hCG Clearance Research Articles

The Curative Effect of a Second Curettage in Low-Risk Gestational Trophoblastic Neoplasia

Background: Gestational trophoblastic neoplasia (GTN), despite its widespread metastases, is a very common cancer in women that is curable. Although the GTN cases show a good response to chemotherapy, in an effort to reduce toxic drug exposure, the second curettage has been suggested for some patients. In the current study, we have aimed to compare the benefits of the second curettage in comparison with single-agent chemotherapy for low-risk GTN patients.
 
 Methods: This retrospective observational study was carried out on GTN patients admitted to the gynecology department of Imam Khomeini Hospital in Ahvaz. The demographic profile of all participants was extracted. Patients' hospitalization records were also extracted from the files. Patients with an endometrial thickness above 10 mm were treated with re-curettage. The β hCG clearance time was estimated by the Kaplan Meier plot. 
 
 Results: In the present study, 148 patients with low-risk GTN stage 1 were studied. The time required for β-hCG clearance in patients undergoing re-curettage was significantly lower than the chemotherapy receiving group (7 months vs. 10 months, p <0.0001). More than 50% of patients treated by re- curettage without needing chemotherapy. Moreover, the other 50% cases needed chemotherapy the number of courses was significantly lower than those received single-agent chemotherapy alone (p <0.0001). The baseline β-hCG levels were significantly lower in those who did not need chemotherapy (p = 0.012). β-hCG resolution occurred more rapidly in patients undergoing re-curettage alone, while, those who received only chemotherapy had a longer duration for β-hCG clearance.
 
 Conclusion: In general, the findings of this study showed that re-curettage could be used effectively in the treatment of GTN following molar pregnancy. This treatment reduces or eliminates the need for chemotherapy. Our findings also showed that the initial level of β-hCG could be considered as a predictive factor in response to curettage.

Management of uterine ectopic pregnancy - local vs. systemic methotrexate.

The aim of this study was to compare ultrasound-guided local methotrexate (MTX) vs. systemic methotrexate in uterine ectopic pregnancy regarding the beta human chorionic gonadotropin (hCG) clearance duration. Patients with interstitial pregnancy, cervical pregnancy or cesarean scar pregnancy were included. Methotrexate was administered locally ultrasound-guided (25mg methotrexate fixed dose) or systemically (intramuscular; 50mg/m2 body weight). Beta hCG clearance duration in days formed the main outcome measure. Forty-six patients with uterine ectopic pregnancy were included. The mean estimated beta hCG clearance duration was 29.2days longer in patients with local methotrexate compared with systemic methotrexate (64.7 vs. 31.5days, respectively; p=0.026). There was no significant difference between local vs. systemic methotrexate regarding adverse events such as bleeding (p=0.376), pain (p=0.146) or secondary surgery (p=0.631). There was no association of initial beta hCG levels (p=0.746), initial progesterone levels (p=0.870) or patients' age (p=0.604) and the beta hCG clearance duration. No significant difference in beta hCG clearance duration comparing local methotrexate injection with aspiration vs. local methotrexate injection without aspiration could be found (mean 49.4 and 71.6days, respectively, p=0.225). In patients with uterine ectopic pregnancies, the mean estimated beta hCG clearance duration was 29.2days longer when applying local methotrexate compared with systemic methotrexate.

Exogenous type CSP cesarean section the safety of the application of combined hysteroscopy surgery in uterine artery embolization and application value

Objective To investigate the clinical value and safety of uterine artery embolization combined with hysteroscopy in the treatment of uterine scar pregnancy after cesarean section. Methods A total of 84 patients uterine scar pregnancy were selected after cesarean section cases with surgical treatment from January 2015 to January 2016 in Heze city of Shandong province maternal and child health care. According to the random principle, the cases were divided into two groups, all patients underwent hysteroscopic surgery, control group received intramuscular injection of methotrexate, and observation group underwent bilateral uterine artery embolization, compared between the two groups in operative time, bleeding volume, postoperative first anal exhaust time, postoperative blood HCG clearance time, total length of time, the lesion disappeared, menstrual recovery time and adverse reaction incidence rate. Results Control group of operative time, postoperative first anal exhaust time and total hospital stay were longer than observation group, and bleeding volume also was more than in the observation group, the differences were statistically significant(P 0.05). Conclusion For patients with uterine scar pregnancy after cesarean section, undergoing hysteroscopy surgery also combined with uterine artery embolization can effectively improve the operation efficiency, reduce injury to patients, help patients recovery from the illness, and adverse reaction rate is low, the operation is safe and reliable, it is worth clinical promotion. Key words: Cesarean section; Uterine scar pregnancy; Arterial embolization; Hysteroscopy

