomy 18 with free beta human chorionic gonadotrophin as a marker.

To determine the relation between maternal serum alpha fetoprotein and free beta human chorionic gonadotrophin concentrations in pregnancies complicated by trisomy 18 and establish whether prenatal biochemical screening for this condition could be developed in a way similar to that proposed for trisomy 21. Serum alpha fetoprotein and free beta human chorionic gonadotrophin concentrations in women with singleton pregnancies affected by cytogenetically confirmed trisomy 18, uncomplicated by neural tube defect or ventral wall defect, were identified from prospective trisomy 21 screening programmes. Additionally, stored maternal serum from similar pregnancies was analysed retrospectively. Analyte concentrations from singleton unaffected pregnancies were identified from a prospective screening programme as controls. Statistical parameters of the affected and unaffected populations were compiled. Biochemical screening laboratories in Britain and the United States. 52 women with singleton pregnancies complicated by trisomy 18; control population of 6661 women with unaffected singleton pregnancies. Median values of each analyte and their distribution in the affected and unaffected populations; detection rate of trisomy 18 and the false positive rate. Maternal serum alpha fetoprotein and free beta human chorionic gonadotrophin concentrations were significantly lower in pregnancies complicated by trisomy 18 (median values 0.71 and 0.37 respectively). By using a multivariate risk algorithm incorporating maternal age risk of trisomy 18 and the concentration of the two biochemical markers it was predicted that 50% of trisomy 18 cases (unaffected by neural tube defect or ventral wall defect) could be detected with a 1% false positive rate. Second trimester biochemical screening for trisomy 18 could be a valuable addition to trisomy 21 screening programmes.

Serum free beta-human chorionic gonadotrophin concentrations increase in unseparated blood specimens.

Serum free beta-human chorionic gonadotrophin concentrations increase in unseparated blood specimens.

Predictive value of plasma human chorionic gonadotrophin beta subunit in diagnosing ectopic pregnancy after in vitro fertilisation and embryo transfer.

A study was conducted aimed at establishing a range of plasma concentrations of the beta subunit of human chorionic gonadotrophin that might predict ectopic pregnancy after in vitro fertilisation and embryo transfer. From May 1984 to February 1986, 161 consecutive pregnancies at the Monash University in vitro fertilisation unit were analysed by determining plasma beta human chorionic gonadotrophin concentrations between two and 10 weeks after oocyte collection. Eighty eight ongoing singleton pregnancies, 25 multiple pregnancies, 27 first trimester spontaneous abortions, 12 anembryonic pregnancies, and nine ectopic pregnancies resulted from these conception cycles. When compared with values for ongoing singleton pregnancies two weeks after oocyte collection plasma beta human chorionic gonadotrophin concentrations in ectopic pregnancies were significantly lower (p less than 0.05; Wilcoxon rank sum test). Two weeks after oocyte collection all plasma beta human chorionic gonadotrophin concentrations in the set of ectopic pregnancies were below 30.6 IU/l, which corresponded to the lower quartile (25th percentile) of beta human chorionic gonadotrophin concentrations in ongoing singleton pregnancies. The beta human chorionic gonadotrophin concentration corresponding to the lower quartile of ongoing singleton pregnancies at each week of gestation was used to derive the predictive value of various statistics in detecting ectopic pregnancy in patients after in vitro fertilisation. The sensitivity, specificity, predictive value of a positive result, predictive value of a negative result, and efficiency of a single plasma beta human chorionic gonadotrophin concentration in predicting ectopic pregnancy were 100%, 68.1%, 16.7%, 100%, and 70%, respectively, two weeks after oocyte collection. These results suggest that a single determination of the plasma beta human chorionic gonadotrophin concentration beginning 14 days after oocyte collection is clinically useful in predicting the outcome of pregnancy achieved by in vitro fertilisation. Ectopic pregnancy after in vitro fertilisation is more likely when beta human chorionic gonadotrophin concentration is below the lower quartile of values in ongoing singleton pregnancies achieved by the technique.