hCG Values Research Articles

Serum biochemistry correlates with the size of tubal ectopic pregnancy on sonography

To investigate whether there is a correlation between serum biochemistry (human chorionic gonadotropin (hCG), CA 125, progesterone and estradiol) and the common sonographic findings (blob sign, bagel sign or extrauterine gestational sac with cardiac activity) or size of a tubal ectopic pregnancy, and whether there is a difference in serum biochemistry between women with a tubal ectopic pregnancy who are hemodynamically unstable (tachycardia, hypotension, falling hemoglobin levels and/or acute severe abdominal pain) and those who are hemodynamically stable. This was a prospective cohort study of 106 women with a tubal ectopic pregnancy. We noted transvaginal ultrasound examination findings including adnexal mass size, and the serum levels of hCG, CA 125, progesterone and estradiol. The data were analyzed retrospectively. The mean maternal and gestational ages were 30.7+/-5.7 years and 44+/-4.2 days, respectively. There was no correlation between serum markers and common sonographic findings. However, in the presence of the bagel sign on ultrasound, hemodynamic stability was more common (P=0.03). The mean serum hCG concentrations in tubal ectopic pregnancies<20 mm, 20-40 mm and >40 mm in size were 2225.3+/-3166.9, 4124.8+/-6121.4, and 11 011.8+/-12 670.1 IU/mL, respectively (P<0.001). Serum hCG, CA 125 and estradiol values were well correlated with adnexal mass size; for CA 125 this correlation was linear. There was no difference in serum biochemistry between hemodynamically stable and hemodynamically unstable women. Common sonographic findings of tubal ectopic pregnancy do not correlate with serum biochemistry. High levels of CA 125, hCG or estradiol may suggest a larger adnexal mass in women with uncomplicated tubal pregnancies. Hemodynamically stable and hemodynamically unstable women do not differ in their serum biochemistry.

Seröses Endometriumkarzinom mit choriokarzinomatöser Komponente

Non-gestational extragonadal choriocarcinomas are extremely rare. A 61-year-old G3 and P3 underwent hysterectomy and bilateral salpingo-oophorectomy and pelvic lymph node sampling for endometrial carcinoma. Histologic examination revealed a serous carcinoma with a choriocarcinomatous component. Postoperatively serum HCG was 225000IU/l. Because of diffuse pulmonary metastatic disease with respiratory problems the patient was initially treated with methotrexate and folinic acid rescue. After three cycles chemotherapy was switched to the EMA-Co scheme because of rising HCG levels. After five cycles of EMA-Co HCG values declined and partial resolution of pulmonary metastatic disease was seen. Because of the metastatic disease and most likely due to the chemotherapeutically induced immunodeficiency, the patient died from pneumonia two months after the initial diagnosis. Endometrial adenocarcinoma with a choriocarcinomatous component is an aggressive neoplasm and should be treated as gestational choriocarcinoma.

Human Chorionic Gonadotropin Profile for Women With Ectopic Pregnancy

Ectopic pregnancy (EP) remains the leading pregnancy-related cause of death in the first trimester and presently complicates 2% of all pregnancies in the United States. As many as half of women ultimately diagnosed as having EP reportedly receive a different diagnosis—or no diagnosis—when initially seen at an emergency department. Pain and vaginal bleeding are not consistent symptoms, and physical examination usually is not informative. Nearly all EPs are diagnosed by a combination of biochemical and ultrasound studies. This study enrolled 200 women in whom EP could not be confirmed at the initial visit and who had a minimum of 2 estimates of human chorionic gonadotropin (hCG) at least 24 hours but not more than 7 days apart. Curves of hCG values were constructed and their slopes calculated. No model could be formulated that adequately characterized the pattern of serial hCG values in women with EP. Rising, declining, and plateauing values all were observed. Increasing values were initially found in 60% of the study group (group A), whereas 40% (group B) presented with declining hCG levels. Group A women had a significantly lower mean hCG value and tended to present earlier in gestation. There were no significant group differences in the number of visits made or the number of days needed to confirm the diagnosis. The median (50%) slope of the hCG curve in group A women was less (slower) than that reported for viable intrauterine pregnancies. The median 2-day slope for women in group B was less than reported for completed spontaneous miscarriages starting with an hCG of 1000 mIU/mL. Approximately one in 5 women with EP (20.8%) had a rate of increase in hCG that was as fast as or faster than the curve defining the first confidence interval (CI) for a viable gestation. Eight percent of women with an EP had a decline in hCG that was as fast as or faster than the slope defining the 95% CI for women with a completed abortion (with an initial hCG of 1000 mIU/mL). More than one third (34.7%) of women in group A presented with a hCG profile consistent with a viable gestation. One fifth of women in group B presented with a profile consistent with a completed spontaneous abortion. The overlap documented in this study among hCG curves for women with intrauterine pregnancy, ectopic pregnancy, and completed spontaneous abortion points to the need for other diagnostic procures. Serial hCG estimates cannot exclude the presence or absence of EP with 100% sensitivity and specificity.