Serum Human Chorionic Gonadotropin (β- hCG) Clearance Curves in Women with Successfully Expectantly Managed Tubal Ectopic Pregnancies: A Retrospective Cohort Study.

ObjectiveTo establish clearance curves for serum β -hCG in women with successfully expectantly managed tubal ectopic pregnancies.DesignRetrospective cohort study. Non- viable tubal ectopic pregnancy was diagnosed on transvaginal ultrasound. If initial serum β hCG was less than 5000 IU/L and patients were asymptomatic, expectant management was offered. Patients underwent serial β hCG measurements until serum β hCG was less than 20 IU/l, or the urine pregnancy test was negative.SettingEarly Pregnancy and Gynaecology Assessment Unit, Kings College Hospital, London (December 1998 to July 2006).PatientsWe included 161 women with diagnosed non-viable tubal ectopic pregnancy who underwent successful expectant management.Main outcome measureSerum β hCG level.ResultsMean initial serum β- hCG was 488 IU/L (41 - 4883) and median serum β hCG clearance time was 19 days (5 - 82). The average half-life of β hCG clearance was 82.5 hours (±SD 50.2) in patients with steadily declining serum β- hCG levels compared to 106.7 hours (±SD 72.0) in patients with primarily plateauing β-hCG levels in the declining phase. However, these differences were not significant (p>0.05).ConclusionWe identified a median follow-up of 19 days until serum β hCG clearance in women with tubal ectopic pregnancy and successful expectant management. Although non- significant, women with initially plateauing serum β hCG showed a longer follow-up time until clearance compared to women with steadily declining β hCG levels. This information may serve as a guideline enabling clinicians to predict the length of follow-up for women with tubal ectopic pregnancy and expectant management.

1. Persistent elevation of BHCG-levels in a patient with stage 5D Chronic Kidney Disease

Introduction and aim: A 24 year old female with Stage 5D chronic kidney disease (CKD) presents with persistent positive BHCG levels. BHCG elevation causes include pregnancy, pituitary production, hydatidiform mole, persistent trophoblast disease, malignancies and false positive hCG. Variants of the hCG molecule has been identified and includes sulfated hCG, hyperglycosylated hCG, hCG free β-subunit and hyperglycosylated hCG free β-subunit. Different hCG fractions are generated depending on the disease process. Isolated cases of falsely raised BHCG in both men and women with CKD have been reported. Origin of hCG has been attributed to pituitary production, coupled with CKD impairing metabolism and clearance of hCG.Methodology: Samples were tested by the NHLS Universitas Academic Laboratory using the Cobas e 601 analyzer (Roche) for intact human chorionic gonadotropin and the β-subunit. This immunoassay detects the holo-hormone, nicked forms of hCG, β-core fragment and free β-subunit. A qualitative urine test, detecting total hCG was negative, while a laboratory urine analysis had a positive result. Analysis on different instruments and serial dilutions excluded assay interference from human antimouse antibodies (HAMA), heterophilic antibodies or a high dose hook effect. Imaging studies including magnetic resonance imaging (MRI) brain, pelvis, computed tomography (CT) chest and pelvic ultra sound was performed. Diagnostic laparoscopy was refused by the patient due to her ongoing peritoneal dialysis.Results: Serial BHCG results show persistent elevation. Imaging studies yielded no explanation to HCG production.Conclusion: Elevated BHCG could be attributed to a tumour of gestational or non-gestational origin, failed pregnancy, familial elevated hCG, reduced clearance and degradation of hCG in CKD or changes of hCG associated with CKD. Immunoassay interference should be considered when patient results and clinical presentation differs. False positive test results may subject patients to unnecessary investigation and it may prevent patients from qualifying for organ transplantation.