Second-trimester double or triple screening for Down syndrome: A comparison of Chinese and Caucasian populations

Objectives: To compare the performance of double screening (measuring maternal serum levels of α-fetoprotein [AFP] and total β-human chorionic gonadotrophin [hCG] as markers for Down syndrome) with that of triple screening (also measuring levels of unconjugated estriol [uE3]) in the second trimester of pregnancy, and to compare ethnic variance between Chinese and Caucasian populations. Methods: The study investigated 15096 normal singleton pregnancies and 24 pregnancies affected with Down syndrome. Frequency distributions of AFP, hCG, and uE3 levels were analyzed. Likelihood ratios (LRs) were calculated using the multiple of median value (MoM) of AFP, hCG, and uE3 as variables. After multiplying maternal age risk by the LR values for the markers used in double and triple screening, the specific risks obtained with double and triple screening were estimated. The detection rate (DR) and false-positive rate (FPR) were calculated at different cut-off points. The serum markers' levels were also compared with those of Caucasian women. Results: The median MoM value of hCG was higher in women with affected pregnancies (1.40) than those with unaffected pregnancies (1.00). However, the median MoMs of AFP and uE3 (0.79 and 0.68) were lower in affected than in unaffected pregnancies. At a FPR of 5%, the detection rates reached with double and triple screening were 50% and 66.7%, respectively. Ratios of the 3 serum markers' medians to those in a study with Caucasian women were 1.06 (range=1.04–1.09) for AFP, 1.14 (range=1.10–1.17) for hCG, and 1.28 (range=1.23–1.41) for uE3 for the relevant gestational weeks. Conclusion: Triple screening performed better than double screening in the second trimester. Ethnic variance should be taken into account in Down syndrome screening.

Application of redefined human chorionic gonadotropin curves for the diagnosis of women at risk for ectopic pregnancy

To validate recently characterized curves of hCG rise and fall that are seen in viable and nonviable pregnancies in a population of women who have pregnancies of unknown location. Historical cohort study. University hospital. One thousand two hundred forty-nine women with symptomatic early pregnancies. None. Comparison of observed hCG values to predicted hCG values; time to diagnosis of ectopic pregnancy; accuracy of diagnosis. Of the 1,249 patients included in this study, 196 had ectopic pregnancy (EP); 261, intrauterine pregnancy (IUP); and 792, spontaneous abortion (SAB). By determining the rate of change in hCG values from two consecutive visits and comparing them with a minimal rise of 35% in 2 days (the bound that is defined by the 99.9% confidence interval [CI] for the rise of hCG in an IUP) or a minimal fall of 21%-35% (the bound that is defined by the 90% CI for the fall of hCG in an SAB), we were able to make the diagnosis of EP an average of 2.5 days sooner than by standard clinical practice. Only 12% of patients had an EP go undiagnosed by using these rules, because the curve of rise or fall of their hCG mimicked that of a non-EP gestation. Recently redefined curves of rise and fall in hCG for IUP and SAB are valid for clinical use on the basis of our application to this large cohort of patients. Using them can shorten the time needed to make the diagnosis of EP. Use of a more conservative cutoff for minimal rise in hCG, one as slow as 35% over 2 days, to characterize a potentially viable gestation would minimize potential interruption of a desired pregnancy.

Screening in early pregnancy for pre‐eclampsia using down syndrome quadruple test markers

To estimate the screening performance of early second-trimester prenatal serum markers for Down syndrome, in screening for the development of pre-eclampsia, and analyse the uncertainty over its screening performance. A nested case-control study was carried out on 96 women with pre-eclampsia and 5 controls for each case from among the women attending three hospitals in London for their prenatal care. Record linkage between computerized obstetric and screening databases identified women with pre-eclampsia and unaffected control women. The stored frozen serum samples collected from these pregnancies between 15 and 22 weeks' gestation were retrieved and assayed for alpha-fetoprotein (AFP), unconjugated estriol (uE(3)), total human chorionic gonadotrophin (hCG), free beta-hCG and inhibin-A. Pre-eclampsia was identified from the computerized obstetric records and confirmed by examination of the medical notes. In the pregnancies that went on to develop pre-eclampsia, early second trimester inhibin-A and hCG values were significantly raised and uE(3) values were significantly lowered, while AFP values were not significantly altered. Using the Quadruple test markers (AFP, uE(3), hCG (total or free beta) and inhibin-A), an estimated 34% of pregnancies that developed pre-eclampsia were detected at a 5% false-positive rate. If all the women who had pre-eclampsia in a previous pregnancy (assuming a pre-eclampsia prevalence of 4%) are considered as screen positive and the serum test is applied to the remaining women, then around 42% of pre-eclamptic pregnancies would be detected at a 6.5% false-positive rate. Pre-eclampsia screening performance using the Quadruple test markers was materially better than that using the Triple test markers. Adding screening for pre-eclampsia to an existing Down syndrome screening programme using the Quadruple test markers is simple and worthwhile. It will detect over 40% of pregnancies with pre-eclampsia at an acceptable false-positive rate (about 6%) and with minimal additional costs.

Gestational trophoblastic diseases: 2. Hyperglycosylated hCG as a reliable marker of active neoplasia

Objectives. To determine whether circulating hyperglycosylated human chorionic gonadotropin (hCG-H), a promoter of choriocarcinoma growth and tumorigenesis, is a reliable marker of active gestational trophoblastic neoplasia (GTN) or choriocarcinoma, and whether hCG-H can consistently discriminate quiescent gestational trophoblastic disease (GTD) from neoplasia. Methods. Patients were those referred to the USA hCG Reference Service for consultation. These included a total of 82 women with GTN, including 30 with histologic choriocarcinoma. They were compared with 26 patients with resolving hydatidiform mole and 69 with quiescent GTD (persistent positive low value of real hCG but no clinical evidence of disease). All were tested for total hCG and hCG-H. hCG-H was calculated as the percentage of total hCG (hCG-H(%)). Results. We compared the utility of total hCG and hCG-H(%) in detecting active GTN and quiescent GTD. There was no significant difference when measuring total hCG (includes regular and hyperglycosylated hCG), between women with quiescent GTD and self-resolving hydatidiform mole compared to choriocarcinoma/GTN cases ( P > 0.05 and P > 0.05). In contrast, hCG-H(%) was significantly higher in choriocarcinoma/GTN cases ( P < 0.000001, and P < 0.000001). The usefulness of hCG and hCG-H(%) testing was assessed for discriminating between the 69 quiescent GTD cases, which required no therapy, and choriocarcinoma/GTN which need treatment. While hCG would detect 62% and 24% of malignancies at a 5% false positive rate, hCG-H(%) would detect 100% and 84% of malignancies at this same false positive rate. Follow-up data were received and repeat consultations were performed in 23 cases in which active disease was subsequently demonstrated. In 12 of 23 cases, hCG-H(%) results were able to first identify active disease 0.5 to 11 months prior to rapidly rising hCG or detection of clinically active neoplasia. In the remaining 11 cases, hCG-H(%) active disease appeared at the same time as rising hCG or demonstrable clinical tumor. Discussion and conclusion. hCG-H(%) appears to reliably identify active trophoblastic malignancy. It is a 100% sensitive marker for discriminating quiescent GTD from active GTN/choriocarcinoma. It is also a marker for the early detection of new or recurrent GTN/choriocarcinoma. The data presented appear sufficient to encourage the adoption of hCG-H as a tumor marker in trophoblastic disease. Further studies are now urgently required to confirm and extend our findings.