Methotrexate or expectant management in women with an ectopic pregnancy or pregnancy of unknown location and low serum hCG concentrations? A randomized comparison

What is the treatment success rate of systemic methotrexate (MTX) compared with expectant management in women with an ectopic pregnancy or a pregnancy of unknown location (PUL) with low and plateauing serum hCG concentrations? In women with an ectopic pregnancy or a PUL and low and plateauing serum hCG concentrations, expectant management is an alternative to medical treatment with single-dose systemic MTX. MTX is often used in asymptomatic women with an ectopic pregnancy or a PUL with low and plateauing serum hCG concentrations. These pregnancies may be self-limiting and watchful waiting is suggested as an alternative, but evidence from RCTs is lacking. The results of this RCT show that expectant management is an alternative to treatment with systemic MTX in a single-dose regimen in these women. A multicentre RCT women were assigned to systemic MTX (single dose) treatment or expectant management, using a web-based randomization program, block randomization with stratification for hospital and serum hCG concentration (<1000 versus 1000-2000 IU/l). The primary outcome measure was an uneventful decline of serum hCG to an undetectable level (<2 IU/l) by the initial intervention strategy. Secondary outcome measures included additional treatment, side effects and serum hCG clearance time. From April 2007 to January 2012, we performed a multicentre study in The Netherlands. All haemodynamically stable women >18 years old with both an ectopic pregnancy visible on transvaginal sonography and a plateauing serum hCG concentration <1500 IU/l or with a PUL and a plateauing serum hCG concentration <2000 IU/l were eligible for the trial. We included 73 women of whom 41 were allocated to single-dose MTX and 32 to expectant management. There was no difference in primary treatment success rate of single-dose MTX versus expectant management, 31/41 (76%) and 19/32 (59%), respectively [relative risk (RR) 1.3 95% confidence interval (CI) 0.9-1.8]. In nine women (22%), additional MTX injections were needed, compared with nine women (28%) in whom systemic MTX was administered after initial expectant management (RR 0.8; 95% CI 0.4-1.7). One woman (2%) from the MTX group underwent surgery compared with four women (13%) in the expectant management group (RR 0.2; 95% CI 0.02-1.7), all after experiencing abdominal pain within the first week of follow-up. In the MTX group, nine women reported side effects versus none in the expectant management group. No serious adverse events were reported. Single-dose systemic MTX does not have a larger treatment effect compared with expectant management in women with an ectopic pregnancy or a PUL and low and plateauing serum hCG concentrations. Sixty percent of women after expectant management had an uneventful clinical course with steadily declining serum hCG levels without any intervention, which means that MTX, a potentially harmful drug, can be withheld in these women. BIAS, LIMITATION AND GENERALISABILITY: A limitation of this RCT is that it was an open (not placebo controlled) trial. Nevertheless, introduction of bias was probably limited by the strict criteria to be fulfilled for treatment with MTX. This trial is supported by a grant of the Netherlands Organization for Health Research and Development (ZonMw Clinical fellow grant 90700154). ISRCTN 48210491.

Predictive values of hCG clearance for risk of methotrexate resistance in low-risk gestational trophoblastic neoplasias

BackgroundEarly identification of patients at high risk for chemoresistance among those treated with methotrexate (MTX) for low-risk gestational trophoblastic neoplasia (GTN) is needed. We modeled human chorionic gonadotropin (hCG) decline during MTX therapy using a kinetic population approach to calculate individual hCG clearance (CLhCG) and assessed the predictive value of CLhCG for MTX resistance. Patients and methodsA total of 154 patients with low-risk GTN treated with 8-day MTX regimen were retrospectively studied. NONMEM™ was used to model hCG decrease equations between day 0 and day 40 of chemotherapy. Receiver operating characteristic curve analysis defined the best CLhCG threshold. Univariate/multivariate survival analyses determined the predictive value of CLhCG and compared it with published predictive factors. ResultsA monoexponential equation best modeled hCG decrease: hCG(t) = 3900 × e-0.149 × t. Median CLhCG was 0.57 l/day (quartiles: 0.37–0.74). Only choriocarcinoma pathology [yes versus no: hazard ratio (HR) = 6.01; 95% confidence interval (CI) 2.2–16.6; P < 0.001] and unfavorable CLhCG quartile (≤0.37 versus >0.37 l/day: HR = 6.75; 95% CI 2.7–16.8; P < 0.001) were significant independent predictive factors of MTX resistance risk. ConclusionIn the second largest cohort of low-risk GTN patients reported to date, choriocarcinoma pathology and CLhCG ≤0.37 l/day were major independent predictive factors for MTX resistance risk.