P-30: Reliability of Predicting Pregnancy Outcome Using Day 12 Serum hCG Following Emryo Transfer in ICSI-IVF Cycles

Objective: Correlation between serum HCG and pregnancy outcome has been the subject of great discussion. We aimed to evaluate the clinical value of a day 12 HCG level in patients undergoing in-vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) in determining the final outcome. Unlike other studies that have reported early pregnancy HCG values in IVF patients with and without the ICSI protocol, this study aims at comparing values in patients that had undergone the ICSI procedure. Design: Retrospective analysis of patients undergoing assisted reproductive technologies at a single in-vitro fertilization center. Materials and Methods: A database containing 190 patients undergoing IVF with intracytoplasmic sperm injection resulting in pregnancy (day 12 HCG as reported by one single laboratory equal to or greater than 5) between January 1993 and February 2005 was analyzed. Pregnancies were categorized as chemical (no fetal pole), spontaneous abortion, ectopic, singleton, twin, and triplet. HCG and outcome information were retrieved from the charts. Results: 190 women met the minimum criteria. Database included 48 chemical pregnancies, 25 spontaneous abortions, 2 ectopics, 67 singletons, 38 twins and 10 triplets. Analysis of variance (ANOVA) test indicated that there was a significant difference between the groups (F-value=10.79, p<0.0001). Repeat ANOVA with the additional Duncan’s Multiple Range Test revealed no significant difference in the mean HCG levels of twins (200.8) versus singletons (160.94) or spontaneous abortions (170.13). There was a significant difference in the mean HCG levels of triplets (340.11) versus all other groups (sensitivity 30%, specificity 89%, positive predictive value 1.6%, and negative predictive value 84%). Conclusion: Day 12 HCG levels from a single laboratory do not reliably predict pregnancy outcomes in terms of spontaneous abortions, singletons or twins. They can however be used as a model to predict triplet pregnancies.

Human Chorionic Gonadotropin Profile for Women With Ectopic Pregnancy

To analyze serial human chorionic gonadotropin (hCG) levels in women presenting to the emergency department who were ultimately confirmed to have ectopic pregnancies. Human chorionic gonadotropin levels were obtained over time until definitive diagnosis. To be included, women had to have at least 2 hCG measurements. Human chorionic gonadotropin curves were characterized and their slopes calculated. Two hundred women received diagnoses of ectopic pregnancy with the help of serial hCG values and were included in the study. No curve adequately characterized the pattern of hCG values so attention was focused on the initial 2 values. The median slope of log hCG among all subjects was 0.11 (25% increase in 2 days). However, 60% of subjects had an initial rise in hCG, and 40% had an initial fall. The rise in hCG for women with ectopic pregnancies (0.28; 75% increase in 2 days) was slower than the mean increase reported for a viable intrauterine pregnancy. The decline in hCG for women with ectopic pregnancies (-0.225; 27% decline in 2 days) was slower than the mean reported for completed spontaneous abortion. However, 20.8% of women presented with a rise in hCG values similar to the minimal rise for women with a viable gestation, and 8% of women presented with a fall in hCG values similar to women with a completed spontaneous abortion. There is no single way to characterize the pattern of hCG for ectopic pregnancy. The number of women with ectopic pregnancy who experience an increase in hCG values is approximately equal to the number of those who experience a decrease. The hCG profile in women with ectopic pregnancy can mimic that of an intrauterine pregnancy or a completed spontaneous abortion in approximately 29% of cases. II-2.

Defining the rise of serum HCG in viable pregnancies achieved through use of IVF

We aimed to characterize the rate of HCG rise associated with viable IVF pregnancies, and to evaluate the association between HCG rise and potentially influential factors. We performed a retrospective cohort analysis of all viable pregnancies achieved through IVF at two centres between January 1999 and March 2004. Of the 455 pregnancies resulting in live births, 391 met inclusion criteria and contributed a total of 1052 HCG values. Using random effects models, the best pattern to describe the rise of log HCG was quadratic with the rate of increase slowing at 24 days post-oocyte retrieval. Limiting the analysis to measurements below the discriminatory zone, the linear model adequately characterized the profile. The average slope was 0.403, yielding a predicted increase of 1.50 (50% increase) in 1 day and 2.24 (124%) in 2 days. In the final model, absolute HCG values, but not rate of rise, were significantly higher for twins and triplets and significantly lower for patients with BMI>30 kg/m2. The HCG profile of viable pregnancies conceived with IVF is quadratic with an earlier plateau than has been reported for non-IVF pregnancies. The average rate of rise is comparable to previous estimates in symptomatic spontaneous conceptions.

Suspected Ectopic Pregnancy

Women who present with pain and bleeding in the first trimester are at risk for ectopic pregnancy, a life-threatening condition. Conditions that predispose a woman to ectopic pregnancy are damaged fallopian tubes from prior tubal surgery or previous pelvic infection, smoking, and conception using assisted reproduction. Many women without risk factors can develop an ectopic pregnancy. A diagnostic algorithm that includes the use of transvaginal ultrasonography, human chorionic gonadotropin (hCG) concentrations, and, sometimes, uterine curettage can definitively diagnose women at risk in a timely manner. The absence of an intrauterine pregnancy above an established cut point of hCG is consistent with an abnormal pregnancy but does not distinguish a miscarriage from an ectopic pregnancy. When the initial hCG value is low, serial hCG values can be used to determine whether a gestation is potentially viable or spontaneously resolving. The minimal rise in hCG for a viable pregnancy is 53% in 2 days. The minimal decline of a spontaneous abortion is 21-35% in 2 days, depending on the initial level. A rise or fall in serial hCG values that is slower than this is suggestive of an ectopic pregnancy. Women diagnosed with an unruptured ectopic pregnancy are potential candidates for medical management with methotrexate. Intramuscular injection with methotrexate can be used to safely treat an ectopic pregnancy with success rates, tubal patency rates, and future fertility that are similar to those obtained with conservative surgery. Success rates using methotrexate are inversely rated to baseline hCG values and are higher using "multidose" compared with "single-dose" regimens. Surgical treatment may be conservative or definitive and should be attempted in most cases via laparoscopy.

Sonographic monitoring of systemic and local methotrexate (MTX) therapy in patients with intact interstitial pregnancies

After the confirmation of an intact interstitial pregnancy through sonographic diagnosis and laparoscopy, systemic and local methotrexate therapy is a well established conservative treatment to preserve the uterus. The parameters of successful treatment are the course of serum hCG value and sonographic changes. In this case series we describe sonographic monitoring under methotrexate (MTX) application and the residual sonographic findings after completing therapy. Three consecutive patients (two singleton and one twin pregnancy) with intact interstitial pregnancies were diagnosed and treated with MTX between 2000 and 2004. During the treatment we recorded the hCG values, maximum size of the interstitial lesion, vitality of the pregnancy, and vascularization. In all patients the sonographic diagnosis of an interstitial pregnancy was confirmed by laparoscopy. Following systemic MTX therapy, the hCG values normalised within 8 weeks in the singleton pregnancies and in 10 weeks in the twin pregnancy. During conservative therapy vascularization in the lesion withered continuously. The size of the primary myometrial lesion decreased at a slow rate and part of the lesion persisted in all three patients. Despite decreasing hCG levels, residual sonographic patterns of an interstitial ectopic pregnancy persist in the uterine wall.

Development of Colorimetric Enzyme‐Linked Immunosorbent Assay for Human Chorionic Gonadotropin

The present study demonstrated the development of a solid phase competitive enzyme linked immunosorbent assay (ELISA) for direct estimation of human chorionic gonadotropin (hCG) in serum and urine. Polyclonal antisera raised against the β‐ subunit of peak‐I hCG was used in the assay. The Peak‐IA hCG‐penicillinase was used as tracer. The performance of this antiserum and tracer was compared against hCG‐β antisera of NIH, USA and penicillinase conjugated to hCG‐β obtained from NIH, respectively. Almost parallel standard curves were obtained in both cases, suggesting that these antisera and enzyme label have much potential for developing ELISA system. To the anti‐rabbit gamma globulin (ARGG) coated polystyrene tubes, standard or serum or urine samples (50 µL), 100 µL of hCG‐β antiserum, 100 µL of peak‐I(A) hCG‐penicillinase conjugate and 350 µL of assay buffer were incubated at 37°C for 2 hours. Bound enzyme activity was measured using Penicilline V as substrate. In this new strategy, locally available polystyrene tubes were ground from inside and coated with ARGG. The sensitivity of the assay was 17 mIU/mL in urine and 18 mIU/mL in serum. The intra‐assay and inter‐assay coefficients of variation (CVs) appeared to be within acceptable limits of 10%. The serum and urinary hCG values, obtained by this method, correlated well with those obtained by radioimmunoassay (RIA) r=0.98 (n=100 for serum samples; n=250 for urinary samples).