OP04.02: Serum hCG clearance curves in patients with tubal ectopic pregnancies managed expectantly

OP04.02: Serum hCG clearance curves in patients with tubal ectopic pregnancies managed expectantly

Trophoblast Production of a Weakly Bioactive Human Chorionic Gonadotropin in Trisomy 21-Affected Pregnancy

Total human chorionic gonadotropin (hCG) is high in maternal serum at 14-18 wk of trisomy 21 (T21)-affected pregnancy, despite low placental hCG synthesis. We sought an explanation for this paradox. We first observed that, in T21-affected pregnancies, maternal serum hCG levels peaked at around 10 wk and then followed the same pattern throughout pregnancy as in controls, albeit at a higher (2.2-fold) level. After delivery, hCG clearance was not significantly different from that in controls. We isolated cytotrophoblasts from 29 T21-affected placentas (12-25 wk) and 13 gestational age-matched control placentas and cultured them for 3 d. In this large series, we confirmed that, in the culture medium of trophoblasts isolated from T21 placentas, hCG secretion was significantly lower (P < 0.003) than in controls, in contrast to the high hCG in maternal serum of the same patients. In T21 cultured trophoblasts, transcripts of sialyltransferase-1 and fucosyltransferase-1 were abnormally high. In corresponding culture medium, hCG was abnormally glycosylated; highly acidic [isoelectric points (pHi) = 4.5] as shown by isoelectric focusing, immunoblotting, and lectin binding; and weakly bioactive (46% of control) as determined using the Leydig cell model. In conclusion, T21 trophoblast cells produced hCG that was weakly bioactive and abnormally glycosylated but whose maternal clearance was unaltered.

Renal Handling of Endogenous Human Chorionic Gonadotrophin in Preeclampsia

Objective: To test the hypothesis that the elevated maternal serum concentration of human chorionic gonadotrophin (hCG) in preeclampsia is due to altered renal handling of the hormone.Setting: Department of Obstetrics and Gynecology, Al Ain Hospital, United Arab Emirates, a tertiary center affiliated with the Faculty of Medicine and Health Sciences, UAE University.Methods: The renal clearances and handling of endogenous creatinine and human chorionic gonadotrophin were compared in 14 normotensive volunteer and 14 preeclamptic mothers who received oral hydration at 34–37 weeks' gestation. The hCG content in the placentas was estimated immunohisto-chemically after delivery.Results: Maternal serum concentration of hCG (p=0.0057), the placental hCG immunopositive cell (p< 0.0001), and syncytial knot counts (p<0.0001) were significantly higher in preeclamptic mothers. The renal clearances of endogenous creatinine and hCG and fractional hCG clearance were not significantly different in both groups. Significantly increased amounts of hCG were filtered (p=0.007) and excreted (p=0.007) by preeclamptic mothers. Only a small but fixed proportion of the filtered load of hCG is excreted in both groups and there was a positive correlation (r=0.5, p=0.005) between filtered and excreted loads of hCG.Conclusion: The results indicate increased placental content of hCG in preeclampsia. The resultant increased maternal serum concentration is probably sustained by the mechanism of renal handling of the hormone.

Are serum human chorionic gonadotropin clearance curves of use in monitoring methotrexate treatment in cervical pregnancy?