Early pregnancy masquerading as a marker for malignancy in a young woman with curable neoplasm of the pancreas

The so-called solid or cystic papillary neoplasm of the pancreas is a rare type of tumour occurring almost exclusively in young women. This neoplasm is not associated with any endocrine dysfunction, and typically it has assumed considerable size when discovered. Since most cases are curable by surgery, their distinction from other types of neoplasms with less favourable prognosis is important'. The case reported here illustrates a potential pitfall in this context. Case report A 19-year-old previously healthy woman was admitted to hospital because of intermittent abdominal pain of 2 weeks duration. A pregnancy test was positive and she was examined by ultrasound with regard to ectopic pregnancy. The uterus had normal size and uniform echo distribution, but in the right upper quadrant of the abdomen an 8 cm non-homogeneous partially cystic mass was demonstrated. Considering the history given, this lesion was suspected to represent an ectopic pregnancy. At subsequent exploratory laparotomy the mass was found to be located within the head of the pancreas. A biopsy was taken and pathological examination revealed an islet-cell neoplasm. The pelvic organs looked quite normal, and the elevated serum chorionic gonadotrophin (HCG) level was now interpreted as an expression of malignancy although no metastases were evident. Tumour resection was not attempted, but the patient was referred to the University of Michigan Medical Center for further evaluation and treatment. Repeat serum analyses showed levels of /3-HCG at 775 milliunits/ml (normal < 10 milliunits/ml) and c(-HCG at 4ng/ml (normal < 1.2 ngiml). Angiographically the tumour appeared hypervascular with the exception of supposedly necrotic central areas. There was no apparent invasion of the surrounding major vessels, and neither angiography nor computed tomography (Figure I ) showed any evidence of liver metastases. The patient was reoperated on and the tumour was found to be removable by a Whipple procedure. The HCG values did not fall after the operation as expected but continued to rise, and a week later (3 weeks after initial admission) repeat ultrasound examination revealed an intrauterine pregnancy with measures that suggested an age of approximately 7 weeks. Histological examination of the resected tumour did not verify the previous diagnosis of islet-cell carcinoma, but showed a picture characteristic of the so-called solid or cystic papillary neoplasm of the pancreas (Figures 2 and 3). The patient, who subsequently underwent abortion, is doing well 1 year after the operation without any evidence of tumour recurrence.

Risk Factors for Spontaneous Abortion in Early Symptomatic First-Trimester Pregnancies

To evaluate the association of an ultimate diagnosis of miscarriage with various clinical symptoms and historical factors in a cohort of women presenting with pain, bleeding, or both in the first trimester of pregnancy. This was a case-control study from a population of women presenting for care with pelvic pain or vaginal bleeding in the first trimester of pregnancy whose diagnoses were not definite upon initial evaluation. Analyses were performed in 2 ways. In one instance cases were defined as women ultimately definitively diagnosed with a miscarriage and controls were defined as women with a pregnancy that did not result in miscarriage (ectopic pregnancy or ongoing intrauterine pregnancy). The second analysis compared women with a miscarriage only to women who had an ongoing intrauterine pregnancy. A total of 2,026 women were evaluated, with 1,192 ultimately diagnosed with a spontaneous abortion, 367 with ectopic pregnancy, and 467 with a viable intrauterine pregnancy. Although many risk factors were individually associated with miscarriage in preliminary analysis, in the final analysis only extremes in age (< 25 and > 35) and the complaint of bleeding (odds ratio [OR] 7.35, 95% confidence interval[CI] 5.74-9.41) were associated with miscarriage. The complaint of pain (OR 0.72, 95% CI 0.57-0.92), human chorionic gonadotropin (hCG) value greater than 500 (hCG < or = 500 IU/mL compared with hCG 501-2000: OR 0.52, 95% CI 0.39-0.69) and concurrent cervical infection (OR 0.69, 95% CI 0.55-0.88) were negatively associated with miscarriage. Few factors predict miscarriage in women who present with a symptomatic first trimester pregnancy of unknown location. Heavy bleeding was most strongly associated with miscarriage. Concurrent cervical infections should not be overlooked as a cause of bleeding in early pregnancy and were not associated with miscarriage. II-2.