Objective: To describe the monitoring of an unsuccessful case of methotrexate treatment of cervical pregnancy. Design: Case report. Setting: University hospital. Patient(s): A 27-year-old woman, gravida 3, para 1, with a vital cervical pregnancy. Intervention(s): Feticide and methotrexate administered both locally and systemically. Main Outcome Measure(s): Treatment success, defined as elimination of the cervical pregnancy with preservation of the uterus. Result(s): Despite reassuringly declining serum hCG concentrations, several episodes of severe vaginal bleeding demanded transfusions of 19 U of packed cells, two angiographic embolizations that were complicated by septicemia, and a balloon catheter tamponade followed by a third angiographic embolization. Ultimately, a hysterectomy was necessary because of uncontrollable vaginal bleeding. Conclusion(s): This case report shows that serum hCG monitoring was not helpful in the detection of impending treatment failure. Currently, no guidelines are available to clinicians for predicting treatment failure of methotrexate in patients with cervical pregnancy. Serum hCG clearance curves do enable the timely detection of inadequately declining serum hCG concentrations, for which additional methotrexate can be administered.

Ist eine Curettage nach Abortus completus noch zeitgemäß?

Fragestellung: In einer prospektiven randomisierten Studie wurde untersucht, ob ein Abortus completus im ersten Trimenon ohne Curettage behandelt werden kann und ob eine zusätzliche Hormontherapie von Nutzen ist. Patientinnen und Methodik: 50 Frauen mit einem Abortus completus vor der 13. SSW und einer sonographischen Endometriumhöhe bis 8 mm wurden in drei Gruppen randomisiert. In Gruppe A (n = 15) erfolgte eine Curettage, in Gruppe B (n = 20) eine Verlaufsbeobachtung und in Gruppe C (n = 15) eine Hormonbehandlung (2 mg Norethesteronazetat und 0,01 mg Ethinylestradiol 3 × pro Tg p.o. für 10 Tage). Alle Patientinnen wurden wöchentlich mittels Ultraschall und hCG-Messungen nachkontrolliert und die Blutungsdauer wurde dokumentiert. Ergebnisse: Der hCG-Spiegel sank in allen drei Gruppen gleich schnell unter die Nachweisgrenze (Median ± IQR; 18 ± 9, 15 ± 6,75,14 ± 15 Tage). Die Nachblutungsdauer war in Gruppe A signifikant kürzer als in Gruppe C (Median, IQR; 1 ± 1 bzw. 4 ±1 Tage, p = 0.005); Gruppe B (2 ± 6 Tage) unterschied sich nicht von der Gruppe A oder C. Hormongaben ergaben keinen Vorteil. Bei einer Patientin in Gruppe C wurde eine Eileiterschwangerschaft diagnostiziert; alle anderen Patientinnen hatten einen unauffälligen Heilungsverlauf, und keine Patientin der Gruppe B oder C mußte einer Curettage unterzogen werden. Schlußfolgerung: Bei klinischem Abortus completus im ersten Trimenon kann auf eine Curettage verzichtet werden, wenn der Uterus sonographisch leer ist, hCG ist ein Marker zur Verifizierung der Abwesenheit von aktivem Trophoblastgewebe. Zusätzliche Hormongaben bringen keinen Vorteil.

Serum human chorionic gonadotropin clearance curves in patients with interstitial pregnancy treated with systemic methotrexate

To evaluate short-term effectiveness of systemic methotrexate (MTX) in interstitial pregnancy. Case series. Two Dutch teaching hospitals. Eight consecutive patients with an unruptured interstitial pregnancy. Four doses of 1.0 mg/kg IM MTX alternated with 0.1 mg/kg oral folinic acid. Serum hCG concentrations were determined before the first MTX injection and followed until levels were undetectable. A second MTX course was started on day 14, if by then serum hCG concentrations were > 40% of the initial value. Serum hCG clearance curves of all patients in the present study were compared with those from our earlier studies, in which a different folinic acid regimen (15 mg orally) was used. Serum hCG clearance curves. All patients were treated successfully: five with one course and three with two courses. Serum hCG clearance curves of these patients tended to decline more rapidly than those successfully treated with the 15 mg folinic acid regimen. Systemic MTX is an attractive therapeutic option in the conservative treatment of unruptured interstitial pregnancy. The regimen of four doses of 1.0 mg/kg IM MTX alternated with 0.1 mg/kg folinic acid is effective. Serum hCG clearance curves may serve as a guideline for monitoring MTX treatment, thus enabling a timely detection of impending treatment failure.