A Novel “Two Dose” Regimen of Methotrexate to Treat Ectopic Pregnancy

A Novel “Two Dose” Regimen of Methotrexate to Treat Ectopic Pregnancy

Defining the Decline in Human Chorionic Gonadotropin (hCG) for Complete Resolution of Chemical Pregnancies

To provide a detailed description of the expected rate of hCG decline in patients presenting with very low initial hCG levels and ultimately confirmed to have spontaneous abortions (sAB). Retrospective cohort. Using a computerized database of all women presenting to the emergency room in the first trimester of pregnancy with symptoms of pain and/or vaginal bleeding, a cohort of women who presented between January 1, 1990 and July 31, 1999 was evaluated. Inclusion required that patients had a non-diagnostic transvaginal ultrasound and follow-up with serial hCG measurements to determine the definitive diagnosis. We extracted those patients with decreasing levels and the ultimate diagnosis of sAB, defined as a spontaneous decline of hCG levels to less than 5 mIU/mL in the absence of surgical or medical intervention, or as the presence of products of conception on dilation and curettage. Using a model created by hCG values for the entire cohort of sAB, we performed a sub-analysis of those patients with initial hCG values < 500 mIU/mL. The model derived from the entire cohort of sAB patients was used rather than re-fitting the model with the sub-group of interest in order to take advantage of the precision achieved with the original model. The total cohort of 710 patients contributing 2150 hCG values was used to define the decline of hCG. The best model to explain these data was a parametric random effects model for the natural log of hCG, including terms for a fixed quadratic effect and random linear and intercept effects for number of days since presentation. An interaction term between initial hCG and the slope (quadratic and linear fixed effects) was needed to describe that faster rates of fall were associated with higher starting concentrations. For this analysis, there were 447 patients who presented with initial hCG values < 500 mIU/mL, contributing 1619 hCG values. The slowest rates of decline were associated with the lowest initial hCG values. Patients with an initial hCG of 500 mIU/mL experienced a mean reduction of 71% in two days, while those with an initial hCG of 50 mIU/mL experienced a smaller mean reduction of 68% in two days. When initial levels were between 50 and 500 mIU/mL, the slowest expected percent decline (defined from the 95% CI) ranged from 12% to 24% in two days and 34% to 68% in seven days. The hCG values predicted by the model will be presented as expected percentage decline over the first seven days. Because the expected decline of hCG can not be described adequately by a single curve but rather, differs depending on the initial hCG, a simple clinical rule is not applicable. Using a model fit from a large cohort of patients, we report precise estimates for a sub-group of patients presenting with very low initial hCG levels. These data can be used by clinicians for comparison when managing patients with chemical pregnancies. The information presented is likely to be particularly useful in the setting of early surveillance of serial hCG levels, a common practice when caring for infertility patients.

Early Consecutive Beta HCG, Progesterone and Estradiol Measurements May Predict Pregnancy Outcome Following Fresh Embryo Transfer

Early prediction of pregnancy outcome is of major importance for both patients and the medical team in ART. It may reduce patients’ stress and anxiety when favorable outcome is expected and on the other hand to alert the physician when the risk of unfavorable outcome like abortion or ectopic pregnancy is increased. Our study is aimed at examining the value of early consecutive beta HCG, progesterone and estradiol measurements in predicting pregnancy outcome.

Serum β-hCG Values as a Reliable Pregnancy Marker After Vitrified-Thawed Single Blastocyst Transfer

Serum human chorionic gonadotropin (hCG) values is one of the most important markers of early human pregnancy. However, the large amount of exogenous HCG used for oocyte maturation, ovulation induction and luteal phase support in assisted reproduction may result in misleading information. The objective of this study is to establish a new blastocyst transfer method based on natural ovulation cycle without HCG administration and to evaluate serum β-HCG values in ongoing pregnancy.

A comparison of human chorionic gonadotropin- related components in fresh frozen serum with the proficiency testing material used by the College of American Pathologists.

Abstract Context.—As part of a College of American Pathologists (CAP) proficiency testing survey, a comparison is made between human chorionic gonadotropin (hCG) results from an actual patient pool and a similarly targeted artificial sample. The goal is to gain insight into the possible source(s) of bias attributable to the proficiency testing material (PTM) with a view toward creating more appropriate survey materials. Objective.—To compare hCG and related variants in a pool of fresh frozen sera (FFS) with that found in PTM. Design.—The 2003 CAP K/KN-A Survey included a FFS specimen along with admixtures of PTM. The FFS (K-02) and 1 PTM admixture (K-01) had similar mean hCG values. Five hCG-related analytes were measured on these 2 samples by a reference laboratory. Participants.—Approximately 1800 clinical laboratories and diagnostic test kit manufacturers participated in the K/ KN-A Survey. Main Outcome Measures.—Method imprecision (coefficient of variation) and method bias (relative difference between...