Relationship between circulating human chorionic gonadotropin levels and premature luteinization in cycles of controlled ovarian hyperstimulation

To determine if premature luteinization (serum P levels > 1.1 ng/mL on or before the day of hCG administration) during controlled ovarian hyperstimulation (COH) is associated with elevated levels of serum hCG. Tertiary fertility center. Retrospective evaluation of ovum donors undergoing COH. Forty-four women underwent COH. Comparisons of serum hCG levels and hormonal and cycle characteristics were made between cycles with premature luteinization (group I) and without premature luteinization (group II). Group I (16 women) were similar to women in group II in age, amount of hMG, and the ratio of FSH:hMG received. Both groups received hCG on similar days, but women in group I had higher peak E2 levels. Serum hCG levels increased and correlated with serum P levels in group I only and were higher on the day of hCG administration (group I 1.8 +/- 0.9 mIU/mL versus group II 1.2 +/- 0.45 mIU/mL; conversion factor to SI unit, 1.00). Peak E2 and LH levels, ampules of hMG and the FSH:LH ratio, and day of hCG administration did not correlate with hCG levels. Human chorionic gonadotropin exposure, as measured by area under the curve, was significantly higher in group I compared with group II. Higher serum levels of hCG and integrated hCG exposure are found in COH cycles with premature luteinization compared with cycles without premature luteinization. Higher hCG levels may be due to decreased clearance of hCG from the circulation and/or the hCG content of hMG.

β-human chorionic gonadotropin as a monitor of pregnancy outcome in in vitro fertilization-embryo transfer patients

Serum human chorionic gonadotropin (hCG) was studied to test its predictability of pregnancy outcome in in vitro fertilization (IVF) patients. The mean +/- standard deviation of serum hCG concentration related to the day complete clearance of exogenous hCG was derived from 47 single term pregnancies as a normal range. This range can be used to predict spontaneous abortion (77%), multiple pregnancy (60%), and abortion in multiple-sac pregnancies terminating in the birth of fewer infants than the initial number of sacs (80%). The results also showed that our stimulation protocol did not affect the clearance rate and doubling time of endogenous hCG or implantation time as suggested by the time of endogenous hCG detection and that spontaneous abortion may be due to late implantation.

The efficiency of human reproduction after in vitro fertilization and embryo transfer

Two hundred ninety-seven nonpregnant patients were used to study the possibility of early transient implantation as a parameter of the efficiency of in vitro fertilization (IVF) procedures. Ten patients without embryo transfer (ET) were used as controls. The luteal estradiol, progesterone, and human chorionic gonadotropin were measured by radioimmunoassay (RIA). In 31 cases, a transient elevation of hCG occurred after complete serum clearance of exogenous hCG, suggesting that the transient increase in hCG was of embryonic origin. In addition, five patients were found to have prolonged clearance of hCG, which was due not to individual variation in clearance, but to a minimal production of hCG by trophoblastic tissue. These data suggest that implantations occurred in 12.1% of our so-called "nonpregnant" patients.

Rate of clearance of immunoreactive hCG from the serum of the pregnant bonnet monkey ( Macaca radiata)

The rate of clearance of immunoreactive hCG (human chorionic gonadotrophin) from serum in six pregnant and three non-pregnant monkeys was determined by radioimmunoassay, following the i.v. injection of 2 mg of highly purified hCG. The study revealed that the disappearance of hCG takes place in two phases in both groups, an initial fast (197.5 ± 14.5 min for pregnant and 94 ± 4.8 min for non-pregnant monkeys) phase, followed by a slow (1230 ± 62 min for pregnant and 966 ± 43 min for non-pregnant monkeys) phase. The rate of clearance appears to be faster in non-pregnant than in pregnant monkeys.

Impaired gonadotrophin uptake in vivo by the cryptorchid rat testis.

The specific testicular uptake in vivo of 125I-labelled hCG was compared in control adult rats and adult rats made bilaterally cryptorchid 5 weeks previously. Although a similar temporal pattern of uptake was observed in both groups, uptake of hCG by cryptorchid testes was reduced at all times after injection by up to 70%. The possible causes of this impairment were investigated. It could not be accounted for by differences in the rate of absorption or clearance of 125I-labelled hCG in the two groups. Therefore, because hCG-induced increase in the permeability of testicular capillaries is a crucial factor in determining hCG uptake by the testis, this change was compared in control and cryptorchid testes. Although hCG induced a characteristic increase in testicular capillary wall permeability in both groups, this change was temporally delayed in cryptorchid testes, and occurred after hCG values in the blood had fallen. Even when hCG had crossed the capillary wall into testicular interstitial fluid, its uptake into the testicular tissue was significantly lower in cryptorchid than in control testes. These changes probably account for the impairment of gonadotrophin uptake by the cryptorchid testis and have important implications with respect to the aetiology of Leydig cell changes in cryptorchidism.

Testicular and adrenal androgens and their binding to plasma proteins in the perinatal period: Developmental patterns of plasma testosterone, 4-androstenedione, dehydroepiandrosterone and its sulfate in premature and small for date infants as compared with that of full-term infants

The patterns of the plasma concentrations of testosterone (T), 4-androstenedionc (Δ 4), dehydroepiandrosterone (DHA) and its sulfate (DHAS) and of Cortisol (F) observed during the first year of life in 96 premature (group I), 23 small for date (group 2) were compared to those of 430 full-term infants (group 3). The per cent of T and DHA bound to plasma proteins was measured by equilibrium dialysis and the unbound levels of T and DHA determined. In group 3, testicular activity, high at birth, declined by the first week of life parallel to the clearance of hCG, and reincreased thereafter. In males, peak levels of T were observed at 15–60 days of life: from 3 to 6 months T decreased correlatively with time. The triphasic pattern of T observed during the first month of life was similar in the three groups. However, in premature infants (group 1). the post-natal testicular activation lasted significantly longer than in group 3 while, in group 2. the temporal decline in T levels was intermediate between those observed in groups 1 and 3. The pattern of T was comparable among the females of the three groups. In group 3, adrenal androgens, high at birth, decreased progressively throughout the first year of life in a like manner in both sexes. In contrast in group 1, DHA and DHAS remained at comparable high levels for the first two months of life, then declined in both sexes, but DHA and DHAS were significantly higher in females than in males until 3 months of age. In group 2 adrenal production of androgens. both in level and duration, was again intermediate of that seen in groups I and 3. Plasma F levels did not differ between groups. The plasma binding of T and DHA increased both within the first month postnatally to prepubertal values with no sex difference and similarly in the three groups. It is hypothetized that maturational processes of the interrelationships of the components of both the hypothalamo-hypophyseal-testicular axis and the hypothalamo-hypophyscal-adrenal axis are related to a similar ontogenic evolution.

Disappearance of human chorionic gonadotropin and resumption of ovulation following abortion

The disappearance of human chorionic gonadotropin (hCG) and resumption of pituitary ovarian function was investigated in 13 patients following first- and second-trimester abortions. First-trimester abortion patients (with suction curettage) had a mean time of 37.5 ± 6.4 days for the clearance of hCG to a level of 2 mlU/ml. Second trimester abortions (with prostaglandin) had a mean time of 27.4 ± 4.8 days. Patients undergoing second-trimester hysterectomy had a mean disappearance time of 39.7 ± 5.3 days and only 12 days if the hysterectomy was initiated with ligation of the uterine and ovarian vessels. No significant difference in clearance time was found when it was compared on the basis of the baseline hCG levels. Based on a concomitant luteinizing hormone (LH) and follicle-stimulating hormone (FSH) peak, nine of 12 patients resumed normal pituitary function. These LH and FSH peaks were seen even though the serum hCG levels were as high as 35 mlU/ml. Based on serum progesterone levels of greater than 3 ng/ml, all these nine patients ovulated as early as 21 days after abortion. In view of these results, the clearance of hCG after pregnancy termination depends mainly upon the type of procedure used. Moreover, in view of the early time of ovulatory recovery, contraception should be instituted within the first 2 weeks following pregnancy termination.